RECONSIDERATION DECISION
Before:
Craig Mazerolle, Vice-Chair
Licence Appeal Tribunal File Number:
25-004132/AABS
Case Name:
Gabriella Lengyel v. Certas Home and Auto Insurance Company
Written Submissions by:
For the Applicant:
Gabriella Lengyel, Applicant
For the Respondent:
Philippa G. Samworth, Counsel
OVERVIEW
1Stemming from an accident on April 6, 2018 and a request for benefits made pursuant to the Statutory Accident Benefits Schedule – Effective September 1, 2010 (the “Schedule”), the parties participated in a written hearing. In the resulting decision (dated October 22, 2025), the Tribunal found the applicant was statute-barred from proceeding with her application pursuant to s. 55(1)2 of the Schedule. Briefly, despite receiving valid Notices of Examination (“NOE”) for a series of insurer’s examinations (“IE”), the applicant did not attend the respondent’s assessments.
2On October 24, 2025, the applicant requested reconsideration of the decision. An amended version of the request for reconsideration was submitted by the applicant on October 27, 2025.
3According to an order from the Tribunal released on October 29, 2025, the Tribunal accepted the amended version of the applicant’s reconsideration request. The Tribunal further ordered at paragraph 6 that: “… the ‘Amended Notice of Reconsideration’ received on October 27, 2025 is the last version of the applicant’s reconsideration request that the Tribunal will accept”.
4The 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.
5The applicant relies on all three criteria under Rule 18.2 to support her request. She is asking for the following forms of relief:
a. An order allowing her application for catastrophic impairment determination to proceed;
b. An order requiring the respondent to designate her catastrophically impaired;
c. An order to have the Tribunal accommodate her “disability”;
d. An order for document disclosure; and,
e. An order finding she is entitled to certain accident benefits, including case manager services, speech pathology services, attendant care benefits, psychological services, as well as an award and interest.
6The applicant is also seeking costs.
7The respondent asks the Tribunal to dismiss the request for reconsideration.
RESULT
8The applicant’s request for reconsideration is dismissed.
9The applicant’s costs request is dismissed.
ANALYSIS
10The applicant raises many issues with the decision. She also provided a copy of the decision with her reconsideration submissions that includes in-text commentary on why she believes certain findings are incorrect.
11Taken together, I find the applicant’s concerns with the decision can be grouped into three main categories. First, the applicant submits that she was seriously injured in the accident, such that she needs to be deemed catastrophically impaired. Second, the applicant argues that the Tribunal did not correctly analyze the respondent’s NOEs, and this analysis resulted in the Tribunal breaching her right to procedural fairness. Third, by claiming that the Tribunal did not consider s. 55(2) of the Schedule, the applicant challenges the finding that she did not provide a reasonable explanation for missing the IEs. She points to her medical evidence to support this last complaint.
12The test for reconsideration under Rule 18.2 involves a high threshold, and the requesting party—in this case, the applicant—must show how 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 decision, or with the weight assigned to the evidence. Instead, the requesting party must show how at least one of the three criteria under Rule 18.2 is met.
13Though I sympathize with the difficulties expressed in her submissions, especially as she is attempting to navigate this process without legal help, I find the applicant has not met any of the grounds for reconsideration under Rule 18.2. Rather, I find her submissions are attempts to re-litigate positions and evidence that the Tribunal considered at first instance. This is not a proper use of the reconsideration process.
14To help explain my conclusion, it is important to review what the Tribunal found in the decision. After reviewing the key provisions in the Schedule involving missed IEs, as well as the parties’ positions, the Tribunal made the following findings about the NOEs and proposed IEs at paragraphs 21 – 24:
I note that duplicates of the occupational therapy assessment scheduled for June 23, 2025, the neuropsychology assessment scheduled for September 15, 2025, and the neuropsychology assessment scheduled for September 16, 2025 were submitted. As such, a total of 12 NoEs were provided to the applicant rather than 15 as submitted by the respondent.
I also note that the NoE for the orthopaedic assessment scheduled for July 9, 2025 does not provide the location for the assessment nor does it provide an appropriate time – the time indicated is from 9:00 a.m. to 8:00 a.m. For these reasons, I find that the NoE of July 9, 2025 for an orthopaedic assessment is not in compliance with section 44(5) of the Schedule.
On review of the remaining 11 NoEs and the requirements of section 44(5), I find the letters comply with the requirements for proper notice of an IE. The notices identify the applicant’s claim for CAT, they state that the applicant’s attendance is required (except for the “general practice” assessment of October 7, 2025), provide the date, time and location of the assessment in a clearly formatted table, and provide the identity and professional designation of the assessor who would be conducting the IE. In addition, the notices offer the accommodations noted at paragraph [16] above and explain:
Dr. Kavours has not attached any reports to explain his findings as and how or why you meet the test under section b: criteria 6, 7, 8. We have several medical records and reports that are associated with your accident in 2011. We understand that you have a complicated and long standing pre accident medical history from both a psychological and physical perspective. As per our letter Sept 10, 2019, I continue to maintain the position that we have a lack of compelling medical documentation to support the injuries you sustained as a result of the April 6, 2018 accident meet the definition or threshold of a catastrophic impairment. We do not have medical records from your treating health practitioners beyond 2020, as such I have requested updated medical records.
