Licence Appeal Tribunal
Messina v. Unica Insurance Inc., 2024 ONLAT 22-000289/AABS-R
RECONSIDERATION DECISION
Before: Michael Beauchesne
Licence Appeal Tribunal File Number: 22-000289/AABS
Case Name: Matthew Messina v. Unica Insurance Inc.
Written Submissions by:
For the Applicant: None submitted
For the Respondent: Olga Zemlinsky, Counsel
OVERVIEW
1On March 6, 2024, the respondent requested reconsideration of the Tribunal’s decision dated February 14, 2024 (the “decision”).
2The decision ordered the respondent to pay the applicant $448.83 plus interest for each of three disputed treatment plans for psychological services. The applicant was not entitled to any of the other disputed treatment plans in this matter, nor the disputed expenses.
3The grounds for a request for reconsideration are found in Rule 18.2 of the Licence Appeal Tribunal Rules, 2023 (“Rules”). To grant a request for reconsideration, the Tribunal must be satisfied that one or more of the following criteria are met:
a) The Tribunal acted outside its jurisdiction or committed a material breach 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; or
c) 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.
4In this case, the respondent is arguing criteria (a) and (b) as outlined in Rule 18.2.
5The respondent requests the Tribunal’s order be varied to correspond with the result as articulated in the decision. Specifically, the respondent asks that the Tribunal’s order convey that the applicant is “entitled” to payment as opposed to stating that the respondent “shall pay.”
6The applicant did not file submissions on this matter.
RESULT
7The respondent’s request for reconsideration is granted.
ANALYSIS
8The test for reconsideration under Rule 18.2 involves a high threshold. The reconsideration process is not an opportunity for a party to re-litigate its position where it disagrees with the Tribunal’s decision, or with the weight assigned to the evidence. The requestor must show how or why the decision falls into one of the categories in Rule 18.2.
Rule 18.2(a): The Tribunal acted outside its jurisdiction by ordering the respondent to pay a benefit.
9I find the Tribunal acted outside its jurisdiction when ordering that the respondent shall pay the outstanding amounts of the three disputed OCF-18s that proposed psychological services.
10The respondent submits that in using the words “the respondent shall pay (emphasis added) the applicant $448.38 plus interest for each of the three OCF-18’s for psychological treatment” at paragraph 38 of the decision, the Tribunal acted outside its jurisdiction. The respondent explains that these treatment plans were only payable if incurred, and that the issue of whether the expenses in dispute were incurred was not before the Tribunal in the initial hearing. The respondent adds that the parties did not lead evidence as to whether the expenses were incurred, nor were invoices included with the submissions. As such, the respondent submits the Tribunal, in the context of its decision, may find only that the applicant is entitled to the treatment plans, and not that the respondent is obligated to pay them.
11I agree with the respondent. In fact, the results section of the decision at paragraph 9 correctly indicates the applicant is “entitled” to the disputed expenses. I find ordering that the respondent “shall pay” those expenses at paragraph 38 of the decision is an error that caused the Tribunal to act outside its jurisdiction and should be remedied as requested by the respondent.
12Given that I have found the respondent has established grounds for reconsideration under Rule 18.2(a), it is not necessary to address the arguments per Rule 18.2(b).
13Rule 18.4 provides that upon reconsidering a decision, the Tribunal may:
a. Dismiss the request; or
b. After providing responding parties an opportunity to make submissions,
i. Confirm, vary, or cancel the decision or order; or
ii. Order a rehearing on all or part of the matter.
14In this case, I am varying the Tribunal’s order such that paragraph 38 of the decision reads: “The applicant is entitled to payment for, and interest on, the three OCF-18s for psychological treatment submitted in December 2019, July 2020, and January 2021, each in the amount of $448.83. The applicant is not entitled to any of the remaining OCF-18s in dispute, nor the OCF-6.”
CONCLUSION & ORDER
15The respondent’s request for reconsideration is granted. Pursuant to Rule 18.4, I order that paragraph 38 of the decision be varied to read, in its entirety: “The applicant is entitled to payment for, and interest on, the three OCF-18s for psychological treatment submitted in December 2019, July 2020, and January 2021, each in the amount of $448.83. The applicant is not entitled to any of the remaining OCF-18s in dispute, nor the OCF-6.”
Michael Beauchesne Adjudicator Tribunals Ontario – Licence Appeal Tribunal
Released: May 24, 2024