RECONSIDERATION DECISION
Before: Craig Mazerolle, Vice-Chair
Licence Appeal Tribunal File Number: 23-007890/AABS
Case Name: Amal Khalaf v. Aviva General Insurance
Written Submissions by:
For the Applicant: Kelisa Reyes, Paralegal
For the Respondent: Maggie Morgan, Counsel
OVERVIEW
1On July 25, 2025, the applicant requested reconsideration of the Tribunal’s decision released July 4, 2025 (“decision”).
2Stemming from an accident on January 14, 2018 and a request for benefits made pursuant to the Statutory Accident Benefits Schedule – Effective September 1, 2010 (including amendments effective June 1, 2016) (“Schedule”), the parties participated in a written hearing. In the decision, the adjudicator found the applicant was entitled to one of the eight treatment plans in dispute, with interest. The adjudicator declined to order payment of the remaining seven plans, and she denied the request for an award and costs.
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 for reconsideration. She is seeking an order finding she is entitled to six of the seven denied plans, i.e., all but the plan for an orthopaedic assessment submitted on July 20, 2021.
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. 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.
8I find the applicant has not established a ground for reconsideration.
9The applicant alleges that the adjudicator made an error by choosing not “to afford the appropriate amount of weight to the S.38(8) deficiencies found in the Respondent’s denial letters.” Specifically, the applicant highlights what she sees as insufficient information about the insurer’s examinations (“IE”). The applicant also claims that the adjudicator’s weighing of her medical evidence—based primarily on the extent of her self-reporting—was “unreasonable, lacks procedural fairness, and fails to consider education and expertise” of the practitioners. Additionally, the applicant notes that concerns about inconsistencies in her self-reporting should have accounted for the memory issues that are “common after head trauma”. The applicant then claims that there is no need to be diagnosed with a neurological impairment to conclude that a treatment plan for a neurological assessment is reasonable and necessary. Finally, the applicant submits that the adjudicator erred in her treatment of the evidence from Drs. Andre Douen and Galit Kleiner.
10Though the applicant selected both Rule 18.2(a) and Rule 18.2(b) to support her request, these grounds largely involve alleged errors, not procedural fairness. For instance, the one specific reference to an alleged breach of procedural fairness involves the weight assigned to certain medical evidence. There is no explanation of how this weighing constitutes a material breach of procedural fairness. As such, I have focused my analysis on Rule 18.2(b).
11First, I find the applicant’s argument about s. 38(8) of the Schedule is a request to reconsider an argument made at first instance. The adjudicator provided an extensive and detailed analysis of the respondent’s denial letters in the decision, and this analysis included an assessment of the applicant’s arguments that there was missing IE information. The applicant has not identified any specific errors in this analysis, but rather she takes issue with the result. Disagreement alone is not sufficient to engage Rule 18.2(b).
12In a similar vein, I find the applicant’s arguments about the handling of her medical evidence is another attempt to reconsider arguments and evidence that have already been evaluated. The applicant argues that the adjudicator focused too heavily on her self-reporting when weighing the opinions of Drs. Mehdiratta, Ivswarya Mani Bhaskar, Mohamed Abunaji, neurologists, and Linda C. Johnson, nurse practitioner. Specifically, she highlights paragraph 65 of the decision:
I find that the applicant has not provided sufficient evidence to suspect that she has a neurological impairment, which would warrant investigation. First, I place very little weight on Dr. Mehdiratta Dr. Ivswarya Mani Bhaskar, neurologist, Dr. Mohamed Abunaji, neurologist and Ms. Linda C. Johnson, nurse practitioner, diagnoses of post-concussion syndrome, chronic migraines, head injury, post traumatic vestibulopathy, loss of smell and taste, head injury and mood and sleep disturbance because they relied heavily on the applicant’s self-reporting and were unaware that the applicant was inconsistent about losing consciousness following the accident. I find that the applicant was inconsistent with her self-reported loss of consciousness because in the evidence most contemporaneous to the date of the accident, she reported no loss of consciousness. Indeed, in both the ambulance call report and CNR of March 20, 2018 of Dr. Spencer, the applicant reported no loss of consciousness, and the first time the applicant reported that she loss consciousness from the accident was not until November 7, 2018 (11 months following the accident) to Dr. Abunaji.
