RECONSIDERATION DECISION
Before:
Robert Rock, Adjudicator
Licence Appeal Tribunal File Number:
23-011051/AABS
Case Name:
Sathiyan Subramanian v. Co-operators General Insurance Company
Written Submissions by:
For the Applicant:
Jono Schneider, Counsel
For the Respondent:
Sonya Reid, Counsel
OVERVIEW
1On July 7, 2025, the applicant requested reconsideration of the Tribunal’s decision dated June 18, 2025 (“decision”).
2In the decision, I found that the applicant had not met his onus to prove that the various treatment plans in dispute were reasonable and necessary, and that he was not owed either interest or an award.
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 applicant requested the decision be varied to deem all the treatment plans at issue are payable. Alternatively, the applicant is asking to set aside my decision and order a new hearing.
5The respondent requests the reconsideration be denied.
RESULT
6The applicant’s request for reconsideration is dismissed.
ANALYSIS
Rule 18.2(a) – Outside the Tribunal’s Jurisdiction
7I find that the applicant has not established grounds for the reconsideration, under Rule 18.2(a), regarding my removal of two issues from the dispute.
8The 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.
9The applicant submits I acted outside my jurisdiction by removing two issues from the Case Conference Report and Order. The first issue was the removal of the applicant from the Minor Injury Guideline (“MIG”), and the second issue was an OCF-18 from July 14, 2023. Both were removed based on the respondent’s written submissions.
10The applicant submits that removing these two issues in dispute was potentially outside my scope of authority. The applicant did not dispute the respondent’s position that he had been removed from MIG, or that the OCF-18 from July 14, 2023 was approved. As such, there were no issues for me to adjudicate, and they were removed from my analysis.
11The applicant has not directed me to how the removal of these two issues from the substantive issues in dispute was outside of my scope of authority. Indeed, s. 280(1), (2) and (4) of the Insurance Act spell out that Tribunal resolves disputes between an insured and insured person over the latter’s entitlement to and amount of accident benefits. Where there ceases to be a dispute over an issue, the Tribunal’s statutory jurisdiction to decide the issue similarly ceases.
12I find the applicant has not established grounds for reconsideration, with respect to Rule 18.2(a), regarding my removal of two issues from the dispute.
Rule 18.2(b) – Errors of Fact or Law
13I find that the applicant has not established grounds for the reconsideration under Rule 18.2(b).
14Once again, the 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.
15The applicant submits I made three errors of law or fact in the decision:
a. My analysis of the interest and an award.
b. My analysis regarding the in-home assessment treatment plan.
c. My analysis regarding the chiropractic treatment plans (“physical therapy”).
Analysis of interest and an award
16I find that the applicant has not established grounds for a reconsideration, with respect to Rule 18.2(b), regarding my analysis of interest and an award.
17The applicant submits that my removal of the two issues in dispute, as outlined above, resulted in a lack of adjudication of interest and an award on these two issues. The applicant submits that the claim to an award was not withdrawn. The applicant also claimed that the respondent did not submit the adjuster’s log notes.
18I disagree with the applicant. In my analysis of both interest and an award, I included the two removed issues in my consideration. I was not persuaded by the applicant’s argument in his submissions that the respondent unreasonably withheld or delayed payments. The applicant’s claim that the respondent did not submit the adjuster’s log notes also does not hold up, as I note the respondent did produce the adjuster’s log notes, as Tab 8 of their document brief.
19The applicant has not directed me in his submissions as to what my error in law was regarding interest. I did not find that there were any overdue benefit payments in my decision, and the applicant has not shown me how the decision was wrong in this regard. The applicant has the onus to establish that a reconsideration is merited.
20I find that the applicant has not established grounds for a reconsideration, with respect to Rule 18.2(b), regarding my analysis of interest and an award.
Analysis of the in-home assessment treatment plan
21I find that the applicant has not established grounds for a reconsideration, with respect to Rule 18.2(b), regarding my analysis of the in-home assessment treatment plan.
22The applicant submits that I found insufficient evidence to justify further investigation through an assessment and that this finding is an error of law. The applicant relies on s. 25(1)(4) and s. 42(1) of the Schedule, arguing there is mandatory language in these sections that the insurer shall pay. Additionally the applicant directs me to two cases to argue the importance of the in-home assessment. Hormis v Aviva General Insurance, 2022 CanLII 53760 (ON LAT) and L.F.B. v. Intact Insurance Company, 2021 CanLII 48377 (ON LAT)
23Section 25(1)(4) states that an insurer shall pay: “Reasonable fees charged by an occupational therapist or a registered nurse for preparing an assessment of attendant care needs under section 42, including any assessment or examination necessary for that purpose”.
24Section 42(1) states:
i. Subject to subsection (2), an application for attendant care benefits for an insured person must be,
(a) in the form of and contain the information required to be provided in the version of the document entitled “Assessment of Attendant Care Needs” that is approved by the Chief Executive Officer for use in connection with the claim; and
(b) prepared and submitted to the insurer by an occupational therapist or a registered nurse.
