RECONSIDERATION DECISION
Before: Chloe Lester, Vice-Chair
File: 18-006437/AABS
Case Name: CD v. Certas Home and Auto Insurance Company
Written Submissions by:
For the Applicant: Michelle Jorge, Counsel
For the Respondent: Marianne Davies, Counsel
OVERVIEW
1The applicant, CD, asks for a reconsideration of the Tribunal’s1 decision released on August 7, 2019 where the applicant was denied two treatment plans for case manager services.
2The applicant makes the request pursuant to Rule 18.2 (b) of the Licence Appeal Tribunal (LAT) Rules of Practice and Procedure (October 2, 2017) (“the Tribunal’s Rules”), with the February 7, 2019 amendment to Rule 18 on reconsiderations.
ISSUES IN DISPUTE
3The applicant submits it meets the reconsideration criteria in the following ways:
(1) The Tribunal erred in fact and law when it determined the applicant was not entitled to $600 for mileage; and
(2) The Tribunal erred in fact and law when it determined the applicant was not entitled to a treatment plan for case manager services.
RESULT
4The request for reconsideration is dismissed.
BACKGROUND
5The applicant was injured in an automobile accident on June 12, 2012 and was, as a result, determined to be catastrophically impaired. Therefore, the applicant is entitled to apply for case manager services.
6The applicant applied for case manager services in a treatment plan submitted on October 3, 2015 and it was partially approved by the respondent. $600.00 was denied on the basis that the respondent was not obligated to pay for transportation mileage costs in accordance with the Professional Services Guideline2 and the Schedule.3
7The applicant applied for further case manager services in a treatment plan submitted on May 23, 2018. This treatment plan was denied by the respondent.
8The Tribunal issued a decision on the issues in dispute and determined that the $600.00 for mileage was not an expense the respondent was liable to pay for under the Professional Service Guideline. The Tribunal’s decision also found that the treatment plan for case manager service was not reasonable and necessary.
ANALYSIS
Erred in Fact and Law
9The applicant argues that the Tribunal’s decision erred in fact and law by not determining whether the expenses for mileage were necessary in the circumstances of this case and in its determination that the treatment plan for case manager services was not reasonable and necessary when the evidence demonstrates otherwise.
10The respondent argues that the applicant has not made a compelling case for reconsideration and is asking to Tribunal to re-hear the issues in dispute. The respondent argues that a request for reconsideration is not to second-guess the factual findings of a decision and that the adjudicator should be granted deference to make those decisions.
11Upon review of her submissions, the applicant does not explain how the decision errs in fact or law in comparison to the law or the evidence presented. In the case for mileage, the applicant asserts the adjudicator ought to have considered the necessity of the request. She then re-argues her case for the expenses. The applicant does not explain how the adjudicator was obligated to consider this factor in its decision. The same is true of her second argument relating to whether the treatment plan was reasonable and necessary.
12The applicant is re-arguing the same submissions from the hearing and looking for a different result. This is not a basis for a reconsideration and the request for reconsideration is dismissed.4
Released: February 13, 2020
Chloe Lester
Vice-Chair
Footnotes
- Tribunals Ontario, Safety, Licensing Appeals and Standards Division, Licence Appeal Tribunal – Automobile Accident Benefits Service (the “Tribunal”)
- FSCO Bulletin No. A-14/14; Superintendent’s Guideline No. 03/14 (September 2014)
- Statutory Accident Benefits Schedule -Effective September 1, 2010 (the “Schedule”)
- See 16-000066 v. Waterloo Regional Municipalities Insurance, 2017 CanLII 19186 at para 13; M.V. v. Aviva Insurance Company of Canada, 2019 CanLII 72212 at paras 16 and 24;