13I see no issues with this focus on the perceived inconsistencies in the applicant’s reporting to these medical practitioners, as the adjudicator was entitled to consider and assign weight to this evidence as she saw fit. I then note that her analysis of several of these opinions also went on to consider the results of the practitioners’ examinations (at paragraph 66): “Second, the results of the objective neurological examinations conducted by Dr. Mehdiratta, Dr. Abunaji and Ms. Johnson were normal with the exception that Dr. Abunjai noted the applicant could not smell the coffee in either nostril.” The applicant is entitled to disagree with the outcome of the adjudicator’s analysis, but—unless she can identify a specific legal or factual error in this assessment—she has not met the test to engage Rule 18.2(b).
14I also note that the applicant’s position that the adjudicator must account for her memory issues when assessing the consistency of her self-reports was not presented as an argument during the written hearing. Parties are expected to present their full cases during the initial hearing, as new arguments will not generally be considered on reconsideration.
15Turning to the adjudicator’s denial of the neurological assessment treatment plan, I again find the applicant has not established an error that would likely have led to a different result. The applicant claims that the adjudicator erroneously required there to be a diagnosis of a neurological impairment to meet the reasonable and necessary test for this plan—a diagnosis that would have removed the need for a neurological assessment in the first place. I find the applicant’s understanding of this part of the decision is a narrow reading of the adjudicator’s reasoning.
16The focus of the applicant’s submissions appears to be the following phrase at the start of paragraph 65: “I find that the applicant has not provided sufficient evidence to suspect that she has a neurological impairment, which would warrant investigation.” The adjudicator does use the term “neurological impairment”, which could suggest that she was looking for evidence of a diagnosis. However, it is clear from the rest of this passage that she was focused on whether there was “sufficient evidence to suspect” that such a condition existed for the purpose of warranting “investigation”.
17Further, when reviewing the analysis conducted in paragraphs 65 – 68, it is clear the adjudicator turned her mind to the correct chain of reasoning to determine whether the plan was reasonable and necessary: i.e., is there sufficient evidence to support an assessment of the applicant’s neurological condition? In light of this detailed assessment of the evidence, I find the applicant’s submission about the “ample notations of neurological symptoms” is, again, an attempt to re-weigh evidence considered at first instance.
18Finally, I do not find the applicant’s arguments about the adjudicator’s summary of the evidence from Drs. Douen and Kleiner meet the standard under Rule 18.2(b). As part of her analysis of the neurological assessment treatment plan, the adjudicator summarized the findings about the applicant’s headaches from these experts at paragraph 67:
Third, both Dr. Douen, and s. 44 assessor, Dr. Galit Kleiner, neurologist, have concluded that the applicant’s headaches are caused by cervicogenic/musculoskeletal headaches, migraine, and medication overuse.
19A party requesting reconsideration under Rule 18.2(b) must not only establish a legal or factual error. They must also show that this error would likely have impacted the result. Even if I accept that the adjudicator erred in her summary of this evidence (as there appears to be a circular logic to her description of the source of the applicant’s headaches), I find the applicant has not shown how amending this error would likely have affected the final result about this plan.
20Aside from the fact that this evidence was first introduced to the dispute by the respondent (with the applicant maintaining the onus to show entitlement), the adjudicator’s assessment of the opinions of Drs. Douen and Kleiner only plays a small role in this part of the decision. Beyond these two doctors, the adjudicator based her findings about this plan on the records from six other practitioners, along with the ambulance call report. Taken together, I am not satisfied, on a balance of probabilities, that changing the adjudicator’s summary of the evidence from Drs. Douen and Kleiner would likely have changed the result. Without this second stage of the test met, the applicant has not engaged Rule 18.2(b).
CONCLUSION & ORDER
21The applicant’s request for reconsideration is dismissed.
Craig Mazerolle
Vice-Chair
Tribunals Ontario – Licence Appeal Tribunal
Released: September 17, 2025