RECONSIDERATION DECISION
Before: Melanie Malach, Adjudicator
Licence Appeal Tribunal File Number: 23-012463/AABS
Case Name: Donna Matthews v. Intact Insurance Company
Written Submissions by:
For the Applicant: Donna Matthews, Applicant Robin Russell, Applicant’s Spouse
For the Respondent: Doug Wallace, Counsel
OVERVIEW
1On May 15, 2025, the applicant requested reconsideration of the Tribunal’s decision dated April 24, 2025 (“decision”).
2Stemming from an accident on August 1, 2014, the applicant sought benefits under the Statutory Accident Benefits Schedule – Effective September 1, 2010 (the “Schedule”). Following a written hearing, I found that with respect to the preliminary issue in dispute, the Tribunal does not have jurisdiction under s. 280 of the Insurance Act, R.S.O. 1990, c. 1.8, with respect to the applicant’s entitlement to $45,054.65, which is the balance of the $50,000.00 policy limit.
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 criteria cited by the applicant in support of her reconsideration request is Rules 18.2(a), (b) and (c).
5The applicant is requesting that an order be granted reversing my decision.
6The respondent opposes the request for reconsideration.
RESULT
7The applicant’s request for reconsideration is dismissed.
ANALYSIS
Rule 18.2(a) – The Tribunal did not commit a material breach of procedural fairness
8I find that the applicant has not established that I committed a material breach of procedural fairness, in accordance with Rule 18.2(a).
9The applicant submits that there are factual inaccuracies in my decision and therefore I committed a material breach of procedural fairness. She claims that the preliminary issue in dispute as stated in the Case Conference Report and Order (“CCRO”), dated February 22, 2024, is not the issue raised by either her or the respondent in their Case Conference Summaries. She submits that I only dealt with the issue stated in the CCRO and I did not deal with the contents of her submissions. She submits that her entire appeal is about bad faith which has not been addressed in my decision.
10The respondent submits that the description of the issues in the CCRO are accurate, and they were the decision of the Case Conference adjudicator.
11While neither party raised the Divisional Court decision in Intact Insurance Company v. Lanziner-Brackett, 2018 ONSC 6546, I am bound by it. The Court held that it is a breach of procedural fairness for the Tribunal to unilaterally alter the issues that were agreed to on consent at a Case Conference.
12The CCRO identifies the preliminary issue in dispute as follows:
Does the Tribunal have jurisdiction under s. 280 of the Insurance Act RSO 1990 with respect to the applicant’s entitlement to $45,054.65, which is the balance of the $50,000.00 policy limit?
13At paragraph 2 of the CCRO, the adjudicator confirms that, “the parties participated in a case conference during which I issued the following orders. Unless noted below, all orders were made on consent, and were issued orally to the parties during the case conference with immediate effect.”
14Prior to filing her submissions, the applicant was in receipt of the CCRO, as it was sent to all parties on February 22, 2024. The CCRO clearly sets out the preliminary issue in dispute, and that the parties consented to the orders made at the Case Conference. To the extent that the applicant disagreed with the characterization of the preliminary issue, it was open to her to file a motion to amend or clarify the issue. She did not do so.
15I further note that the applicant in her preliminary issue submissions addressed the preliminary issue as noted in the CCRO. As such I relied upon the issues stated in the CCRO and both parties’ submissions in rendering my decision.
16For these reasons, I do not find that the applicant has shown a material breach of procedural fairness such that a reconsideration is warranted under Rule 18.2(a).
Rule 18.2(b) – The Tribunal did not commit an error of law or fact
17I find that the applicant has not established that I committed an error of law or fact, in accordance with Rule 18.2(b).
18The applicant submits that I made errors of law or fact which impacted my analysis. Specifically, the applicant submits that I erred by:
a. Finding no issues in dispute;
b. Improperly addressing substantive issues related to the quantum of benefits; and
c. Not considering the reply submissions when rendering my decision.
19The applicant submits that I erred in fact and law in my findings at paragraph 14 and 16 of my decision where I found that the Tribunal lacked jurisdiction to grant the applicant entitlement to the balance of the remaining medical and rehabilitation limits.
20At paragraph 14 of my decision, I found that:
In the matter before me there are no treatment plans in dispute and there is no other benefit in dispute, that has been denied by the respondent. Therefore, there is no dispute with respect to the applicant’s entitlement to a statutory accident benefit or in respect of the amount of that statutory accident benefit.
21At paragraph 16 of my decision, I note that:
While there was a dispute about entitlement to a treatment plan at the time of the applicant’s application, this issue was resolved at the Case Conference and was no longer in dispute or listed as an issue in dispute. The Tribunal can only deal with the issues before it. As this issue is not listed on the Case Conference Report and Order, it is not before me.
22The applicant submits that there was a treatment plan in dispute at the time she filed her application. She relies upon the decision in 17-001937 v. Primmum Insurance Company, 2018 CanLII 140991 (ON LAT) (“17-001937 v Primmum”), which states at paragraph 8,
In my view, there must be a dispute at the time of application. The Tribunal’s jurisdiction over a matter is determined as of the date upon which the Notice of Application for Dispute Resolution is first filed with the Tribunal. If, at the date, there is a dispute over entitlement to or the quantum of a benefit, then the tribunal has jurisdiction.
