RECONSIDERATION DECISION
Before: Avril A. Farlam, Vice Chair
File: 19-010125/AABS
Case Name: N.R. vs. Unifund Assurance Company
Written Submissions by:
For the Applicant: Jeton Memeti, Paralegal
For the Respondent: Mikhail Shloznikov, Counsel
OVERVIEW
1N.R. (“applicant”) filed this Request for Reconsideration. It arises out of a decision in which I found the applicant was not entitled to the disputed treatment plans because they are not reasonable and necessary.
2The applicant makes this request under Rule 18 of the Licence Appeal Tribunal, Animal Care Review Board, and Fire Safety Commission Common Rules of Practice and Procedure, Version I (October 2, 2017) (“Common Rules”).1 He relies on Rules 18.2(a), (b), (c) and (d) as the basis for reconsideration. The applicant submits that I “erred in law by creating and applying an incorrect test to the issues in dispute” and “…on the basis of his test, every single treatment plan would be found not to be reasonable and necessary.” The applicant also submits that the treatment plans in dispute should be deemed incurred pursuant to s. 3(8) of the Schedule.
3In response, Unifund Assurance Company (“respondent”) submits that my decision is correct and there is no basis for reconsideration.
RESULT
4The applicant’s request for reconsideration is dismissed.
ANALYSIS
5I find no error of law or fact in my analysis of the applicant’s injuries and the reasonableness and necessity of the treatment plans.
6I applied the correct test in determining that the treatment plans are not reasonable and necessary. All of the evidence and submissions were reviewed and I found no persuasive evidence that the treatment plans are reasonable and necessary as set out in paragraphs 17 through 27 of the decision. These findings were reached after a thorough review of the applicant’s evidence. I weighed his evidence and found the applicant failed to prove the treatment plans were reasonable and necessary.
7There is no basis for the applicant’s submission that the treatment plans in dispute should be deemed incurred pursuant to s. 3(8) of the Schedule. The basic principles of “deemed incurred” are:
a. Payment for the benefit in question must be payable under the Schedule;
b. Insurer must have withheld or delayed payment;
c. Such withheld/delayed payment must have been unreasonable.
8I found that the treatment plans in dispute were not reasonable and necessary as set out in paragraphs 17 through 27 of the decision and as a result were not payable under the Schedule. There is no finding that the treatment plans were not incurred because the insurer unreasonably withheld or delayed payment of them. In paragraph 29 of the decision I found that no payment was due and therefore there was no unreasonable withholding or delay. Section 3(8) does not apply.
9The applicant has not persuasively identified any legal or evidentiary error that would have led to a different outcome as required by Rule 18.2(b).
10The applicant has not established any ground for reconsideration under Rule 18.2(a), (c) or (d).
11I find that the applicant has not established his grounds for reconsideration. The grounds for reconsideration of a Tribunal decision are limited and specific. In order to succeed on a reconsideration request, at least one of the grounds must be proven. Here, because the applicant has requested reconsideration, the onus is on the applicant to prove grounds for reconsideration and he has not done so. Instead, the applicant’s submissions appear to be an attempt to reargue the case in a new way. A reconsideration is not an opportunity to reargue one’s case or an appeal.
CONCLUSION
12For the reasons noted above, I dismiss the applicant’s request for reconsideration.
Avril A. Farlam
Vice Chair
Released: December 10, 2020
Footnotes
- Although the applicant’s submissions cited the language of a previous version of Rule 18 of the Common Rules, applicant’s submissions included the current version of Rule 18, as amended. Therefore, the applicant’s request for reconsideration will be considered to be properly made under the current version of Rule 18.