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J.K. v Aviva Insurance Company of Canada (18-008054)

  • April 9, 2020

The insurer submitted a request for reconsideration following a decision in which the Tribunal found that the claimant was entitled to various medical benefits. In making its decision, the Tribunal addressed a procedural issue that arose as a result of the parties not filing the OCF-18s in dispute with their written submissions and evidence. As a result, the Tribunal issued an Order directing the parties to serve on each other and file with the Tribunal a copy of the missing OCF-18s along with written submissions on whether the claimant should be permitted to file the missing OCF-18s as evidence for the written hearing. Ultimately, the Tribunal allowed the missing OCF-18s into evidence and proceeded to determine that the claimant was entitled to the treatment set out in those OCF-18s. The insurer argued that the Tribunal made significant errors of fact and law such that the Tribunal would likely have reached a different decision by finding that the missing OCF-18s were submitted by the claimant (when they were in fact submitted by the insurer), by accepting the missing OCF-18s into evidence, and by making the claimant’s case for her on arguments that were never made by the claimant. Adjudicator Lake dismissed the insurer’s request for reconsideration, noting that the Tribunal did not err in admitting the missing OCF-18s into evidence, and that while it erred in stating that the treatment plans were submitted by the claimant when they were in fact submitted by the insurer, this error would not have led the Tribunal to a different decision. Adjudicator Lake further noted that the Tribunal correctly placed the onus on the claimant to prove entitlement, and did not act as an advocate for the claimant. Rather, the Tribunal reviewed all of the evidence in the matter, which included the missing OCF-18s.

Full decision here

TGP Analysis

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  • FILED UNDER Medical Benefits, LAT Rules, Reconsideration
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