RECONSIDERATION DECISION
Before:
Kate Grieves, Adjudicator
Licence Appeal Tribunal File Number:
23-015766/AABS
Case Name:
Sumaiyabanu Lala v. TD General Insurance Company
Written Submissions by:
For the Applicant:
Muhammad Aftab Alam, Counsel
For the Respondent:
Robert Bowman, Counsel
OVERVIEW
1On August 28, 2024, the applicant requested reconsideration of the Tribunal’s preliminary issue decision dated August 7, 2024 (“decision”).
2In that decision, I found that the applicant was statute barred from proceeding with her application because she failed to dispute the denial within the two-year limitation period.
3Given that this decision was released after August 21, 2023, this reconsideration is governed by the Licence Appeal Tribunal Rules, 2023 (“Rules”). The grounds for a request for reconsideration are found in Rule 18.2 of the 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.
4The applicant seeks reconsideration under Rule 18.2(b), on the basis that I made a significant error of law and/or fact in finding that the denial notice was compliant with the Statutory Accident Benefits Schedule – Effective September 1, 2010 (including amendments effective June 1, 2016) (Schedule) which then triggered the limitation period. The applicant submits that the limitation period was never triggered as the denial notice was defective.
5The applicant seeks an order quashing the decision and finding that the applicant may proceed with her application.
RESULT
6The applicant’s request for reconsideration is dismissed.
ANALYSIS
7The 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.
No error in finding the notice was a valid denial
8The applicant submits that the Tribunal made a significant error of law and/or fact by finding that the denial notice was not defective. The applicant submits that the denial letter was defective because the conclusions of the two insurer’s examination reports on which it was based were deficient.
9I find that the applicant’s arguments are largely an attempt to re-litigate the same issues and arguments advanced in the original submissions. In my decision, I considered the relevant case law that establish the principles that govern a valid refusal (See: Smith v. Co-operators General Insurance Company, 2002 SCC 30 (“Smith”); T.F. v. Peel Mutual Insurance Company, 2018 CanLII 39373 (ON LAT) (“T.F.”); Hedley v. Aviva Insurance Company of Canada, 2019 ONSC 5318 (“Hedley”); and Sietzema v. Economical Mutual Insurance Company, 2014 ONCA 111 (“Sietzema”). I found that there was a valid refusal to pay the disputed benefits, the denial was clear and unequivocal, the denial provided valid reasons, it outlined the dispute resolution process, and the two-year time limit to dispute the decision.
10The applicant again challenges the reasons for the denial of the benefits rather than addressing the sufficiency of the denial. As noted at paragraph 10 of the decision, even legally incorrect reasons for denying a benefit is sufficient to trigger a limitation period if the notice is clear and unequivocal. As a result, I find that there was no error in the decision regarding my finding that there was a valid denial and, as a result, a reconsideration is not granted on this basis.