AMENDED RECONSIDERATION DECISION
Before: Heather Trojek, Vice Chair
File: 17-007972/AABS
Case Name: O.G v. RSA Insurance Company
Written Submissions by:
For the Applicant: Michelle Jorge, Counsel
For the Respondent: Stefania Sdao, Counsel
OVERVIEW
1This request for reconsideration was filed by the applicant. I am asked to reconsider the Tribunal’s findings that the treatment plans and cost of assessments sought by the applicant were not reasonable and necessary1.
2Essentially the applicant argues that the Tribunal did not properly consider the evidence submitted by the applicant and as a result, the decision, should be varied or cancelled.
3The respondent opposes the applicant’s request for reconsideration and submits that the applicant has failed to provide any basis upon which the Tribunal’s decision should be reconsidered.
4Pursuant to s. 17(2) of the Adjudicative Tribunals Accountability, Governance and Appointments Act, 2009, S.O. 2009, c. 33, Sched. 5, I have been delegated responsibility to decide this matter in accordance with the applicable rules of the Tribunal.
RESULT
5The applicant’s request for reconsideration is dismissed for the reasons provided below.
BACKGROUND
6The applicant was involved in a motor vehicle accident on December 16, 2015.
7The applicant participated in treatment following the accident. When the respondent denied the applicant entitlement to certain benefits, he applied to the Tribunal. The parties participated in a case conference but were unable to resolve the issues in dispute. The matter was decided by way of a written hearing.
ANALYSIS
8The grounds for a request for reconsideration are contained in Rule 18 of the Tribunal’s Common Rules of Practice and Procedure. In this case, the applicant argues that:
a. The Tribunal acted outside its jurisdiction or violated the rules of natural justice or procedural fairness; and
b. The Tribunal made a significant error of law or fact such that the Tribunal would likely have reached a different decision.
9The applicant essentially argues that the Tribunal erred because it:
a. did not consider or properly weigh the totality of the medical evidence before it;
b. failed to consider the applicant’s argument with regarding the amount of treatment previously paid by the respondent; and
c. did not specifically address four treatment plans in its decision;
10The respondent argued, and in general, I agree, that the applicant’s reconsideration submissions are board and ambiguous. As a result, I find that the applicant has failed to establish any specific ground upon which the Tribunal’s decision should varied or cancelled.
The Tribunal did not act outside its jurisdiction or violate the rules of natural justice or procedural fairness
11The applicant made no submissions and therefore I have no reason to find that the Tribunal violated the rules of natural justice or procedural fairness in this case.
The Tribunal did consider and/or properly weigh the totality of the evidence
12The applicant has provided me with no reason upon to find that the Tribunal’s decision, which is thorough and well-reasoned, should be varied or cancelled.
13Contrary to the allegations made by the applicant, I find that the Tribunal considered all the evidence before it. In paragraphs 4 and 5 of the applicant’s reconsideration submissions, he argues that the Tribunal failed to consider targeted medial evidence which addressed how the applicant’s treatment has helped him. More specifically the applicant argues that in its decision the Tribunal failed to refer to specific notations in the medical documents relating medication (“better with amitriptyline”), a back brace (“helps walking”) and an injection. I do not agree.
14In paragraph 10 if its decision, the Tribunal clearly states that it reviewed the CNRs, medical reports and OCF-18’s submitted by the applicant. The Tribunal states that although the evidence supplied by the applicant may establish that he had an injury and/or needed treatment it was not sufficient to establish or validate the applicant’s entitlement to the specific benefits claimed. I agree with the Tribunal’s interpretation. The fact that the applicant used medication, or a back brace is not directly relevant to the ultimate decision of whether the chiropractic treatment sought by the applicant is reasonable and necessary.
15Moreover, even if the Tribunal did not specifically refer to the evidence noted by the applicant in its decision, it does not mean that it failed to consider it. It is trite law that the Tribunal is not required to refer to every piece of evidence that it considered in arriving at its decision. I therefore reject the applicant’s claim that the Tribunal failed to consider the evidence before it.
16In addition, I do not find that the Tribunal erred in considering or weighing the evidence before it. Weighing the evidence one of the primary jobs of the Tribunal and should rightly be performed by the trier of fact in the first instance. Although a party may disagree with how the Tribunal weighed the evidence, it is not the role of the reconsideration process to interfere with a Tribunal’s decision unless one of the grounds under Rule 18 are met. In his request for reconsideration, the applicant has failed to point me to any significant error the Tribunal made in assessing and weighing the evidence that would lead me to the conclusion that this reconsideration is warranted.
The Tribunal did consider the submissions made by the applicant
17I find no evidence that the Tribunal failed to consider the arguments advanced by the applicant. The applicant argues that the Tribunal did not consider and/or was not persuaded by the fact that the respondent paid over $5,800.00 in treatment to the applicant. The applicant submitted that if the Tribunal had considered this, it would have found that the applicant was entitled to the treatment in dispute. I do not agree.
18In paragraph 6 of its decision, the Tribunal explicitly considered the argument in question and rejected it. I agree with the respondent, that it was properly within the Tribunal’s discretion to do so. Therefore, I reject the applicant’s claim that the Tribunal failed to properly consider the submissions he advanced at the hearing.
The Tribunal provided reasons for denying all treatment plans
19I find that the Tribunal provided clear reasons for denying the applicant’s entitlement to all treatment plans in dispute. In his request for reconsideration, the applicant acknowledges that in its decision, the Tribunal specifically addresses three of the treatment plans in dispute2. The applicant, however argues that the Tribunal’s decision should be overturned because it failed to provide a clear explanation for why it rejected the applicant’s entitlement to the four other treatment plans in dispute3. Based on the evidence, the submissions of the applicant and the similarities in between many of the treatment plans, I find that the Tribunal provided sufficient reasons for denying all the treatment plans in dispute and find no error in law in the way the Tribunal’s decision is written.
20In paragraphs 8, 9 and 10 if its decision the Tribunal analyzes the medical evidence adduced by the applicant and provides reasons why it denied “all” of the treatment plans in dispute. The Tribunal for instance, states in paragraph 8 that the applicant failed to link “any” [emphasis mine] of his claimed treatment plans to pain relief or to other rehabilitative goals. In paragraph 10 (v), the Tribunal goes on to state that while some of the disputed treatment plans have stated goals and assessment methodology, they fail to address how they are reasonable and necessary in terms cost, frequency and duration. I find that the Tribunal provided sufficient reasons why it denied entitlement to all seven treatment plans and therefore have no reason to allow the request for reconsideration.
21Moreover, the four treatment plans that the applicant alleges the Tribunal failed to specifically address in its decision are all for chiropractic treatment. Based on the similarity in the type of treatment, and the fact that the treatment plans where submitted by the same facility over a 15-month span, I see no need or error in the Tribunal not addressing each individually.
22In addition, in his hearings submissions the applicant did not address how each treatment plan in dispute was reasonable and necessary but instead chose to address them collectively4. The Tribunal assessed the evidence and addressed the arguments made by the applicant in a similar fashion. Contrary to the submissions made by the applicant in his request for reconsideration, I find no error or nothing inappropriate in the Tribunal presenting its findings in this manner.
CONCLUSION
23I find that the applicant has failed to satisfy any of the grounds that warrant reconsideration. For the reasons noted above, I dismiss the applicant’s request for reconsideration.
Released: August 12, 2019
_____________________
Heather Trojek
Vice Chair