Category: Reconsideration

H.T. v. TD General Insurance Company (16-000608)

The claimant sought reconsideration of a Tribunal decision that dismissed all claims. Executive Chair Linda Lamoureux reviewed the submissions and concluded that no significant error of fact or law took place and noted that it was open to the Tribunal to hold that benefits were suspended due to non-attendance at an EUO. Additionally, no procedural fairness or issues of natural justice warranted disturbing the Tribunal decision

Aviva Canada Inc. v. R.R. (16-004445)

The insurer appealed the dismissal of its repayment claim, which had been denied because there was no proof that the claimant was given the notice of repayment. Executive Chair Lamoureux held that there had been a breach of procedural fairness because the issue of whether a notice was provided to the claimant was not addressed in the written materials, and the insurer had failed to include the repayment notice in its materials due to “administrative oversight.” The matter was remitted for rehearing.

G.K. v. Security National Insurance Company (16-001904)

The insurer sought reconsideration of the Tribunal’s decision that the claimant was a resident of Ontario at the time of the accident, and therefore an “insured person.” Executive Chair Lamoureux rejected the reconsideration. She held that the Tribunal was asked to make a determination that largely turned on the facts of the case, and that the Tribunal had not erred in finding that the claimant resided in Ontario. She also held that section 3 of the SABS was the pertinent section to consider, and that section 59 was only relevant to determining whether an insured could elect benefits in another jurisdiction. Finally, Executive Chair Lamoureux noted that the insurer was essentially asking for reconsideration on the Tribunal’s findings of fact, which was not an appropriate request.

G.T. v. Unifund Assurance Company (16-001283)

The insurer appealed a ruling in which the claimant was awarded an orthopaedic assessment. The insurer argued that the assessment was available through OHIP, and therefore not payable under the SABS. Executive Chair Lamoureux rejected the reconsideration. She held that the obligation was on the insurer to advance evidence establishing that a benefit at issue was available through a collateral source (such as OHIP), and could not rely upon bare assertions. No evidence was presented about what benefits OHIP covered or the speed at which the claimant could obtain such an assessment through OHIP.

M.C. v. Aviva General Insurance (17-002614)

The insurer sought reconsideration of an order made by the Tribunal allowing the claimant to summons the adjuster who had handled his matter. The insurer argued that it should have been given a copy of the claimant’s summons request, and should have had the opportunity to respond to that request. Executive Chair Lamoureux rejected the reconsideration. She held that Rules 8 and 4.3, when read together, allowed the claimant to request a summons without notifying the insurer.

C.T. v. Aviva Insurance Canada (16-000958)

The claimant sought entitlement to income replacement benefits and was successful at the LAT. The insurer sought reconsideration as it asserted that the claimant was working during a period in which IRBs were awarded. The claimant countered by asserting improper notice was provided under Rule 18.1. Executive Chair Linda Lamoureux determined that the proviso noting a party indicate if it is seeking judicial review was only if the party is indeed seeking an appeal and that a party need not declare it is not appealing. Moreover, Rule 3.1 allowed for a liberal interpretation of the Rules so as to not cause unfairness or prejudice. The reconsideration was allowed and on review, Executive Chair Lamoureux noted that the LAT decision did not properly consider evidence that the claimant worked during a period in which IRBs were claimed. As a result, the reconsideration was granted and the matter remitted for a rehearing.

C.T. v. Aviva Insurance Canada (16-000958)

The claimant sought entitlement to income replacement benefits and was successful at the LAT. The insurer sought reconsideration as it asserted that the claimant was working during a period in which IRBs were awarded. The claimant countered by asserting improper notice was provided under Rule 18.1. Executive Chair Linda Lamoureux determined that the proviso noting a party indicate if it is seeking judicial review was only if the party is indeed seeking an appeal and that a party need not declare it is not appealing. Moreover, Rule 3.1 allowed for a liberal interpretation of the Rules so as to not cause unfairness or prejudice. The reconsideration was allowed and on review, Executive Chair Lamoureux noted that the LAT decision did not properly consider evidence that the claimant worked during a period in which IRBs were claimed. As a result, the reconsideration was granted and the matter remitted for a rehearing.

F.F. v. Aviva Canada (16-000941)

The claimant sought entitlement to income replacement benefits and was successful at the LAT. The insurer sought reconsideration and pled the claimant did not comply with a section 33 information request and it is therefore not required to pay for benefits during the period of non-compliance. Executive Chair Linda Lamoureux determined that the information requested was reasonable and the claimant did not provide a reasonable explanation for failing to comply with the request. As a result, the LAT decision was varied to deny the payment of IRBs during the period of non-compliance.

F.F. v. Aviva Canada (16-000941)

The claimant sought entitlement to income replacement benefits and was successful at the LAT. The insurer sought reconsideration and pled the claimant did not comply with a section 33 information request and it is therefore not required to pay for benefits during the period of non-compliance. Executive Chair Linda Lamoureux determined that the information requested was reasonable and the claimant did not provide a reasonable explanation for failing to comply with the request. As a result, the LAT decision was varied to deny the payment of IRBs during the period of non-compliance.

G.P. v. Aviva Insurance Company of Canada (16-000726)

The insurer appealed the Tribunal decision that a 2006 denial of income replacement benefits was not valid. Executive Chair Lamoureux agreed with the insurer and held that the Tribunal’s decision was a substantial error in law. She wrote that the denial had clearly and unequivocally communicated to the claimant that her entitlement to further income replacement benefits had been denied, and provided the claimant with the dispute process. Further, Executive Chair Lamoureux held that the claimant’s re-application for income replacement benefits in 2015 did not create a second triggering event for the limitation period. The claim for income replacement benefits was therefore barred.