RECONSIDERATION DECISION
Before:
Laura Goulet, Adjudicator
Licence Appeal Tribunal File Number:
23-003348/AABS
Case Name:
Anthony Okafor-Ogbujiagba v. Security National Insurance Company
Written Submissions by:
For the Applicant:
Georgiana Masgras, Counsel
For the Respondent:
Matthew Nieuwland, Counsel
OVERVIEW
1On May 13, 2025, the applicant requested reconsideration of the Tribunal’s decision dated April 22, 2025 (“decision”).
2In the decision, I found that the applicant was not entitled to two assessments, four OCF-6 expense claims, six treatment plans, an award or 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 is seeking a reconsideration pursuant to Rule 18.2(a) and (b). The respondent submits that the applicant’s request for reconsideration should be dismissed, with costs, if appropriate.
5The applicant is requesting that the Tribunal set aside the decision and order a rehearing on the matter, or in the alternative, that the Tribunal issue a new decision granting his claim for catastrophic impairment (“CAT”) based on the full evidentiary record.
6In an email dated May 13, 2025, addressed to the respondent and to the Tribunal, the applicant acknowledged that the issue of CAT had been withdrawn in advance of the hearing and was not in dispute.
RESULT
7The applicant’s request for reconsideration is dismissed.
8The respondent is not entitled to costs.
ANALYSIS
9The 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.
Rule 18.2(a) – The Tribunal did not commit a material breach of procedural fairness
10For the following reasons, I find that the applicant has not established grounds for reconsideration based on a material breach of procedural fairness.
11The applicant submits that I did not consider the entirety of his evidence, relying only on those portions specifically referenced, as the document brief did not include bookmarked tabs in accordance with the Tribunal’s filing requirements. The applicant further submits that, as a result, I did not review critical evidence that supported his position, which materially affected the outcome. The applicant argues that he provided detailed medical documentation and attempted to explain its relevance in his submissions. The applicant submits that to deny consideration of such evidence solely because of technical referencing issues undermines the fairness of the hearing, as procedural orders are meant to facilitate the process, and not to defeat a claim on technical grounds.
12The applicant also submits that I erred by failing to fully and properly consider the detailed evidence submitted by the applicant in support of his claim for CAT. The applicant argues that he filed a comprehensive document brief, including multiple medical reports, specialist assessments, and corroborating records, all of which addressed the statutory tests under the Schedule. The applicant further submits that, contrary to my conclusion, he did not simply submit documents as “tabs” without explanation, but that his submissions clearly referred to, summarized, and analyzed this evidence. The applicant goes on to submit that my finding that there was insufficient evidence fails to engage with the actual content and strength of the applicant’s evidence.
13The applicant further submits that written hearings place particular importance on the Tribunal’s careful and thorough review of all submitted evidence, and that my failure to fully consider his documented evidence, while crediting the respondent’s broad and unsubstantiated arguments, deprived him of a fair hearing.
14The applicant also argues that procedural fairness requires that the Tribunal meaningfully engage with the applicant’s case and evidence. The applicant submits that the decision does not demonstrate that I adequately reviewed his submissions and thus breached fundamental principles of natural justice.
15The respondent submits that my findings were based on a thorough review of the evidence referenced by the applicant, in accordance with Tribunal orders, and a correct application of the Schedule in addressing all issues in dispute. The respondent further submits that the decision systematically evaluated each claim, finding that the applicant did not meet his burden of proof due to insufficient or non-contemporaneous medical evidence and a lack of specific submissions. The respondent argues that the decision was grounded in the evidence properly before me, and the applicant’s failure to reference specific evidence, despite clear Tribunal orders, limited the scope of review. The respondent submits that my conclusions were reasonable and supported by the record.
16I find that I appropriately considered and referred to the applicant’s evidence in the decision.
17With respect to the two proposed social work services assessments, at paragraphs 15, 17 and 21 of the decision, I considered the progress report as referenced by the applicant which I found was authored by an individual who is not qualified to make psychological diagnoses, as well as the lack of corroborating medical evidence and the lack of submissions made by the applicant.
18In relation to the proposed plans for case management services, rehab support services and attendant care assessment plan, at paragraphs 26, 31, and 36 of the decision, I found that the applicant did not direct me to medical evidence to corroborate the proposed plans. In relation to the plan for vision therapy, at paragraphs 40 to 43, I considered the report that was submitted by the applicant, the applicant’s submissions, as well as the insurer’s examination report, and I provided reasons with respect to why I was persuaded by the respondent’s report.
19With respect to the plan for psychological services, at paragraphs 48 to 50 of the decision, I considered the report submitted by the applicant, the applicant’s submissions, as well as the lack of contemporaneous medical evidence in support of the plan. At paragraph 52, I found that the in-home assessment plan was not put in evidence, and the applicant’s submissions incorrectly referenced a different plan.
20With respect to the OCF-6s for eye care, health supplements and transportation, dental repairs, and an eye exam, at paragraphs 56, 60, 62, 65, and 66 of the decision, I based my findings on a lack of submissions by the applicant and/or the absence of medical evidence supporting the reasonableness and necessity of the OCF-6s.
21Although the applicant submits that I did not consider the entirety of his evidence, and that I did not review critical evidence that supported his position, he does not direct me to any of the evidence that I purportedly failed to consider. As indicated above, I find that I considered the applicant’s submissions and evidence, as presented in his written submissions. It is not the Tribunal’s task to make the case for the applicant by reviewing over four thousand pages of medical documents and finding those records that support his position, because doing so would cross into impermissible advocacy on behalf of one of the parties when it is the Tribunal’s place to be a neutral decision maker. Doing so would be procedurally unfair to the respondent, who crafted its arguments based on those made by the applicant, and not those the adjudicator may come to (see, e.g., Dooman v. TD Insurance Co., 2025 ONSC 184 at para 50 (Div. Ct.).
