RECONSIDERATION DECISION
Before: Craig Mazerolle, Vice-Chair
Licence Appeal Tribunal File Number: 23-011141/AABS
Case Name: Hiam Rida v. Wawanesa Insurance
Written Submissions by:
For the Applicant: Wayne Fryer, Counsel
For the Respondent: Morgan MacDonald, Counsel
OVERVIEW
1On October 16, 2025, the applicant requested reconsideration of the Tribunal’s decision released September 29, 2025 (“decision”).
2Stemming from an accident on November 3, 2011 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 decision, the Tribunal found the applicant was entitled to a treatment plan for occupational therapy and two OCF-6s for craft supplies, plus interest. The Tribunal denied the applicant’s claims for an attendant care benefit (“ACB”), an assistive devices treatment plan, OCF-6s for prescription medication and housekeeping services, and 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) to support her request. She takes issue with all the denials, save for the assistive devices treatment plan.
5The respondent asks the Tribunal to dismiss the request. It also seeks costs.
RESULT
6The applicant’s request for reconsideration is granted, in part.
7Pursuant to Rule 18.4, part of the dispute will be sent to a rehearing, namely, the ACB and the related claims for an award and interest. The remaining findings from the decision are confirmed.
8The respondent’s request for costs is dismissed.
ANALYSIS
9The 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.
Rule 18.2(a) and Rule 18.2(b) – ACB and Economic Loss
12The applicant raises several issues with the Tribunal’s handling of her claim for an ACB. Chief among these issues was the applicant’s position that the Tribunal erred in its assessment of her daughter’s alleged economic loss. Though the decision correctly identified the need for these services to be “incurred” in accordance with the Schedule, the applicant argues the Tribunal overlooked affidavit evidence that showed how her daughter experienced employment and educational losses on account of providing this care.
13Relatedly, the applicant submits that the Tribunal did not provide adequate reasons to explain why this evidence did not satisfy her onus. For instance, the applicant claims there is no explanation for why transportation costs incurred by the attendant were not found to be economic losses. The applicant also alleges that the decision does not contain “any analysis as to why the foregone tuition and other educational related expenses do not constitute an economic loss in this case”.
14The respondent disputes the applicant’s allegation that the Tribunal erred in its assessment of the ACB, arguing that it correctly dismissed her submissions about lost expenses. Not only is this finding in line with established case law, but, according to the respondent, the Tribunal accurately determined that her daughter’s educational and employment expenses “were not causally connected to the provision of care.” It also claims that the Tribunal’s finding that there were no invoices, receipts, etc. showing that the daughter had rendered these services was “fatal” to the ACB claim.
15Turning to the argument about the Tribunal’s reasons, the respondent disputes the applicant’s position that the decision only contains one paragraph of analysis about the ACB, i.e., paragraph 19. Pointing to paragraphs 7 – 20 of the decision, the respondent claims the Tribunal met the standard for adequate reasons from Canada (Minister of Citizenship and Immigration) v. Vavilov, 2019 SCC 65 (“Vavilov”).
16Procedural fairness is premised on the principle that parties affected by a decision have the right to be heard during the decision-making process. Though parties may be afforded ample opportunities to participate in the hearing (be it through their submissions, motions, etc.), the final decision is often the primary vehicle that a decision-maker uses to show the parties that they were, in fact, heard. Reasons allow the parties to see how their arguments and evidence impacted the outcome of the decision.
17The Supreme Court of Canada has repeatedly recognized the importance of reasons. For instance, the Supreme Court noted in Vavilov that reasons ensure the fairness and legitimacy of administrative decision-making (at paragraph 79, citations removed):
Reasons explain how and why a decision was made. They help to show affected parties that their arguments have been considered and demonstrate that the decision was made in a fair and lawful manner. Reasons shield against arbitrariness as well as the perception of arbitrariness in the exercise of public power…
18In Baker v. Canada (Minister of Citizenship and Immigration, 1999 CanLII 699 (SCC) (“Baker”) at paragraph 39, the Court ruled that reasons allow decisions to be questioned: “Reasons… are invaluable if a decision is to be appealed, questioned, or considered on judicial review”.
19Considering these principles, I find the applicant has shown the Tribunal did not adequately grapple with the key ACB arguments presented by the parties. As such, she has established a material breach of procedural fairness, pursuant to Rule 18.2(a).
20The core of the Tribunal’s ACB analysis can be found in two sections. First, at paragraphs 12 + 13, the Tribunal states that the applicant has not pointed to specific details about what “services or goods” her daughter has provided:
The applicant’s submissions do not address what goods or services were provided or what prong of s. 3(7)(e) the benefits were incurred under. The applicant’s submission is mostly focussed on whether the ACBs are reasonable and necessary and should be deemed incurred.
