Licence Appeal Tribunal
RECONSIDERATION DECISION
Before:
Kate Grieves
Licence Appeal Tribunal File Number:
20-012141/AABS
Case Name:
Haiyun Chen v. Safety Insurance Company
Written Submissions by:
For the Applicant:
Miryam Gorelashvili, Counsel
For the Respondent:
Crystal Schulz, Counsel
OVERVIEW
1This request for reconsideration was filed by the applicant in this matter. It arises out of an August 4, 2023 decision (“decision”) in which I found that the applicant was subject to the Minor Injury Guideline (“MIG”), that she was not entitled to treatment plans in dispute that proposed treatment outside the MIG, and that she was not entitled to interest or an award.
2The grounds for a request for reconsideration to be allowed are contained in 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) as amended (“Rules”). 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 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.
3Reconsideration requires a high threshold.
4The applicant advances her request for reconsideration pursuant to criteria 18.2(a) and (b). The applicant submits that I violated the rules of natural justice, and made errors of law such that I would have reached a different result in my decision if the errors had not been made.
5The applicant seeks an order to vary the decision and find that the applicant is entitled to the massage therapy and physiotherapy that was incurred, within the MIG limits.
RESULT
6The applicant’s request for reconsideration is granted.
ANALYSIS
7The applicant has not requested reconsideration of the finding that the applicant was subject to the MIG. The applicant submits that I made an error of law in failing to address the reasonableness and necessity of the disputed treatment plans, regardless of whether she was found to be subject to the MIG. Zero benefits have been paid to date. The applicant submits that not addressing the reasonableness and necessity of the treatment plans was a violation of the rules of natural justice, as the legislation is consumer protection. She submits that the Tribunal should have approved the massage therapy and physiotherapy in dispute up to the limit of the MIG.
8The respondent requests that I either affirm my decision or vary my decision to confirm that the treatment plans are not reasonable and necessary.
9I find the applicant has established grounds for reconsideration. Given my finding that the applicant's injuries are subject to the MIG, and that no treatment plans had been approved, I should have considered the treatment plans under section 40(8) of the Schedule.
10Section 40(8) states that if it is determined that the MIG applies to an insured person following a dispute before the Tribunal, the benefits and/or assessments incurred under the MIG are deemed reasonable and necessary. Therefore, pursuant to s. 40(8), I agree with the applicant that the disputed treatment and assessment plans that were incurred up to the MIG limits are deemed reasonable and necessary.
11I vary my decision to find that the applicant is entitled to the benefits set out in the disputed treatment plans, if incurred, up to the amount of the MIG limits plus interest in accordance with s.51 of the Schedule.
12As I have found the applicant has established grounds for reconsideration under Rule 18.2(b), it is not necessary for me to consider the arguments under Rule 18.2(a).
CONCLUSION & ORDER
13The applicant’s request for reconsideration is granted. I am varying my decision to find that the applicant is entitled to the benefits set out in the disputed treatment plans, if incurred, up to the amount of the MIG limits plus interest in accordance with s. 51 of the Schedule.
Kate Grieves
Adjudicator
Tribunals Ontario – Licence Appeal Tribunal
Released: January 15, 2024