22For these reasons, I find that the applicant has not established grounds for reconsideration based on a material breach of procedural fairness, pursuant to Rule 18.2(a).
Rule 18.2(b) – The Tribunal has not committed an error of fact or law such that the Tribunal would likely have reached a different result had the error not been made
23For the following reasons, I find the applicant has not established grounds for reconsideration based on an error of fact or law.
24The applicant submits that I committed errors of fact and law that likely affected the outcome of the proceeding, particularly in the context of a written hearing where a full and fair review of the submitted evidence was critical.
25The applicant argues that I accepted the respondent’s generalized assertions over the applicant’s detailed, medically supported evidence, which constitutes an error of law and fact. The applicant submits that I heavily relied on insurer examination reports, to the near exclusion of treating professionals’ opinions, resulting in a failure to weigh the evidence fairly and reasonably. The applicant further submits that the findings were not balanced, and I appear to have favored one set of evidence over another without sufficient explanation. The applicant argues that, in a written hearing, where the record consists entirely of the filed documents, the Tribunal has a heightened responsibility to assess the substance of the evidence submitted, rather than simply weighing the parties’ conclusions.
26The applicant further submits that the errors identified above - misapprehension of evidence, improper evidentiary weighing, and breach of procedural fairness - were material to the outcome of the proceeding. The applicant argues that, had I properly assessed his evidence in the manner required, I would likely have reached a different conclusion regarding CAT.
27The applicant also submits that I erred in finding that the evidence was insufficient to support the treatment plans and expense claims. The applicant argues that his submissions did reference and discuss relevant medical records and assessments, many of which directly supported the claims in issue.
28The applicant also submits that I misapprehended or overlooked specific documents that were part of the record. Specifically, some treatment plans and assessments were described in the written submissions, but they were disregarded on the basis that they were not properly cited by tab and page number. The applicant argues that this approach resulted in the exclusion of probative evidence, which was not warranted, especially in a written hearing, where the opportunity to clarify or explain the evidence orally does not exist.
29The applicant generally submits that reconsideration is warranted to correct significant errors in the Tribunal’s decision and to uphold the principles of fairness and justice.
30The respondent submits that the applicant was afforded procedural fairness throughout the process. The respondent further submits that the applicant had the opportunity to submit evidence and arguments, as evidenced by the 4,301-page document brief. The respondent argues that the fact that the applicant did not comply with Tribunal orders requiring specific references to evidence by tab and page number does not constitute unfairness by the Tribunal. The respondent submits that these Tribunal orders ensure an efficient and focused adjudication process, given the voluminous document brief. The respondent is of the view that I adhered to these orders, considering only the evidence properly referenced by the applicant, and that his choice not to bookmark, tab, or index the document brief, or to provide page references, was within his control and does not reflect a procedural defect.
31Despite references to CAT in his reconsideration submissions, I note that the applicant has since acknowledged that the issue of CAT was not in dispute at the written hearing.
32I find that, although the applicant submits that I appear to have favored the respondent’s evidence over his, without sufficient explanation, he does not provide any examples from the decision to substantiate this claim. Further, the applicant does not point to any part of the decision where I weighed the parties’ conclusions rather than assessing the substance of their evidence.
33In addition, although the applicant submits that I erred in finding that the evidence was insufficient to support the treatment plans and expense claims and argues that his submissions did reference and discuss relevant medical records and assessments, he does not direct me to any examples from his submissions to support this claim. Finally, although the applicant submits that I misapprehended or overlooked specific documents that were part of the record, alleging that some treatment plans and assessments were described in the written submissions, but were disregarded on the basis that they were not properly cited by tab and page number, he does not provide examples to substantiate this. Further, these arguments appear to be a request to re-weigh factual findings made in the decision, which is not the purpose of a reconsideration.
34For these reasons, I find that the applicant has not established grounds for reconsideration based on an error of fact or law, pursuant to Rule 18.2(b).
35As noted above, the applicant – as the party requesting reconsideration – has the onus to show that one of the criteria under Rule 18.2 has been met. I find he has not met this onus. Accordingly, the applicant’s request for reconsideration is dismissed.
Costs
36I find that the respondent is not entitled to costs.
37Rule 19.1 states that where a party believes that another party in a proceeding has acted unreasonably, frivolously, vexatiously or in bad faith, that party may make a request to the Tribunal for costs.
38Rule 19.5 outlines the relevant factors which should be considered by the Tribunal when determining whether to order costs and the amount of costs to be awarded, which include the seriousness of the misconduct, whether the conduct was in breach of a direction or order issued by the Tribunal, whether or not a party's behaviour interfered with the Tribunal's ability to carry out a fair, efficient, and effective process, prejudice to other parties, and the potential impact an order for costs would have on individuals accessing the Tribunal system. Rule 19.6 allows for a maximum of $1,000.00 for each full day of attendance at a motion, case conference or hearing.
39The respondent makes a request for costs, submitting that the applicant has not met the high threshold required for reconsideration.
40The respondent does not direct me to any evidence that the applicant has acted unreasonably, frivolously, vexatiously or in bad faith.
41For these reasons, I find that the respondent has not provided sufficient evidence to satisfy Rule 19.1, and its claim for costs is denied.
CONCLUSION & ORDER
42The applicant’s request for reconsideration is dismissed.
43The respondent is not entitled to costs.
Laura Goulet
Adjudicator
Tribunals Ontario – Licence Appeal Tribunal
Released: August 1, 2025