RECONSIDERATION DECISION
Before:
Jesse A. Boyce, Vice-Chair
07/09/2021
Tribunal File Number:
19-010782/AABS
Case Name:
Selvanyaki Manoharan v. Allstate Canada
Written Submissions by:
For the Applicant:
No submissions
For the Respondent:
Diana M. Oliveira, Counsel
OVERVIEW
1This request for reconsideration was filed by the respondent, Allstate. It arises out of a Decision dated January 21, 2021, in which I determined that the applicant was entitled to interest on the incurred amounts of three treatment plans, amongst other benefits.1 In its narrow request, Allstate asserts that I erred in law and fact in my application of s. 38 and s. 51 of the Schedule2 in finding that interest was owed on the treatment plans and, had the error not been made, that I would have likely reached a different conclusion.
RESULT
2The request for reconsideration is granted.
ANALYSIS
3The grounds for a request for reconsideration are contained in Rule 18.2 of the Licence Appeal Tribunal, Animal Care Review Board, and Fire Safety Commission Common Rules of Practice and Procedure, Version I (October 2, 2017), as amended (“Common Rules”). A request for reconsideration will not be granted unless one or more of the criteria are met.
4Here, Allstate relies on Rule 18.2(b) of the Tribunal’s Common Rules, submitting that my decision to award interest on the three treatment plans was an error of law and fact because it fulfilled all its obligations under s. 38. Further, regarding the three treatment plans (identified in the Decision as issues (v)[a-c]), it asserts that there is no interest payable, as there was no overdue payments, because an invoice was not received and that, since the treatment plans were paid in full before the Tribunal application was filed, the application of s. 51(4) of the Schedule should have been moot. Allstate submits that, had these errors not been made, I would have reached a different conclusion. It requests that I reverse my Decision that interest is owed for issues (v)[a-c] or, in the alternative, that the Tribunal provide direction as to the date from which interest is payable.
5While the applicant was copied on Allstate’s request for reconsideration, and the Tribunal provided the applicant with a deadline for submission dates to respond, the applicant did not provide reconsideration submissions in response.
Allstate is not required to pay interest on issues (v)[a-c]
6The offending paragraphs of my initial Decision are 10-13, where I concluded that interest was owed to the applicant on the three treatment plans under s. 51(4). I find it was an error of law to find interest payable where, on review, Allstate complied with its s. 38 obligations and, notably, made payment in full following receipt of the s. 44 report and prior to the Tribunal application being filed.
7Indeed, on review, I agree that Allstate responded to all three claims within 10 days of receipt of the treatment plans under s. 38(8). It provided Explanation of Benefits (partially approving (v)[a] and requesting s. 44 assessments for (v)[b] and (v)[c]) speaking to its determination, pursuant to s. 38(10). On receipt of the s. 44 reports, and under s. 38(14), it notified the applicant of its determination within 10 days. Critically, Allstate paid the treatment plans within 30 days of receipt of the May 16, 2018 s. 44 report of Dr. Day and the applicable invoices, pursuant to s. 38(15).
8My finding at para. 13 that “interest applies when there is an overdue payment of a benefit and s. 51 does not allow an insurer to escape interest through the actions or inactions of an insured” was an error that results in a different conclusion, chiefly: that interest was improperly ordered. My finding was an error because it did not appreciate that the delay in Allstate’s final determination (and full payment of v[a]) was as a result of the applicant’s failure to attend at several properly scheduled s. 44 assessments, facts that I outlined in paras. 11-12 before making a finding in para. 13, that Allstate was within its rights to request those s. 44 assessments due to the applicant’s standing within the Minor Injury Guideline.
9Once the applicant attended and Allstate received Dr. Day’s report, Allstate approved payment of all three treatment plans within 30 days, which was proper under s. 38(15). I agree that it was then an error to automatically apply s. 51(4) as Allstate not only complied with its s. 38 obligations but it also made payment of the treatment plans in full on May 16, 2018, prior to the application being filed with the Tribunal on September 4, 2019. Finally, where the applicant also never provided Allstate with an invoice for interest owed, it follows that the interest issue was moot and should not have triggered an interest order under s. 51(4).
ORDER
10Accordingly, for these reasons, I reverse the Order at para. 36 of my initial Decision that interest is owed for the issues identified as (v)[a-c], as it was an error of law and fact that resulted in a different outcome, pursuant to Rule 18.2(b). The applicant is not entitled to interest for these issues.
Jesse A. Boyce
Vice Chair
Licensing Appeals Tribunal
Tribunals Ontario
Released: July 9, 2021
Footnotes
- The Decision also found that a physiatry assessment was reasonable and necessary, that the applicant was entitled to interest on the unpaid balance of incurred psychological treatment and ordered a s. 10 award totaling $1,500. These issues did not form part of Allstate’s request for reconsideration.
- O. Reg. 34/10, as amended.