RECONSIDERATION DECISION
Before: Craig Mazerolle, Vice-Chair
Licence Appeal Tribunal File Number: 23-006147/AABS
Case Name: Walid Al Ali v. Co-operators General Insurance Company
Written Submissions by:
For the Applicant: Darya Katkouskaya, Counsel
For the Respondent: Amanda Lennox, Counsel
OVERVIEW
1On September 5, 2025, the applicant requested reconsideration of the Tribunal’s decision released August 15, 2025 (“decision”).
2Stemming from an accident on May 29, 2021 and a request for benefits made pursuant to the Statutory Accident Benefits Schedule – Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”), the parties participated in a written hearing. In the resulting decision, the adjudicator found the applicant remained within the Minor Injury Guideline (“MIG”). He further concluded that the applicant was not entitled to an income replacement benefit (“IRB”), the disputed treatment plans, an award, or interest.
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.
4The applicant relies on Rule 18.2(b) to support his request for reconsideration. He is seeking an order finding he is removed from the MIG, and that he is entitled to the benefits in dispute (along with an award and interest).
5The respondent asks the Tribunal to dismiss the request.
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.
8I find the applicant has not established any grounds for reconsideration, pursuant to Rule 18.2(b).
9The applicant highlights several alleged errors in the decision. First, though he concedes that the “issue was not expressly advanced” by his former counsel, the applicant claims that the adjudicator incorrectly found he remained within the MIG. According to the applicant, there was evidence in both parties’ submissions that demonstrated psychological concerns and chronic pain that merit removal from the MIG. Second, the applicant submits the adjudicator erred in his analysis of the Notice of Examination related to his claim for an IRB. Finally, the applicant disagreed with the adjudicator’s analysis of the treatment plan denials under s. 38 of the Schedule.
10To start, I find the applicant has not demonstrated an error with the adjudicator’s handling of his claim for removal from the MIG. After stating that the onus rests with the applicant, the adjudicator found at paragraphs 9 and 10:
The applicant has made no submissions regarding removal from the MIG. I have not been presented with any arguments supporting removal based on a pre-existing injury, chronic pain with a functional impairment, or a psychological condition.
Therefore, I find that the applicant has not met his onus and is subject to the MIG.
11As is well-established in the case law, applicants have the onus to demonstrate that their accident-related injuries merit removal from the MIG. With no express submissions on this point being provided during the written hearing, the adjudicator correctly noted that the applicant did not meet his onus.
12It is not the duty of the Tribunal to review the evidence to determine if there is a possible case that can be made out in the parties’ document briefs. This kind of inquisitorial investigation would not only place the adjudicator squarely and inappropriately in the fray, but it would also deprive the respondent of knowing what case it had to meet. This inability to respond to the applicant’s stated reasons for removal would violate the respondent’s right to procedural fairness.
13I also note that, while the applicant now highlights several conditions that he believes merit removal from the MIG, the reconsideration process is not meant to be a venue for advancing new arguments not presented at first instance.
14Turning to the IRB, the applicant makes several specific claims about the adjudicator’s handling of this benefit. First, the applicant submits that the adjudicator incorrectly relied on s. 37(4) of the Schedule, which governs ongoing entitlement to specified benefits, as opposed to s. 36(4)—the provision that addresses initial entitlement. Second, the applicant argues that the adjudicator should not have found the respondent’s Notice of Examination was compliant, as it is “internally inconsistent, demands the completion of an unspecified form, and improperly refers to both initial and ongoing entitlement to IRBs.” Finally, the applicant contends that the adjudicator incorrectly determined that Taksali v. Aviva Insurance Company, 2023 CanLII 96347 (ON LAT) (“Taksali”) was not binding, and, in turn, he “erred in disentitling the applicant to IRBs on the basis that he made no arguments regarding entitlement.”
15Starting with the provision cited by the adjudicator, I find the applicant has not demonstrated an error that would trigger Rule 18.2(b). While I accept that s. 36(4) addresses initial claims for specified benefits (which appears to be the status of the IRB claim in this case), I note that the applicant cited s. 37(4) in his written hearing submissions. It was, therefore, appropriate for the adjudicator to at least reference this part of the Schedule. Further, it appears the part of s. 37(4) that the adjudicator relied upon in his reasons is identical to the operative wording from s. 36(4), i.e., both sections require insurers to provide “medical and other reasons” if they deny entitlement to a specified benefit. Therefore, even if the adjudicator may have cited the incorrect provision, I do not see how this error would likely have impacted the adjudicator’s assessment of the claim.
16Then, while the applicant may highlight several issues with the respondent’s denial of the IRB, I find these arguments are largely an attempt to have the Tribunal re-litigate the adjudicator’s finding that this notice was compliant. The adjudicator provided clear reasons to explain why he reached this conclusion at paragraph 17 of the decision, and I do not find the applicant’s reconsideration submissions establish that they constitute an error in accordance with Rule 18.2(b).
17Regarding Taksali, the applicant has not demonstrated that the adjudicator erred in finding this case was not binding. Aside from the fact that this principle about the non-binding nature of Tribunal decisions is well-established, the adjudicator explained at paragraph 16 that—even if Taksali was binding—he found the Notice of Examination was “compliant as it clearly outlines medical and other reasons.” I see no error in this approach.
18Finally, I conclude that the applicant’s arguments about the adjudicator’s analysis of the treatment plan denials is an attempt to re-litigate findings made at first instance. Specifically, the applicant raises several complaints about this analysis, e.g., the denials contain “boilerplate language”; they did not address a psychological assessment report from January 2022; etc.
19The adjudicator’s analysis of the denials is contained in paragraphs 21 – 23 of the decision:
It is the applicant’s position that their psychological injuries fall outside the scope of the MIG. The applicant’s argument regarding all the various treatment plans is the same: each plan lists “reaction to severe stress” and “adjustment disorder” as reasons for denial.
I find that the explanation of benefits (EOB) provided by the respondent were compliant with s. 38(8). In all instances the EOBs outlined the treatment plans in question. They also clearly provided the medical and all other reasons for the denial indicating that the applicant was considered to fall within the MIG , and that the list of injuries in the treatment plans are defined as minor. Additionally, all the EOBs requested additional medical information from the applicant to be able to appropriately make determinations of the treatment plans. I find the notices are compliant with s. 38(8).
I disagree with the applicant’s claim that listing “reaction to severe stress, and adjustment disorder” is sufficient to deem that applicant is out of the MIG with no medical evidence to substantiate that claim. As noted above, the applicant did not make a submission to remove themselves from MIG. Further, even if the applicant were removed from the MIG, this would not render the notices non-compliant, as the respondent provided medical reasons for the denial that comply with s. 38(8).
20Though the applicant may disagree with this analysis, disagreement alone is not sufficient to engage the standard under Rule 18.2(b). Rather, the requesting party must show there was a specific factual or legal error in the decision, and that this error would likely have impacted the result. I find the applicant has not met this burden, as there is no clear, identifiable error established in his reconsideration submissions.
21Further, the applicant claims the respondent did not explain “why conditions such as ‘reaction to severe stress’ and ‘adjustment disorders’ were considered within the MIG.” As is apparent from the quotation above, this argument was already considered and dismissed by the Tribunal. Once again, reconsideration is not a venue for re-litigating arguments that were unsuccessful at first instance.
22Taken together, the applicant has not established any grounds for reconsideration.
CONCLUSION & ORDER
23The applicant’s request for reconsideration is dismissed.
Craig Mazerolle
Vice-Chair
Tribunals Ontario – Licence Appeal Tribunal
Released: October 29, 2025