RECONSIDERATION DECISION
Before: Sandeep Johal, Vice-Chair
Licence Appeal Tribunal File Numbers: 20-000279/AABS and 20-000408/AABS
Case Name: Roland Spiegel v. Intact Insurance Company
Written Submissions by:
For the Applicant: Roland Spiegel, Self-Represented
For the Respondent: No Submissions
BACKGROUND
1This request for reconsideration was filed by the applicant (the insured). It arises out of a decision in which I found that the applicant was barred by virtue of s. 55(1)2 of the Schedule from commencing his Tribunal application to dispute medical benefits in the amount of $5,578.26 and $11,589.30 until he attended the insurer examinations (“IEs”) under s. 44.
2The applicant concedes in his submissions that the Tribunal’s determination that he would be precluded to dispute treatment plans until such time as he attends the “properly” scheduled IE’s. (Emphasis in original). However, the applicant submits that the Tribunal acted outside its jurisdiction and violated the rules of procedural fairness by making errors of law and fact and as a result of wrongful findings, conclusions, and determinations, are not supported by the evidence.
3The applicant asks the Tribunal to reconsider the original decision,1 and order a new preliminary issue hearing take place before a different member of the Tribunal.
RESULT
4For the following reasons, the applicant’s request for reconsideration is dismissed.
ANALYSIS
5The grounds for a request for reconsideration are contained in Rule 18.2 of the Tribunal’s Common Rules of Practice and Procedure.2 A request for reconsideration will not be granted unless one or more of the following criteria are met:
a. The Tribunal acted outside its jurisdiction or violated the rules of procedural fairness;
b. The Tribunal made an error of law or fact such that the Tribunal would likely have reached a different result had the error not been made;
c. The Tribunal heard false or misleading evidence from a party or witness, which was discovered only after the hearing and likely affected the result; or
d. There is evidence that was not before the Tribunal when rendering its decision, could not have been obtained previously by the party now seeking to introduce it, and would likely have affected the result.
6The applicant submits that Rule 18.2(a) and (b) applies in this case and, specifically, alleges that I erred in failing to make a “judicious determination” that:
i. Intact’s denials were insufficient;
ii. Intact’s request for an IE were not reasonably necessary;
iii. Intact failed to provide any reasoning on why two IE assessments were required;
iv. Intact failed to comply with the mandatory provisions under s. 44(1) of the Schedule;
v. Intact failed to refer the applicant to the appropriate IE assessors;
vi. Intact failed to schedule an IE at a time that was convenient for the applicant;
vii. Intact failed to provide proper disclosure of documents;
viii. The applicant never refused to attend the IE’s and did not place any conditions on his attendance;
ix. The Tribunal’s legislative authority can be attained by virtue of implication, extension, proximity, or relevance in connection to an insured person attending an IE;
x. the Tribunal failed to recognize that the applicant was waiting for Intact to schedule a “virtual” IE.
7The applicant also seeks to introduce new evidence that was not provided as part of the preliminary issue decision. I will turn to discuss the new evidence at the outset.
New Evidence under Rule 18.2(d)
8In the applicant’s request, he submits and refers to emails between himself and Intact from March 16, 2021 and August 6, 2021 to show that he made inquiries to Intact to have the IE’s conducted virtually.
9The applicant seeks to rely on this new evidence for the first time for the purposes of the reconsideration, however, he makes no further submissions on why it should be accepted as new evidence in accordance with Rule 18.2(d).
10In my view, even if I were to allow the applicant to rely on the new evidence for the purposes of this reconsideration decision, it would not have affected the result of the original decision. The applicant does not provide any evidence to suggest that he attended a virtual IE subsequent to the original hearing, other than simply, “making inquiries” and as a result, I find that the new email evidence, which was not before me at the original hearing, would not have affected the result of the original decision.
The Tribunal did not err under Rule 18.2(b)
Denials were sufficient
11In order to grant a request under Rule 18.2(b), I must not only have made an error of law or fact, but that error must be such that I would likely have reached a different result had the error not been made. On the evidence and submissions before me, I am not persuaded that I made an error of law or fact in finding that the applicant failed to provide a reasonable explanation for not attending the IE assessments.
12The applicant essentially uses the request for a reconsideration to make the same arguments as he made at the original hearing, and submits that I made wrongful findings and conclusions which were not supported by the evidence.
13As discussed in paragraphs 18-31 of the original decision, the applicant’s submissions and evidence were considered in detail, and a review of the denials provided by Intact were reviewed and found to be compliant with the Schedule. See paragraphs 22-26 and 28-30.
14As a result, I fail to see any error of law or fact such that I would likely have reached a different result had the error not been made.
Requests for an IE were reasonably necessary
15Based on a review of the evidence and the applicant’s reconsideration submissions, which are essentially the same as those made in the original hearing. I find no error in the conclusion reached in the original decision.
16In paragraphs 32-42 of the original decision, I reviewed the respondent’s notice for the IE and whether it was in compliance with the Schedule. A finding of fact was made, which I was entitled to do as part of my role as the hearing adjudicator and trier of fact in the matter. The applicant has not directed me any errors of law or fact that were made, other than to restate his original submissions and to use the reconsideration request to bolster his original submissions from the hearing.
No error in finding that the applicant could not place conditions on his attendance at an IE
17The applicant again makes the same arguments as he did in the original decision that the IE assessors were not qualified, the IEs were not scheduled at a convenient time for him, that he has the right to a chaperon, that he has a right to be able to record the IE assessment and that he is entitled to documents or productions from Intact.
18The conditions of attendance were discussed in the original decision at paragraphs 43-55 and the applicant’s reconsideration submissions are an attempt to reargue what was already submitted at the original hearing. Those submissions were considered and rejected with reasons provided in the original decision.
19With respect to the applicant’s request for documentation or productions, making that request at the hearing is untimely. The hearing or reconsideration stage of the process is not the opportunity to discuss or make a request for productions.
20As a result of the above, I am not persuaded that I made an error of law or fact such that the I would likely have reached a different result had the error not been made.
CONCLUSION
21For the reasons noted above, I dismiss the applicant’s Request for Reconsideration.
Sandeep Johal
Vice-Chair
Tribunals Ontario – Licence Appeal Tribunal
Released: March 22, 2022
Footnotes
- Spiegel v Intact Insurance Company, 2021 CanLII 111180 (ON LAT)
- Effective February 7, 2019.