RECONSIDERATION DECISION
Before: E. Louise Logan, Vice-Chair
Licence Appeal Tribunal File Number: 23-007925/AABS
Case Name: Owayne Mcintyre v. Definity Insurance Company*
Written Submissions by:
For the Applicant: Tina Radimisis, Counsel
For the Respondent: Ainsley Shannon, Counsel
OVERVIEW
1On September 10, 2025, the applicant requested reconsideration of the Tribunal’s decision dated August 21, 2025 (“decision”).
2In the decision, the Tribunal determined that the applicant is barred from proceeding to a hearing for income replacement benefits (IRB) and treatment plans for a functional capacity assessment, a driving rehabilitation assessment, as well as a chiropractic and massage services treatment plan submitted August 21, 2020. The Tribunal also determined the applicant is not entitled to an attendant care benefit (ACB) at a rate of $1,110.37 a month, a chronic pain assessment, chiropractic and massage services (treatment plan submitted December 1, 2022), assistive devices, interest, an award, or special damages.
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 submits that the Tribunal made errors of law and fact, did not consider material evidence and denied procedural fairness. He seeks reconsideration pursuant to Rule 18.2(a) and (b). The respondent submits the request for reconsideration should be dismissed.
5The applicant is seeking to “rescind” the decision. He is seeking an order granting the applicant an extension of time to pursue his claims, and a finding that the applicant is entitled to the ACB and treatment plans in dispute, as well as interest and an award.
RESULT
6The applicant’s request for reconsideration is denied.
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 grounds for reconsideration – denial of extension of time
8I find that the applicant has not established grounds for reconsideration with respect to the denial of an extension of time pursuant to s. 7 of the Licence Appeal Tribunal Act (LAT Act).
9The applicant submits that the Tribunal erred in law and violated procedural fairness in determining that the applicant is barred from proceeding with his claim for IRB and treatment plans. He submits that an extension of time is justified pursuant to section 7 of the LAT Act, and that the applicant had a reasonable explanation for the delay in applying within the time limit. He submits that the Tribunal erred in not considering section 34 of the Statutory Accident Benefits Schedule – Effective September 1, 2010 (including amendments effective June 1, 2016) (the Schedule), and in overlooking the subjective aspect of the test when considering whether the delay was reasonable. The applicant cites Horvath v. Allstate Insurance Company of Canada, 2003 ONFSCDRS 92 and K.H. v. Northbridge, (2019) CanLII 101613 (ON LAT) in support of his position.
10The respondent submits that the applicant is attempting to reargue his case. The respondent submits that there is no dispute about the factors to consider in granting an extension pursuant to section 7 of the LAT Act, as set out in Manuel v. Registrar, 2012 ONSC 1492. It argues that the Tribunal weighed these factors in detail in the decision. It submits that section 34 and the case law cited by the applicant do not apply to limitation periods under s. 56. The proper analysis under section 56 is whether or not there are reasonable grounds under section 7 of the LAT Act for the Tribunal to exercise its discretion to extend the limitation period, which was done in this case.
11In reply, the applicant submits that the alleged error lies not in how the factors were weighed, but in the incomplete nature of the analysis and the Tribunal’s “failure to properly consider critical parts of the evidence”. He submits that the Tribunal did not reflect a “justice of the case” approach and does not satisfy the principles in Manuel. He further argues that while section 34 applies to a different part of the Schedule, the underlying principle is relevant to the exercise of discretion under section 56, and the Tribunal erred when it did not consider that procedural time limits should not operate harshly where a reasonable explanation exists.
12The Tribunal’s analysis of whether to extend the limitation period is set out at paragraphs 8 to 30 of the decision. The Tribunal states that the applicant had conceded that the denials were not appealed within the limitation period set out in section 56 of the Schedule. The issue before the Tribunal was whether to exercise its discretion under section 7 of the LAT Act. After setting out the provisions of section 7, the Tribunal considered the Divisional Court’s guidance in Manuel. At paragraph 12, it noted:
Manuel directs a holistic analysis of the factors, as no single factor is determinative. Or, as the Tribunal noted at paragraph 8 of 18-001196 v. Certas Home and Auto Insurance Company, 2018 CanLII 141018 (ON LAT), the four factors are “not strict elements that must each be met in order to grant an extension of time”. The factors are subject to a broader rule that an extension should not be granted unless the “justice of the case” requires it. The applicant has the onus to show “reasonable grounds” for granting an extension.
13The Tribunal then determined that the Manuel factors weighed against granting an extension of time. In conducting this analysis, the Tribunal took a holistic approach and explicitly considered the “justice of the case” for each benefit to which the preliminary issue applied.
14While the applicant initially argued the Tribunal erred in not considering section 34 of the Schedule, on reply he conceded that this section does not apply to section 56. Consequently, the case law cited by the applicant, which is relevant to the test in section 34 also does not apply. I find that the Tribunal correctly identified that section 7 of the LAT Act was the applicable provision, and that the decision in Manuel set out the factors to be considered. I see no error in this regard.