23The applicant submits that at the time she filed her application, there was a dispute and therefore the Tribunal has jurisdiction over the matter. The applicant submits that at the Case Conference, the respondent attempted to use the approval of the treatment plan as a way to have the Tribunal dismiss the whole appeal. The applicant further submits that the amount of entitlement to medical and rehabilitation benefits is a matter for a substantive hearing, and it should not be considered under the preliminary issue hearing.
24The respondent submits that I considered the treatment plan in my decision, and I correctly noted that the issue was resolved at the Case Conference. The respondent submits that the decision in 17-001937 v. Primmum is distinguishable, because in that case, entitlement to income replacement benefits (“IRBs”) remained an issue in dispute at the Case Conference. Therefore, notwithstanding that IRBs were paid in advance of the hearing, interest remained in dispute. The respondent further submits that I am not bound by other Tribunal decisions.
25I agree with the respondent that I am not bound by previous Tribunal decisions. I further agree that the decision in 17-001937 v. Primmum is distinguishable from the present case, as this earlier decision dealt with ongoing entitlement to IRBs. In the decision before me, we are dealing with a treatment plan that was in dispute at the time of the application, but was subsequently resolved at the Case Conference. There was no disputed treatment indicated in the CCRO, and the applicant’s only claim was for entitlement to the remaining medical and rehabilitation benefits. As stated in my decision, there is no treatment plan in dispute that has been denied by the respondent. Therefore, there is no dispute with respect to the applicant’s entitlement to a statutory accident benefit or in respect of the amount of that statutory accident benefit.
26I further agree with the respondent that I did not address or determine any substantive issues in dispute in my decision. As my findings with respect to the preliminary issue determined that the Tribunal did not have jurisdiction over the matter, I had no jurisdiction to deal with the substantive issues in dispute. At paragraph 15 of my decision, I found:
I further find that the applicant has not identified any provision in the Schedule or other authority in support of its proposition that an insured person is entitled to funds up to the limits of funding for medical and rehabilitation benefits, without reference to a specific claim for benefits. The funding limits are not a benefit under the Schedule, and the Schedule does not contemplate such a payment.
27I further find that despite the applicant’s assertion that I did not consider her reply submissions when rendering my decision, all submissions of the parties were considered.
28I find that the applicant’s submissions are an attempt to re-litigate her position and the weight assigned to the evidence because she disagrees with the Tribunal’s decision.
29For these reasons, I find that the applicant has not demonstrated that I erred in fact or law in my decision such that I would likely have reached a different result had the error not been made. As a result, the applicant’s request for reconsideration under Rule 18.2(b) is dismissed.
Rule 18.2(c) – The applicant has not provided new evidence that would likely have affected the result of my decision
30I find that the applicant has not established grounds for reconsideration based on Rule 18.2(c).
31There are three components that a party requesting reconsideration under Rule 18.2(c) must satisfy. First, there must be evidence not before the Tribunal when rendering its decision. Second, the party must demonstrate that the evidence could not have been previously obtained. Third, the party must show that the new evidence would likely have affected the result.
32The applicant submits that there is new information that she did not have until February 25, 2025, after the date of the hearing, namely the adjuster’s file. She submits that this evidence demonstrates that she did not receive notice when the file handling adjuster changed. The applicant submits that she has been treated badly by the respondent, which is evident in the adjuster’s log notes. This behaviour has made it difficult to bring her appeal. She further criticizes the Case Conference adjudicator and the Tribunal for their rulings with respect to document exchange. She also has made submissions that the approved treatment plan is outstanding.
33The respondent submits that this new evidence would not have had any effect on the outcome of this decision. The respondent submits that the Tribunal properly considered whether it had jurisdiction with respect to the applicant’s entitlement to the balance of the policy limit. The respondent submits that the new evidence is not relevant to that issue.
34While I accept that adjuster’s file was not before the Tribunal when I rendered my decision, I find that the applicant has not established that this evidence would likely have affected the result of the decision on the preliminary issue. I agree with the respondent that the fact that the applicant was not notified of the change to the adjuster, is not relevant to the preliminary issue and did not impact her ability to bring the claim. In addition, the applicant’s complaints about the orders made by the Case Conference adjudicator and the Tribunal, are not evidence, but rather a disagreement with the procedural orders made by the Tribunal and not a proper ground for reconsideration under Rule 18.2(c).
35In addition, while the applicant submits that there is an outstanding payment for the approved treatment plan, as this issue was no longer listed as an issue in dispute in the CCRO and therefore was not before me, I do not have the jurisdiction to deal with the treatment plan or arguments made that it has not been paid.
36For these reasons, I find that the applicant has not demonstrated that the new evidence would likely have affected the result of my decision. As a result, the applicant’s request for reconsideration under Rule 18.2(c) is dismissed.
CONCLUSION & ORER
37The applicant’s request for reconsideration is dismissed.
Melanie Malach Adjudicator Tribunals Ontario – Licence Appeal Tribunal
Released: July 30, 2025