Category: Reconsideration

Applicant v. Aviva Insurance Company of Canada (16-001985)

The claimant sought and was successful in obtaining a Tribunal Order for a number of treatment plans. In making the determination, the Tribunal also ordered interest payable at 2 percent per month. On reconsideration, however, Executive Chair Lamoureux noted the Tribunal erred by using the interest provisions of the previous SABS; the correct provision is section 51 at a rate of 1 percent per month, compounded monthly.

Applicant v. Aviva General Insurance Company (17-000370)

The claimant sought entitlement to a number of benefits. At the case conference, a number of timelines were set. The claimant missed a number of document exchange deadlines and subsequently sought an adjournment and the insurer did not consent. The Tribunal did not grant the adjournment. On reconsideration Executive Chair Lamoureux noted the reason for the adjournment request was to allow for receipt of IE reports completed by the insurer on unrelated benefits. The claimant at the time of reconsideration now had the reports and therefore a determination was no longer necessary and the hearing was able to continue.

Applicant v. Co-operators General Insurance Company (16-001976)

The claimant applied for FSCO mediation on January 21, 2016 and disputed a denial of IRBs dated February 26, 2014. The FSCO Mediation was scheduled for May 6, 2016 and was not successful. The claimant subsequently applied to the LAT on August 11, 2016 (97 days after the report of mediator). The insurer raised a preliminary issue asserting the claim was time-barred. The Tribunal agreed and dismissed the claim. On reconsideration, Executive Chair Lamoureux affirmed the applicability of the limitations provisions. The notice letters of the insurer were considered compliant and the insurer was not estopped from relying on the denial letter when it requested a subsequent IE.

Applicant v. Northbridge Personal Insurance Company (16-001066)

The claimant was injured in an accident. The insurer had previously sought and received a declaration from WSIAT that under section 31 of the WSIA the claimant was barred from seeking accident benefits. WSIAT indicated that the claimant only had a claim against its employer, but could not make a declaration against accident benefits due to lack of jurisdiction. The claimant applied to the LAT for accident benefits and the Tribunal allowed the claim to go forward. However, on reconsideration, Executive Chair Lamoureux determined that the claimant was barred from bringing the claim forward. The intention of the claimant to elect by launching an action was considered irrelevant, as WSIAT made a clear determination that no election was available to the claimant.

Applicant v. Waterloo Regional Municipalities Insurance (16-000066)

This reconsideration was requested by the insurer after the claimant’s request for reconsideration of a decision was rejected. In this matter, Executive Chair Lamoureux reviewed the purpose of costs at the LAT and the meaning of “frivolous” and “vexatious,” and declined the insurer’s requests for costs.

Applicant v. Waterloo Regional Municipalities Insurance (16-000066)

This reconsideration was requested by the insurer after the claimant’s request for reconsideration of a decision was rejected. In this matter, Executive Chair Lamoureux reviewed the purpose of costs at the LAT and the meaning of “frivolous” and “vexatious,” and declined the insurer’s requests for costs.

Applicant v. Unica Insurance Inc. (16-000372)

The claimant sought entitlement to attendant care benefits. Her claim was dismissed at a hearing. The claimant applied for reconsideration. It was alleged the Tribunal denied procedural fairness by conducting the original hearing by writing. Executive Chair Linda Lamoureux noted that neither party originally objected to proceeding by way of writing. After reviewing the matter, it was determined the hearing adjudicator did not commit any legal errors. The original decision was upheld.

Applicant v. Wawanesa Mutual Insurance Company (16-000324)

Following the claimant’s success in entitlement to a claimed medical benefit, the insurer sought reconsideration on the basis that the LAT adjudicator should not have admitted late medical documents. Executive Chair Lamoureux held that the Tribunal maintained the discretion to admit any late materials. Further, she wrote that the insurer should have objected to the late documents upon receipt of the late documents, rather than waiting until it filed its submissions on the merits of the claimant’s case.

Applicant v. Wawanesa Mutual Insurance Company (16-000324)

Following the claimant’s success in entitlement to a claimed medical benefit, the insurer sought reconsideration on the basis that the LAT adjudicator should not have admitted late medical documents. Executive Chair Lamoureux held that the Tribunal maintained the discretion to admit any late materials. Further, she wrote that the insurer should have objected to the late documents upon receipt of the late documents, rather than waiting until it filed its submissions on the merits of the claimant’s case.

Applicant v. Intact Insurance Company (16-003927)

The claimant had requested an adjournment of a hearing scheduled for July 2017 to be moved to November 2017 to allow the parties to attend a global mediation. The Case Management Officer (CMO) had denied the request. Following the denial, the claimant’s counsel also told the LAT that their expert witness would be on vacation over the dates the hearing had been scheduled. On reconsideration, EC Lamoureux granted the request for adjournment, but on the basis that the claimant’s expert would be unavailable. She considered this to be new evidence or information that, if previously known, would have affected the Tribunal’s decision.