15I have also considered the applicant’s arguments that the Tribunal did not consider that procedural limits should not operate harshly where there is a reasonable explanation. In this regard, I note that the LAT Act allows the Tribunal to extend a time limit if there are “reasonable grounds” for doing so. In this case, the Tribunal considered that very question. It considered the Manuel factors of the existence of a bona fide intention to appeal within the appeal period, the length of the delay, the prejudice to the other party, and the merits of the appeal. In weighing these factors holistically and in light of the justice of the case, it determined that there were not reasonable grounds.
16While the applicant submits that the Tribunal did not consider critical parts of the evidence, it appears that what is at the heart of the applicant’s argument is a disagreement with the way in which the Manuel factors were applied to the facts of this case. This is not grounds for reconsideration. I see no error and no material breach of procedural fairness in applying the relevant legal test to the specific facts at issue and finding that the Manuel factors weighed against granting the applicant’s request.
17I find that the applicant has not established grounds for reconsideration with respect to the denial of an extension of time.
No grounds for reconsideration – ACB
18I find that the applicant has not established grounds for reconsideration with respect to ACB.
19The applicant submits that the applicant should be entitled to ACB in the amount of $1,110.37 per month or, in the alternative, to a rehearing with direction that the Occupational Therapist’s report satisfies the Form 1 requirements. He submits that:
There is no reason why a decision at the LAT should be that there is no Form 1 referred to when the In-Home and Attendant Care Report dated May 12, 2021 is very detail oriented and provides all the information provided in a Form 1.
20I agree with the respondent that the applicant appears to have misunderstood the Tribunal’s reasons on this issue. The Tribunal did not find that the applicant was not entitled to ACB because of the lack of Form 1. The Tribunal found that in the report of Mr. Sasani, Occupational Therapist, there was no breakdown of the overall amounts into the types of services found under each Part of the Form 1. The Tribunal concluded at paragraph 37 that:
Without the specific amounts of time assigned to each part of the Form-1, I find I cannot assess whether these recommendations are reasonable and necessary. Put another way, by not providing this basic information about Mr. Sasani’s recommendation for attendant care services in the amount of $1,110.37 per month, I find the applicant has not met his burden to demonstrate entitlement to the ACB for this amount.
21At paragraph 38, the Tribunal found that the applicant had not met his burden because he had not indicated what specific services and amounts were being requested.
22The applicant also submits on reconsideration that the Tribunal erred when it did not apply section 3(8) of the Schedule and that its failure to address the provision at all leaves the decision incomplete and deficient. This is not the case. At paragraph 38, the Tribunal acknowledged and considered the applicant’s arguments with respect to section 3(8) as follows:
I do note that much of the applicant’s arguments about the ACB are focused on his concerns about the respondent’s adjusting practices, namely, its scheduling of the IEs. Though these allegations could potentially engage the “deemed incurred” provision under s. 3(8) of the Schedule, the applicant must still demonstrate that the requested attendant care services are reasonable and necessary. Once again, without some indication of what specific services and amounts are being requested, the applicant has not met this burden.
23I find that the Tribunal considered the applicant’s arguments with respect to section 3(8) and determined that as the applicant had not met his burden to establish that the ACB are reasonable and necessary, the provisions were not engaged. I see no error or breach of procedural fairness in this analysis.
24I find that the applicant’s reconsideration submissions do not identify an error in the Tribunal decision or a breach of procedural fairness. The applicant has not established grounds for reconsideration with respect to ACB.
No grounds for reconsideration - chronic pain assessment (July 9, 2021).
25I find that the applicant has not established grounds for reconsideration with respect to the chronic pain assessment.
26The applicant submits the Tribunal erred in fact and law when it determined the chronic pain assessment treatment plan was not reasonable and necessary as the applicant had already been diagnosed with chronic pain by his family physician. He submits that the chronic pain assessment provides multidisciplinary recommendations, evaluates psychosocial impact and charts ongoing care, and that the chronic pain assessment was reasonable and necessary to make a formal diagnosis and provide guidance.
27The applicant also submits the Tribunal erred by not considering the LAT application where the treatment plan was referenced and filed. He submits the Tribunal also erred when it noted that the Tribunal’s attention was not specifically directed to this document and it breached procedural fairness by not considering evidence and basing its decision on procedural issues. The applicant notes he is constrained by the page limitations on submissions and “cannot be expected to reproduce or restate the full evidentiary record within those limitations”. He submits the expectation is that the decision maker will review the filed evidence in its entirety to ensure the hearing is conducted fairly and the parties receive a determination on the merits.
28The respondent submits that the applicant misstates the Tribunal’s finding and that the applicant is attempting to reargue his case.
29On reply, the applicant further submits that the Tribunal appeared to require explicit evidence of the effectiveness of the treatment, imposing a strict standard that was beyond reasonable and necessary.