The applicant has not pointed me to evidence of what goods or services were provided by way of invoices, promissory notes, level of care or the rate of care. Neither the daughter’s or the applicant’s affidavit provide details of services or goods provided, nor details such as the allotted time for any of the services.
21Then, after turning its attention to whether the applicant had established an economic loss, the Tribunal detailed the parties’ positions, the legal test, its analysis, and its conclusion at paragraphs 16 – 20. Of note, paragraphs 16 + 19 provide the clearest articulation of the Tribunal’s chain of reasoning:
The applicant argues she sustained an ongoing economic loss due to foregoing law school education and future paid employment. The applicant relies on Simser v. Aviva Canada and FSCO, 2015 ONSC 2363 [(“Simser”)], stating that “the term “economic loss” may properly include an opportunity cost.” The applicant states she reduced her hours and her lost wages for December 1, 2022 to January 3, 2025 amount to $19,142.56. The applicant relies on her daughter’s student employment offer, pay stubs, and refers to the tentative graduation date had she successfully completed her program in the United Kingdom.
The applicant’s affidavits do not provide specific evidence that the goods and services were provided in the course of employment, or that she suffered an economic loss as a result of providing the services. I was not directed to evidence of a promise to pay for the expenses. Furthermore, I was not directed to evidence to support the first two parts of the test, and the evidence of tuition is not evidence of goods or services for the purposes of ACBs. I am not persuaded of this being an economic loss. The applicant relies on [Simser], however, the distinguishing feature here is that the applicant did not demonstrate what actual employment wages or employment opportunity was foregone.
22The main thrust of the Tribunal’s analysis is, therefore, twofold. On the one hand, the Tribunal found the applicant’s evidence was not detailed enough to show what services were provided by her daughter, including the level or rate of this care. Then, on the question of economic loss, the Tribunal was not satisfied that the daughter’s lost educational and employment opportunities met the standard set out by the Schedule and Simser.
23I find this analysis does not grapple with the case at hand.
24First, while the respondent correctly notes that a lack of evidence about the rate and type of attendant care services may be “fatal” to an ACB claim, this question was not in dispute during the hearing. After reviewing the parties’ written hearing submissions, I am satisfied that their arguments about the ACB were focused on whether the applicant’s daughter experienced an economic loss. For instance, over the course of three pages in its responding submissions, the respondent addressed the ACB by laying out why it believed the daughter’s alleged economic loss was not connected to the provision of her mother’s care. It also challenged the reliability of her affidavit, including what it saw as uncorroborated claims of curtailed employment opportunities.
25While the respondent presented concerns about the veracity and relevance of the daughter’s economic loss, there is no explicit reference to a lack of invoices and receipts, nor did it challenge the amount of detail the applicant had provided about the attendant care she was receiving. By addressing an aspect of the ACB that was not in dispute, the Tribunal has not shown, in the words of Vavilov, the “affected parties that their arguments have been considered”.
26Second, I do not find the Tribunal’s analysis of the daughter’s economic loss adequately grapples with the arguments and evidence presented by the applicant. As noted above, a key aspect of the applicant’s case was the affidavit from her daughter. This affidavit listed a series of expenses she allegedly incurred or forfeited due to her mother’s care, e.g., tuition fees, rental expenses, travel costs, etc.
27As quoted above, the Tribunal dismissed this key aspect of the applicant’s claim at paragraph 19:
… I am not persuaded of this being an economic loss. The applicant relies on [Simser], however, the distinguishing feature here is that the applicant did not demonstrate what actual employment wages or employment opportunity was foregone.
28It is well-established that adjudicators are not expected to address every document and submission presented during a hearing, nor are they expected to go into granular detail about every step along their analytical chain of reasoning. Rather, to meet the standard set out in Vavilov and Baker, an adjudicator’s reasons must show they have grappled with the parties’ key evidence and arguments. Furthermore, again in the words of Vavilov, reasons must “explain how and why a decision was made.”
29When reviewing the reasoning provided, namely, the analysis conducted at paragraph 19, I am not clear on how and why the Tribunal dismissed the daughter’s alleged economic loss. Though the Tribunal accurately laid out the parties’ positions and the legal test for determining if there is an economic loss, I find its application of these arguments and evidence to the test does not allow a reader to understand how and why this conclusion was reached.