I find that the 11 notices identify the relevant benefit, here, the CAT designation, and provide all the information required for proper notice under section 44(5) of the Schedule. I also find that the respondent made reasonable attempts to accommodate the applicant so that she could participate in the IEs pursuant to section 44(9)(2) of the Schedule. In addition, I have also considered the potential issue of causation due to the applicant’s prior accident in 2011 (i.e., whether the injuries claimed were caused by the subject accident), the respondent’s requests for medical documentation, and the absence of any assessment reports provided by the applicant and find that the NoEs meet the threshold of “reasonably necessary”.
15As this analysis shows, the Tribunal assessed the respondent’s compliance with s. 44(5), and it found that some, but not all, of its NOEs were compliant. Then, by focusing on the potential impact of the 2011 accident on the applicant’s claim for catastrophic impairment, the Tribunal concluded that the IEs were “reasonably necessary”, pursuant to s. 44(1). It further determined that the respondent made reasonable efforts to accommodate the applicant under s. 44(9)(2).
16The Tribunal then assessed the applicant’s explanation for missing the IEs. It found her excuse was not “not supported by the medical documentation” (at paragraphs 34 + 36):
I am sensitive to the applicant’s condition and recognize that she was deemed CAT following her accident in 2011. I also recognize that the applicant likely participated in many CAT assessments in relation to her prior accident and might be confusing those assessments with the ones being requested by the respondent, which are to determine injuries sustained in the 2018 accident.
I find that the explanation provided by the applicant that she is unable to attend the scheduled IEs is not supported by the medical documentation. While I acknowledge that the applicant sustained serious injuries following her 2011 accident and she was deemed CAT following that accident, the evidence shows that the applicant continues to attend other appointments such as those with her family physician and Dr. Pace.
17Earlier on in the decision (at paragraph 17), the Tribunal noted that this explanation was grounded in the applicant’s argument that she should be permitted to proceed with her application based on s. 55(2) of the Schedule.
18In light of the comprehensive nature of the Tribunal’s decision (as well as its responsiveness to the applicant’s submissions), I am satisfied that her grounds for reconsideration involve disagreements with these findings. The applicant is entitled to disagree with the decision, but disagreement alone will not be enough to trigger Rule 18.2. Instead, a party must show how at least one of the criteria under Rule 18.2 has been met. The applicant has not done so. Instead, she is asking the Tribunal to re-litigate evidence and arguments it addressed at length about the respondent’s NOEs, as well as her explanation for missing the IEs. Once again, this is not a proper use of the reconsideration process.
19Beyond her three major sources of concern with the decision, I do note that there are several other issues that the applicant pointed to with the Tribunal’s hearing process. First, related to her complaint about how the Tribunal did not properly assess her explanation for missing the IEs, the applicant argues that the denial of several motions for productions limited her ability to support this explanation. Second, the applicant claims that information contained in the NOEs must have come “from the old TD insurance file”, which amounts to a “conflict of interest”.
20Though I accept that these arguments go beyond a disagreement with the outcome, I still find they are not sufficient to trigger a reconsideration. Briefly, the applicant does not provide a persuasive explanation for how granting her motions for productions would have assisted her in establishing the reasonableness of her explanation. The applicant also provides little detail about why she believes the respondent’s adjusting practices amount to a “conflict of interest”. The applicant has the onus to show why she is entitled to a reconsideration, and I find she has not met this onus.
21Finally, I note that the applicant’s reconsideration reply restated many of the same arguments she made in her amended request for reconsideration. However, she did add that the decision was “unconstitutional”. She also claims that the Tribunal did not consider how the Human Rights Code, R.S.O. 1990, c. H.19 applied to the dispute. Aside from the fact that parties are expected to present all the grounds that they are seeking to rely upon in their initial reconsideration submissions, the applicant did not provide a persuasive explanation to support these allegations.
22Taken together, I am dismissing the applicant’s request for reconsideration, including all the forms of relief she is seeking as part of this request.
COSTS REQUEST
23I do not find the applicant has met the threshold necessary for ordering costs.
24Rule 19.1 states that the Tribunal may award costs when “another party in a proceeding has acted unreasonably, frivolously, vexatiously, or in bad faith”. The party requesting costs has the onus to demonstrate such an order is merited.
25I find the applicant has not established that the respondent’s behaviour merits an order for costs. The applicant only states in her reconsideration submissions that she is seeking costs, because she “believes that another party in a proceeding has acted unreasonably, frivolously, vexatiously, or in bad faith”. This brief statement is insufficient to merit a costs order under Rule 19.1.
CONCLUSION & ORDER
26The applicant’s request for reconsideration is dismissed.
27The applicant’s costs request is dismissed.
Craig Mazerolle
Vice-Chair
Released: December 18, 2025