30In determining that the applicant had not met his onus, the Tribunal stated, at paragraph 44 to 46, as follows:
44In support of all the disputed plans, the applicant broadly asserts that the proposed treatments and assessments have been “specifically tailored to meet [his] individual goals and treat his collision-related impairments.” There is also a general submission that his accident-related impairments have “made it impossible for him to return to his pre-collision capabilities”, adding that a lack of treatment will leave him “trapped in a cycle of physical and psychological pain.” By pointing to the medical evidence summarized in the first half of his initial submissions (and by citing several Tribunal cases), the applicant submits that all the disputed medical benefits are reasonable and necessary.
45I find these submissions do not draw any specific connections to the medical evidence that is summarized in the first half of his submissions, nor do they provide detailed explanations for why each individual plan is reasonable and necessary.
46For instance, in the case of this chronic pain assessment, I note that the applicant’s initial submissions include two records from Dr. Albert Wong, family medicine physician. In these records from 2023 and 2024, Dr. Wong diagnoses the applicant with chronic pain and chronic pain syndrome. With these diagnoses in hand, there is no indication about why the chronic pain assessment in dispute is needed. While I accept that there could be potential reasons for a comprehensive assessment (e.g., charting a course for treatment, re-evaluating prior diagnoses, etc.), the applicant has the onus to detail these reasons at first instance. He is also expected to make explicit references to the evidence to show why this treatment plan meets the entitlement standard. I find the applicant has not met this burden.
31Thus, I find that the Tribunal did not rely on the fact that the applicant had already been diagnosed with chronic pain as a basis to find the treatment plan was not reasonable and necessary. It also did not err by not considering evidence properly before it. While the Tribunal noted, at paragraph 47, that the applicant had not directed attention to the treatment plan, this was not the basis for the Tribunal’s finding that the applicant was not entitled to the treatment plan. The Tribunal determined that the applicant had not connected the medical evidence to the specific treatment plan in dispute. In so doing, the Tribunal acknowledged that there could be potential reasons for a comprehensive assessment, even in light of Dr. Wong’s diagnosis. However, it found that the applicant bore the onus to make this case, which he had not done. The Tribunal concluded that the applicant had not established that the plan was reasonable and necessary.
32Upon review of the decision, I find that the Tribunal did not refuse to consider evidence or make its determination on procedural grounds. It also did not impose a stricter standard than provided for in the Schedule. I see no error in the Tribunal’s analysis, or a breach of procedural fairness.
33Accordingly, I find that the applicant has not met his onus to establish grounds for reconsideration with respect to the chronic pain assessment.
No grounds for reconsideration - treatment plans for chiropractic/massage (December 2022) and assistive devices (June 2021)
34The applicant makes similar arguments about the treatment plans for chiropractic/massage services and assistive devices to those set out above with respect to the chronic pain assessment. He submits that all relevant evidence was properly filed with the Tribunal and the expectation is that the decision maker will review the filed evidence in its entirety to ensure that the hearing is conducted fairly, and the parties receive a determination on the merits. He submits the Tribunal erred by denying entitlement on the basis of the failure to append the OCF-18. He also submits that the Tribunal erred in fact and law by dismissing the treatment plan for assistive devices for lack of specific arguments.
35With respect to these two treatment plans, the Tribunal again found that the applicant’s submissions did not draw specific connections to the medical evidence to show why the treatment plans were reasonable and necessary. It noted that there was no explanation provided for why chiropractic and massage therapy services are needed. It noted that in fact, there was no reference in the applicant’s submissions to massage services, aside from the listing of the issues in dispute.
36The Tribunal noted that the lack of specific arguments and pinpoint references to evidence was especially important for the request for assistive devices, which necessarily involves funding for different items with presumably different uses. By not specifying how the different items will help with the applicant’s recovery, the Tribunal found the applicant had not met his burden. In its reasons, the Tribunal also again noted the applicant had not directed its attention to the OCF-18.
37Thus, while noting the absence of the OCF-18s in evidence, the Tribunal nonetheless considered the submissions of the parties and determined that the applicant had not met his onus by making connections between the medical evidence and the recommended treatment plans in order to establish that the treatment plans were reasonable and necessary. I see no error and no material breach of procedural fairness in these reasons. It is not the Tribunal’s role to review the evidence in order to make a party’s case for them. As noted by the Divisional Court in Dooman v. TD Insurance Co., 2025 ONSC 184 at para 50, the Tribunal has reasonably found that “it is inappropriate for adjudicators to go through a party’s evidence, as suggested by the applicant, to make their case for them”.
38Accordingly, I find that the applicant has not met his onus to establish grounds for reconsideration with respect to the treatment plans for chiropractic and massage services and assistive devices.
No grounds for reconsideration - award and interest
39The applicant’s reconsideration submissions do not identify grounds for reconsideration with respect to an award or interest. He simply notes that if the reconsideration results in entitlement to benefits, interest is payable under s. 51 of the Schedule. He also submits that an award under section 10 of Regulation 664 is warranted due to the respondent’s unreasonable delays and the particulars provided to the Tribunal on March 25, 2024.
40For certainty, I find that the applicant has not established grounds for reconsideration with respect to interest and an award.
CONCLUSION & ORDER
41The applicant’s request for reconsideration is denied.
E. Louise Logan
Vice-Chair
Released: December 9, 2025