30For instance, considering the centrality of Simser to the applicant’s position, more detail was needed to help her understand why this binding case was distinguishable from the present set of circumstances. Relatedly, a more fulsome explanation for why her evidence “did not demonstrate what actual employment wages or employment opportunity was foregone” would have been helpful as well. Then, while the Tribunal mentioned the lost wages and educational expenses, there is no discussion about the daughter’s rental costs or travel expenses.
31Taken together, while the respondent claims these reasons met the standard laid out in Vavilov, I respectfully disagree. Rather, I find the applicant has established a material breach of procedural fairness, pursuant to Rule 18.2(a). For this reason, I do not find I need to address the parties’ arguments about the ACB under Rule 18.2(b).
Rule 18.2(b) – OCF-6s for Housekeeping Services and Medications
32The applicant raises several alleged errors with the Tribunal’s denial of the OCF-6s for housekeeping services and prescription medications. First, the applicant claims that the respondent did not respond to either of these OCF-6s, nor did it address them in its written submissions. This lack of a response is particularly important for the housekeeping services, as s. 36(6) of the Schedule holds that a failure to respond to a claim for a specified benefit within ten business days will require payment.
33For the medications, the applicant further disputes the factual basis for the Tribunal’s denial, namely, its suggestion that she “did not provide contemporaneous medical evidence” to support this claim. By highlighting a case manager report (dated August 31, 2022) included with her written hearing submissions, the applicant submits that this finding is incorrect.
34Starting with housekeeping services, the Tribunal made the following finding at paragraph 45: “The applicant has not directed me to the OCF-6 dated December 1, 2022 for the disputed issue of housekeeping services.” The applicant did not directly address this missing OCF-6 in her reconsideration submissions, but instead claimed:
The insured provided evidence that the insurer failed to respond by way of an email to the adjuster. The respondent provided no evidence whatsoever, and did not dispute the authenticity of the email or attempt to defend this conduct. The issue would not have proceeded to a written hearing without an OCF-6.
35I do not agree. The applicant maintains the onus to show that she is entitled to payment of the services, and part of this onus is met by providing the Tribunal with a copy of the document forming the basis for the claim. Even if the respondent did not dispute this part of the applicant’s case, the onus remained with her. Further, I note that s. 36(6) of the Schedule was not raised by the applicant during the written hearing, and parties are generally discouraged from introducing new arguments on reconsideration.
36For the medications, I do not find the applicant has established an error, pursuant to Rule 18.2(b). Aside from the fact that the onus remains with the applicant to show that she is entitled to this OCF-6, the applicant’s argument about the sufficiency of her medical records is an attempt to have the Tribunal re-weigh evidence addressed at first instance. As noted above, the reconsideration process is not a venue for parties to re-litigate positions and evidence dismissed during the hearing. I also note that, while the case manager’s report was cited in her initial written submissions, these references were made in relation to the disputed occupational therapy and craft supplies.
Rule 18.4 – Rehearing the ACB
37Considering the nature of the established Rule 18.2(a) breach, I find the most appropriate remedy under Rule 18.4 is to send the ACB back to be reheard by a new adjudicator. By not explicitly addressing key aspects of the parties’ positions, the Tribunal must provide a fresh assessment of this issue. However, to protect the interest of efficiency for both sides, I will order the new adjudicator to conduct this rehearing based on the evidence and submissions from the written hearing.
38I also note that the applicant briefly argued on reconsideration that she believes the respondent’s handling of the ACB merits an award. I am satisfied that, by sending the ACB back to be reheard, the award claim should also be reheard.
Costs Request
39I do not find the respondent has met the high threshold needed to order costs.
40Rule 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.
41I find the respondent has not established that the applicant’s behaviour merits costs, as it has not provided a basis for granting this order. Rather, the respondent only states in its submissions that it is seeking “costs on a full-indemnity basis”, pursuant to Rule 19.3. This brief statement is insufficient to merit a costs order.
42Further, Rule 19.3 permits the Tribunal to ask for written submissions when a party has made an oral request for costs. Considering the respondent’s costs request was made in writing, Rule 19.3 has no bearing.
CONCLUSION & ORDER
43The applicant’s request for reconsideration is granted, in part.
44Pursuant to Rule 18.4, part of the dispute will be sent to a rehearing, namely, the ACB and the related claims for an award and interest. The remaining findings from the decision are confirmed.
45The rehearing will be conducted by a new adjudicator. This adjudicator shall review the existing record, i.e., the submissions and evidence from the written hearing.
46I am not seized.
47The respondent’s request for costs is dismissed.
Craig Mazerolle
Vice-Chair
Released: December 17, 2025