RECONSIDERATION DECISION
Before: Craig Mazerolle, Vice-Chair
Licence Appeal Tribunal File Number: 23-013356/AABS
Case Name: Pawan Bhayana v. BelairDirect Insurance Company
Written Submissions by:
For the Applicant: Jonathan Farine, Counsel
For the Respondent: Kristen Bailey, Counsel
OVERVIEW
1On October 20, 2025, the applicant requested reconsideration of the Tribunal’s decision released September 29, 2025 (“decision”).
2Stemming from an accident on April 8, 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 decision, the Tribunal found the applicant was held to the Minor Injury Guideline (“MIG”), and, as such, there was no need to determine whether the disputed treatment plans were reasonable and necessary. The Tribunal further dismissed the applicant’s claims for an award and 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. He is asking for an order finding he is removed from the MIG, and that the other issues in dispute will be re-heard by the Tribunal.
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, 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.
8The applicant raises several issues with the decision. First, the applicant claims the Tribunal erred in its handling of his family physician’s evidence. Dr. Geoffrey Forbes diagnosed the applicant with Chronic Pain Syndrome, but the Tribunal disregarded this diagnosis based on an earlier finding by this same doctor that the applicant had a disc bulge. According to the applicant, the disc bulge may have been caused by the accident (an argument he made during the hearing), and it was “an irrational inference” to claim that there could be no connection between these two elements. The applicant also highlights the March 21, 2023 note from Dr. Forbes where he connected the applicant’s lower back pain to the accident, yet the Tribunal incorrectly found the doctor had attributed this pain to his dancing. Finally, the applicant claims the totality of Dr. Forbes’s records supports the position that his back pain is accident-related.
9The Tribunal addressed the evidence from Dr. Forbes at paragraphs 10 – 12 of the decision:
I find that the CNRs of Dr. Forbes do not support the applicant’s claim that he suffers from chronic pain with functional impairment. While there is ongoing pain reporting in the CNRs, they are sporadic and are not referred to as chronic. Additionally, there are very few references to any functional impairment that the applicant is facing. For example, on April 12, 2022, Dr Forbes notes that a disc issue seems to be causing the back and some leg pain but does not associate this disc issue to the subject accident. On July 22, 2022, the CNRs note, “back pain has improved, but still notes sharp pain at time, doing core strengthening at physio and going to gym”. On November 21, 2022, the applicant reported pain that was associated with lifting weights, not the subject accident. On March 21, 2023 the lower back pain is attributed to “went dancing, got a bad pain flare for a month”. During this visit, the lower back pain that is attributed to dancing is also reported as the source of issues of pain at work, sleep issues, and limited activity.
Medical imaging in the CNRs by Dr. Forbes, including an MRI from June 3, 2022, found a mild broad-based disc bulge at the L3-4 and L4-5. L4-5 had an annular tear with paraspinal soft tissue unremarkable. The evidence also includes an X-Ray and Ultrasound of the applicant’s right hip from May 14, 2022, both of which provided the impression of normal examination.
I find that the letter submitted by Dr. Forbes on June 8, 2023, in which he diagnoses chronic pain related to the subject accident is contradictory to the notes in Dr. Forbes’ CNRs. In the letter, Dr. Forbes states, “chronic pain syndrome with referred burning pain in hands and feet as well as the back, hip, and neck pains. These is a direct result of the motor vehicle accident.” This is contradicted in the CNRs where Dr. Forbes states that the back pain was a result of a disc issue, not the subject accident. Dr Forbes further states “He has been unable to return to previous levels of physical activities e.g. the gym, housekeeping, cooking, social activities, and stopped, badminton, gym, and biking”, yet the CNRs note on multiple occasions that the applicant is actively attending the gym. There is also no mention in the CNRs of any issues with badminton, housekeeping, cleaning, or social activities that are attributed to the subject accident. As such, I put little weight on the letter of June 8, 2023 because the conclusion that “there is no doubt in my mind that the applicant’s condition is directly related to the subject accident” is not supported by the same doctor’s own contemporaneous CNRs.
10As noted above, the reconsideration process is not a venue for parties to request a re-weighing of evidence that was considered at first instance. Rather, to trigger Rule 18.2(b), the requesting party must show that there was a legal or factual error that would likely have impacted the outcome of the decision.
11I find the applicant’s arguments about Dr. Forbes’s diagnosis are largely an attempt to have the Tribunal re-weigh evidence that was considered at first instance. As the quotation above demonstrates, the Tribunal assessed the value of this diagnosis by seeing how it aligned with the doctor’s other records. This review was detailed and expansive in scope. The applicant may disagree with the results of this assessment (including what he sees as the “irrational inference” the Tribunal made about the disc bulge), but the Tribunal is entitled to make these determinations.
12I do recognize that the summary the Tribunal provided of Dr. Forbes’s March 21, 2023 note appears to be an incorrect reading of this record. While Dr. Forbes mentioned dancing as a reason for the “pain flare”, there was also a clear indication that he found the applicant’s pain was related to the subject accident.
13However, I do not find the applicant has shown how correcting this error would likely have impacted the result. As the quotation above demonstrates, the Tribunal conducted a comprehensive review of this evidence, and it found the bulk of the records from Dr. Forbes did not support the applicant’s MIG position, e.g., the sporadic nature of the pain complaints, minimal references to functional impairments, etc. Therefore, even if the Tribunal had the correct reading of this note, I do not find the applicant has shown how this one change would likely have outweighed all the other findings it made about this set of records.
14Second, the applicant claims the Tribunal erred in its determination that there was no need to assess the reasonable and necessary nature of the disputed treatment plans, as one of the plans was for catastrophic impairment assessments. Since funding for catastrophic assessments do not “come out of the monetary limits for medical and rehabilitation benefits”, the applicant argues that the Tribunal’s conclusion about the MIG had no bearing on whether he was entitled to this plan.
15The Tribunal addressed the disputed treatment plans, including the plan for catastrophic impairment assessments, at paragraph 22 of the decision: “As the applicant has been found to remain in the MIG, there is no need to conduct the reasonable and necessary analysis of the disputed treatment plans.”
16The Tribunal did not explicitly single out the catastrophic impairment assessments plan in this analysis, nor did the Tribunal account for the well-established fact that funding for these kinds of assessments is not linked to the funding limits set for medical and rehabilitation benefits. However, despite this oversight, I find the Tribunal’s conclusion is correct.
17To receive funding for catastrophic impairment assessments, an applicant has the onus to show that they are reasonable and necessary: see M.A-Y v. Coachman Insurance, 2021 CanLII 120920 (ON LAT).
18The applicant provided a detailed explanation in his written submissions for why he believed these assessments met the reasonable and necessary standard. For instance, the applicant claims his chronic pain condition has impaired many aspects of his life. He also points out that the 260-week mark post-accident is fast approaching, and I note that the OCF-18 form itself includes arguments in support of the reasonable and necessary nature of the plan.
19Yet, these arguments do not address a central finding made by the Tribunal in the decision—the applicant sustained predominately minor injuries. With this finding, there was no credible means for the applicant to then go on to establish that catastrophic assessments were necessary to evaluate his accident-related injuries. Briefly, if his injuries are not severe enough to remove him from the MIG, it is not necessary to then assess whether these same injuries are catastrophic in nature.
CONCLUSION & ORDER
20The applicant’s request for reconsideration is dismissed.
Craig Mazerolle
Vice-Chair
Released: December 16, 2025