Reconsideration Decision
Before: Emily Morton
Licence Appeal Tribunal File Number: 22-010097/AABS
Case Name: Sasa Puhalo v. The Personal Insurance Company
Written Submissions by:
For the Applicant: Maziar Mortezai, Counsel
For the Respondent: Aly Pabani, Counsel
Overview
1On November 21, 2024, the applicant requested a reconsideration of the Tribunal’s decision dated November 12, 2024 (the decision).
2In the decision, I concluded that the applicant had not met his burden of establishing his injuries fell outside of the Minor Injury Guideline (MIG). I also found that the applicant was not entitled to the treatment plans in dispute, interest, or an award, and that the respondent had complied with the notice requirements under s. 38(8) of the Statutory Accident Benefits Schedule – Effective September 2010 (including amendments effective June 1, 2026) (Schedule).
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.
4In this matter, the applicant seeks a reconsideration of the decision pursuant to s. 18(b) of the Rules on the basis the Tribunal made an error of law or fact by failing to find the respondent did not comply with s. 38(8) of the Schedule, and thus failing to apply the consequences of s. 38(11) based on binding jurisprudence. The applicant requests that the Tribunal grant its request for reconsideration and make an order prohibiting the respondent from taking the position the applicant’s injuries fall within the MIG due to non-compliance with s. 38(8). Alternatively, the applicant seeks an order vacating the decision and ordering a new hearing on all or some issues identified in the initial application to this Tribunal before a different adjudicator.
5The respondent submits the applicant’s bases for a reconsideration amount to a revisitation of the same arguments raised in the application and that the decision properly considered and applied the relevant legislation and jurisprudence. The respondent asks this request for reconsideration be dismissed.
Result
6The applicant’s request for reconsideration is dismissed.
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. The applicant here bases the reconsideration request under Rule 18.2(b) only.
8While the applicant identifies two issues in its submissions, they essentially relate to the same question: whether I erred in fact or law in the interpretation of the notice requirement of s. 38(8) of the Schedule in the decision.
9First, the applicant submits that I erred by failing to apply the consequences of s. 38(11) of the Schedule after finding the three denial letters at issue were largely generic and identical. While I agree I found the letters were largely generic and identical, I found they complied with s. 38(8) of the Schedule and, therefore, the consequences of s. 38(11) were not triggered. Here, the applicant does not point to any errors but is rather disagreeing with my findings which is not a basis for a reconsideration.
10Second, the applicant submits that I erred by failing to consider and apply the Divisional Court decision in Hedley v. Aviva Insurance Company of Canada, 2019 ONSC 5318 (Hedley). The applicant argues that because I identified the three denial letters as largely identical or generic in their language, the decision conflicts with the decision in Hedley at paragraph 18 that “[m]ere boilerplate statements do not provide a principled rationale to which an insured can respond. In essence, such statements constitute no reasons at all.” The applicant also asserts that I erred in law as I did not “apply, review, or otherwise consider” Hedley in the decision.
11The respondent submits that I directly referred to Hedley in my decision and that the applicant’s submissions on this point in its reconsideration request amount to an attempt to relitigate the application of the same principles.
12I do not agree the treatment of Hedley in the decision amounts to an error of law. The applicant’s considerations suggest the reasons for the decision are deficient or amount to error due to a failure to “summarize” the Hedley decision. The applicant provided no support for his submission that an adjudicator is required to “summarize” leading jurisprudence in its reasons. I refer to Hedley in the decision and my reasons go on to hold the insurer met the requirement of Hedley that insurers not provide “mere boilerplate statements” to which an applicant cannot respond. I found that requirement was met, despite the use of identical or what I called “generic” language among the three letters at issue, as each letter was sufficient as it cited a medical reason for denial, the applicability of the MIG.
13The applicant also refers to the tribunal’s decision in Kwan v. Aviva General Insurance Company, 2024 CanLII 94316 (Kwan) as an example of “other decisions of this Tribunal” that have “considered, outlined, and applied the Hedley principles” and reached a finding the notice at issue in that case was insufficient for the purpose of. s. 38(8) of the Schedule. The applicant further refers to Goldsmith v. The Personal Insurance Company, 2024 ONLAT 22-0101011/AABS (Goldsmith) which is a decision released after the decision under consideration here, and which arises from the same motor vehicle accident at issue. Respectfully, I am not bound by other Tribunal decisions. The applicant is not pointing to any errors. Rather he disagrees with my findings regarding the denial letters which it is open for him to do but is not a basis for a reconsideration.
14I agree with the respondent that I am not bound by these two tribunal-level decisions now relied on by the applicant in support of its reconsideration request. The argument related to Kwan is new argument, albeit related to a decision released after the parties filed their submissions on the application. The applicant seeks to relitigate the issue of whether the denial was sufficient by reference to a single decision of the tribunal, which is not binding on me, and which relates to different facts and considerations than those engaged by the present case.
15The adjudicator in Goldsmith reached a different conclusion than I reached in the present decision, after applying the principles in Hedley and considering the content of the denial letters at issue in that case. In Goldsmith, the adjudicator placed greater weight on the identical language used among the denial letters at issue and gave greater emphasis to the fact the letters referred to the “medical file” without a specific reference to the information included. In the decision at issue, after referring to the relevant legislation and the precedent in Hedley, I found the denial letters were sufficient, notwithstanding the use of generic or identical language to deny the treatment plans at issue. I rejected the submission accepted by the adjudicator in Goldsmith that the mere use of identical language among the three denials was fatal to their sufficiency based on the requirements of s. 38(8), as interpreted by the court in Hedley. In citing Goldsmith, the applicant has not raised a legal error in the decision being reconsidered.
16For the reasons given above, I find that the applicant did not prove on a balance of probabilities that I erred in fact or law such that a reconsideration is warranted under Rule 18.2(b).
Conclusion & Order
17The applicant’s request for reconsideration is dismissed.
Emily Morton Adjudicator Tribunals Ontario – Licence Appeal Tribunal
Released: March 6, 2025