RECONSIDERATION DECISION
Before:
Craig Mazerolle, Vice-Chair
Licence Appeal Tribunal File Number:
23-012304/AABS
Case Name:
May-Shan Ng v. TD General Insurance Company
Written Submissions by:
For the Applicant:
Rakesh Sharma, Counsel
For the Respondent:
Al Alilovic, Counsel
OVERVIEW
1On September 3, 2025, the applicant requested reconsideration of the Tribunal’s decision released August 13, 2025 (“decision”).
2Stemming from an accident on October 4, 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 was entitled to attendant care benefits for the period of June 1 to September 30, 2023, plus interest. The adjudicator further concluded that the applicant was not entitled to an income replacement benefit (“IRB”), a treatment plan and three OCF-6s for chiropractic services, or an award.
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(a) and Rule 18.2(b) in her supporting submissions. Her reconsideration request is limited to the IRB. She is asking the Tribunal to find she is entitled to this benefit, along with an award and interest.
5The respondent asks the Tribunal to dismiss the applicant’s request.
RESULT
6The applicant’s request for reconsideration is dismissed.
ANALYSIS
7I find the applicant has not established any grounds for reconsideration.
8The applicant bases her request for reconsideration on the following interpretations of the Schedule. First, the applicant contends that to receive payment of an IRB, s. 36(2)(3) of the Schedule requires an insured person to provide the insurer with an Application for Accident Benefits and a Disability Certificate. The insurer then has several options to respond to the claim (e.g., set up an insurer’s examination), but, according to the applicant, s. 36 “is silent about the requirement upon the applicant to submit any medical evidence to substantiate the eligibility”. According to the applicant, this interpretation is in line with the consumer protection mandate of the Schedule, since it facilitates “easy access” to benefits.
9Second, the applicant submits that, in accordance with s. 54 of the Schedule, “the respondent can not introduce new reasons or evidence of which the applicant was not provided with a statutory denial”.
10With these two interpretations in mind, the applicant argues that the adjudicator’s ruling is not in line with the Schedule, as she allegedly based her denial of the IRB on her own set of criteria. Further, citing Hedley v. Aviva Insurance Company of Canada, 2019 ONSC 5318 (“Hedley”), the applicant argues the respondent did not provide “meaningful reasons” to support its IRB denial.
11The test for reconsideration under Rule 18.2 involves a high threshold, and the requesting party must show how or why the decision falls into one of the categories in Rule 18.2. 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.
12In this request, I find the applicant is either attempting to re-litigate positions that the adjudicator did not accept at first instance, or she is seeking to put forward new positions that were not presented during the written hearing. Both are improper uses of the reconsideration process.
13For instance, the adjudicator dedicated a significant portion of the decision to addressing the applicant’s proposed interpretation of s. 54. The heart of this analysis can be found at paragraphs 14 and 15:
I find that the applicant is attempting to assert that the respondent is not allowed to make new submissions in this hearing, that were not specifically noted in the respondent’s denial letters of the benefits in dispute. I do not find that s. 54 of the Schedule states that the respondent in a hearing before the Tribunal can only make submissions based on its denial letters and is not permitted to make new submissions. Section 54 requires that the respondent provide a clear and unequivocal denial and advise the applicant of her right to dispute the refusal. It says nothing about the respondent’s right to make submissions at a hearing.
I find that the respondent has complied with s. 54 of the Schedule and provided the applicant with clear and unequivocal denials. It further advised the applicant of her right to dispute the refusal within these denials. I further find that the respondent is entitled to make submissions on its position and respond to the applicant’s submissions, in this hearing. I have therefore reviewed the entirety of the respondent’s submissions in reaching my decision.
14The applicant may disagree with this interpretation, but disagreement alone is not sufficient to demonstrate either a material breach of procedural fairness or an error of fact or law.
15Similarly, though there is no mention of s. 36 in her written hearing submissions, the applicant’s position that she did not need to present medical evidence to support her IRB claim was addressed and dismissed in the decision. Briefly, at paragraph 7 of her initial written submissions, the applicant stated:
Therefore, for the Applicant to succeed in respect of entitlement to IRB, the Applicant’s onus is to disprove on the balance of probability that the said IE reports referred in the denial letter dated October 17, 2022 are flawed or statutory deficient.
16This submission, and the corollary position that she was under no obligation to present her own medical evidence, was addressed in the decision at paragraphs 25 and 26:
First, I agree with the respondent that the applicant is arguing the wrong test for entitlement to an IRB. The onus is on the applicant to prove on a balance of probabilities that she suffers a substantial inability to perform the essential tasks of her pre-accident employment. I find that the applicant is incorrect in her submission that her onus is to prove that the IE reports are flawed and statutory deficient.
Second, I find on review of the applicant’s submissions that she has not referred to any medical evidence that supports her entitlement to an IRB. The entire focus of the applicant’s submissions is on the flaws of the IE reports. While the applicant is entitled to dispute the findings of the IE reports, it is still her onus to provide medical evidence to support her own entitlement. I find that the applicant has not done this.
17The applicant has not established any error or breach of procedural fairness related to this analysis. Instead, I find the applicant is asking the Tribunal to effectively re-litigate a position that was not successful at first instance.
18Finally, I note that the applicant did not raise the sufficiency of the IRB denial in her submissions for the written hearing, nor did she cite Hedley at first instance. The reconsideration process is not a venue for advancing new arguments that could have been reasonably raised at first instance. I see no reason why this argument could not have been raised during the written hearing.
19I note that the applicant adds in reply that the IRB issue could have been more clearly defined in the case conference report and order, such that her concerns about s. 36 of the Schedule would have been apparent to the hearing adjudicator. There is no indication as to why the applicant did not take any steps to clarify this issue following the case conference.
20Taken together, I conclude that the applicant has not established any grounds for reconsideration based on the criteria under Rule 18.2.
CONCLUSION & ORDER
21The applicant’s request for reconsideration is dismissed.
Craig Mazerolle
Vice-Chair
Released: November 12, 2025