Citation: Myllymaa v. Wawanesa Insurance, 2025 ONLAT 23-011344/AABS-R
RECONSIDERATION DECISION
Before: Craig Mazerolle, Vice-Chair
Licence Appeal Tribunal File Number: 23-011344/AABS
Case Name: Katia Myllymaa v. Wawanesa Insurance
Written Submissions by:
For the Applicant: Peter White, Counsel Kristen Hamilton, Counsel
For the Respondent: Priyanka Monpara, Counsel
OVERVIEW
1On July 23, 2025, the applicant requested reconsideration of the Tribunal’s decision released July 3, 2025 (“decision”).
2Stemming from an accident on December 11, 2022 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 resulting decision, the adjudicator found the applicant was not entitled to three treatment plans for physiotherapy services. He further concluded that the applicant was not entitled to 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 relies on Rule 18.2(b) to support her request for reconsideration. She is seeking an order finding she is entitled to the treatment plans and an award.
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 an error of fact or law, pursuant to Rule 18.2(b).
9The applicant argues the adjudicator misapplied the Schedule in two ways. First, the applicant submits that the adjudicator’s “decision does not address and/or ignores Section 49.1”, such that he incorrectly applied the Health Claims for Auto Insurance Guideline (“Guideline”) to her claims from a non-licensed service provider. The applicant takes issue with this lack of analysis, since she “submits that she has complied” with this provision. Second, the applicant claims the adjudicator misapplied s. 64 of the Schedule. According to the applicant, this provision allows an insurer to waive the requirement that a treatment plan needs to be submitted through HCAI. The applicant also submits that the disputed treatment plans are reasonable and necessary for her recovery.
10Section 49.1 provides the following rules when addressing requests for payment from unlicensed service providers:
i. If an insured person receives goods or services specified in a Guideline that applies for the purposes of section 49 from a provider who does not hold a licence issued under subsection 288.5 (3) of the Act, the following rules apply in addition to the requirements of section 49:
The provider shall deliver an invoice for the expense, in the form approved by the Chief Executive Officer and including all of the information required by the form, to the insured person to whom the goods or services referred to in the invoice were delivered or rendered.
The insured person to whom the goods or services were delivered or rendered shall deliver the invoice described in paragraph 1 to the insurer.
11Section 64 of the Schedule details a list of requirements and procedures as it relates to notices and delivery of documents between insurers and insured persons. Section 64(15) then states that certain subsections of s. 64 “do not apply to a document if the insurer has waived the requirement that the document be submitted to the insurer in circumstances permitted by this Regulation.”
12First, I note that s. 49.1 of the Schedule was not raised by the applicant during the written hearing. Considering the physiotherapy provider’s status as a non-licensed service provider was discussed at length in the decision, I see no reason why this section of the Schedule could not have been addressed by the applicant in her written submissions.
13It is incumbent upon parties to put their best foot forward at first instance. The reconsideration process is not meant to be a venue for introducing new arguments that could have been raised before: see 17-000608 v. TD Home and Auto Insurance Company, 2018 CanLII 141004 (ON LAT), at para. 15. By attempting to raise a new argument that could have been presented at first instance, I find this ground does not engage the criteria under Rule 18.2(b).
14I also note that this provision was raised by the respondent in its written hearing submissions as a defense against the claim, yet the applicant did not file a reply. Specifically, the respondent argued at paragraph 20 of its responding submissions (emphasis in original):
Section 49.1 of the [Schedule] contemplates that there will be occasions where unlicensed service providers will render treatment to insured persons. The preamble in section 49.1 indicates that this section provides rules and requirements which are in addition to those set out in section 49.
15The applicant has the onus to demonstrate entitlement to the disputed medical benefits. As such, if she wanted to engage the route for payment under s. 49.1, the applicant had the onus to show that her payment requests were made in compliance with the additional requirements laid out in this provision. By not addressing this section of the Schedule at first instance, I find the applicant has not shown how the adjudicator’s handling of this claim was an error, pursuant to Rule 18.2(b).
16Turning to the argument about s. 64, this ground is an attempt to re-argue a position presented at first instance. When discussing the procedural requirements contained in the Guideline at paragraph 17 of the decision, the adjudicator noted that: “Further, the respondent has not provided a waiver of these requirements pursuant to s. 64(15).” This argument about a potential waiver was considered and dismissed. I find the applicant’s assertion that the adjudicator misapplied this provision is an attempt to have this position re-tried through reconsideration. As noted, above, this is not a proper use of the reconsideration process.
17Finally, while the applicant may maintain her position that the disputed treatment plans are reasonable and necessary, disagreement alone with a finding made at first instance is not sufficient to engage Rule 18.2(b). Rather, the requesting party must establish a legal or factual error, and they must show that this error would likely have impacted the result. The applicant has not met this standard.
CONCLUSION & ORDER
18The applicant’s request for reconsideration is dismissed.
Craig Mazerolle Vice-Chair Tribunals Ontario – Licence Appeal Tribunal
Released: September 29, 2025