25I disagree with the applicant’s argument, as neither section addresses the “reasonable and necessary” test for medical benefits. Following on s. 15 and s. 16 of the Schedule, the applicant bears the burden of demonstrating, on a balance of probabilities, that a medical benefit is reasonable and necessary as a result of the accident. To do so, the applicant should identify the goals of treatment, how the goals would be met to a reasonable degree and that the overall costs of achieving them are reasonable.
26In paragraph 15 of my decision, I outline that the applicant did not direct me to any evidence that argued that this treatment plan was reasonable and necessary. In the applicant’s original submission, he argued that the assessment should be completed because “it is possible that the assessor would put the amount at $0”. Additionally, the applicant argued that, as he was no longer in the MIG, funds were available to pay for it. The applicant did not make an argument as to the specific reason that this treatment plan was reasonable and necessary, and, as such, he did not meet his onus.
27In the two cases that the applicant has directed me to in their reconsideration request, I note that neither case was used in first instances by the applicant to argue that the in-home assessment was reasonable and necessary. I disagree with the applicant that either case has a direct correlation to the applicant’s argument. Beyond the points above, in the applicant’s original submission, the need for the in-home assessment is framed by “the request to fund an occupational therapy assessment was reasonable and necessary in order to address what assistance the applicant may or may not need around the home”. The applicant did not direct me to any medical evidence that would substantiate why there may or may not be a need.
28I find that the applicant has not established grounds for a reconsideration, with respect to Rule 18.2(b), regarding my analysis of the in-home assessment treatment plan.
Analysis of the physical therapy
29I find that the applicant has not established grounds for a reconsideration, with respect to Rule 18.2(b), regarding my analysis of the physical therapy.
30The applicant argues that that my preference for the respondent’s evidence over his evidence (as well as my finding that his argument about the “reasonable and necessary” test was lacking) is a legal error. Additionally, the applicant directs me to two cases, Corridon vs. Aviva Insurance Company, 2021 CanLII 40645 (ON LAT) and 18-007668 v Aviva General Insurance, 2019 CanLII 58168 (ON LAT).
31The applicant relied on a s. 25 assessment by Dr. Getahun that was completed on April 8, 2024. In this assessment, Dr. Getahun recommended physiotherapy focusing on range of motion and strengthening of the cervical spine. A physiotherapy treatment plan was approved by the respondent. In my analysis at paragraph 21, I note that Dr. Getahun does not specifically address why five separate chiropractic treatment plans, all with the same goals and treatments, were also reasonable and necessary.
32In paragraph 23 of my decision, I outlined why I had placed significant weight on the respondent’s s. 44 addendum by Dr. Urovitz, completed on March 7, 2024. In the addendum, Dr. Urovitz examined additional evidence, and he updated his original diagnosis to remove the applicant from MIG. However, he did not change his findings regarding the five chiropractic treatment plans, stating that the plans at issue would not result in substantial further improvement.
33On this issue, the applicant has not directed me to an error in law stemming from my analysis, beyond a claim that I did not apply the legal test.
34I disagree with the applicant. My analysis of the evidence focused on if the applicant had met his onus to prove, on a balance of probabilities, that the five chiropractic treatment plans were reasonable and necessary. The main focus of the applicant’s argument centered on how he “is supposed to have $65,000 in coverage to be utilized over the course of five years”, and not on how the proposed treatment plans were reasonable and necessary. The applicant has not directed me to an error in law or fact, and it appears to be an attempt to re-litigate my decision. Re-litigation of evidence and arguments considered at first instance is not the purpose of a reconsideration.
35The applicant also submits that I did not significantly engage with the broader context and relevant evidence submitted, and this insufficient engagement may have affected my decision.
36The applicant does not direct me to any examples of the broader context or relevant evidence that he feels I did not engage with in my decision, nor does he explain how the broader context or relevant evidence would have changed my decision. The applicant has not directed me to an error in law or fact, and it again appears to be an attempt to re-litigate my decision.
37I note that neither of the two cases referred to by the applicant were submitted in the first instance to support the claim of the physical therapies. In neither case do the facts match those of this case. In Corridon, the argument on cost does not match, as cost was not a feature of my decision. In 18-007668, the applicant points to the term totality of evidence used in the decision. In that case specific examples of evidence are cited when that term is used. As noted above, the applicant has made no claim of what evidence he feels I did not consider.
38I find that the applicant has not established grounds for a reconsideration, with respect to Rule 18.2(b), regarding my analysis of the physical therapy.
CONCLUSION & ORDER
39For the reasons noted above, the applicant’s request for reconsideration is dismissed.
Robert Rock
Adjudicator
Tribunals Ontario – Licence Appeal Tribunal
Released: September 29, 2025