Category: Reconsideration

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.

Applicant v. TD Home and Auto Insurance Company (16-000929)

The claimant sought reconsideration of the original adjudicator’s denial of further IRBs. Executive Chair Lamoureux denied the request for reconsideration and held that the adjudicator’s reasons were based on the medical evidence before the Tribunal, and the adjudicator was entitled to weigh the evidence as he saw fit.

J.M. v. Wawanesa Mutual Insurance Company (16-000258)

The claimant sought reconsideration of the Tribunal’s decision to deny psychological treatment. Executive Chair Lamoureux rejected the reconsideration request. She held that all of the grounds raised by the claimant were essentially a re-weighing of facts of findings made by the Tribunal.

Applicant v. TD Home and Auto Insurance Company (16-000929)

The claimant sought reconsideration of the original adjudicator’s denial of further IRBs. Executive Chair Lamoureux denied the request for reconsideration and held that the adjudicator’s reasons were based on the medical evidence before the Tribunal, and the adjudicator was entitled to weigh the evidence as he saw fit.

J.M. v. Wawanesa Mutual Insurance Company (16-000258)

The claimant sought reconsideration of the Tribunal’s decision to deny psychological treatment. Executive Chair Lamoureux rejected the reconsideration request. She held that all of the grounds raised by the claimant were essentially a re-weighing of facts of findings made by the Tribunal.

Applicant v. Wawanesa Mutual Insurance Company (16-001181)

This is a reconsideration decision under LAT Rule 18.2(b) wherein the original decision found the claimant not entitled to claim expenses related to a trip to Disney World. Executive Chair Lamoureux noted that there were no further submissions on the part of the claimant, and it appeared the Tribunal was merely “urged to discover the error.” Although Executive Chair Lamoureux did not entirely agree with the original Adjudicator’s analysis, it was concluded that the proper interpretation of section 16 of the SABS was conducted and the same result would have occurred. Executive Chair Lamoureux interpreted section 16(3) as a provision aimed to serve a rehabilitative purpose. The trip to Disney was seen as an event meant to be enjoyed as a result of the rehabilitation process, not for, or part of, the rehabilitation of the claimant. As a result, the original decision was maintained and the expenses claimed remained denied.