RECONSIDERATION DECISION
Before: Bruce Stanton, Adjudicator
Licence Appeal Tribunal File Number: 24-000774/AABS
Case Name: Rayan Alsafadi v. Primmum Insurance Company
Written Submissions by:
For the Applicant: Mobina Khan, Counsel
For the Respondent: Stefan Sistilli-Sguazzin, Counsel
OVERVIEW
1On January 6, 2026, the applicant requested reconsideration of the Tribunal’s decision dated December 12, 2025 (“decision”).
2In the decision, the Tribunal determined that the applicant was not entitled to income replacement benefits (“IRBs”), a treatment plan for an electrophysiological assessment, interest, or an award.
3For reconsideration of decisions released on or after August 21, 2023, the 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.
4In his Request for Reconsideration Form, the applicant checked off that he is requesting reconsideration on the grounds cited in Rules 18.2(b) and 18.2(c). However, it appears from his submissions that he is also alleging that the Tribunal committed a material breach in procedural fairness, i.e., Rule 18.2(a).
5Although the applicant checked off that he was relying on Rule 18.2(c), the applicant did not identify what evidence exists regarding that ground.
6I take note that the applicant’s submissions on the grounds for reconsideration were organized under the headings: Error of Fact, Error of Law, Error of Law and Fact, and Procedural Unfairness, suggesting that he is relying only on Rules 18.2(a) and 18.2(b). There was no such item or section in his grounds for reconsideration relating to Rule 18.2(c). As the applicant has not identified the new evidence in relation to Rule 18.2(c), or provided any submissions on that subject, I will proceed to analyse the applicant’s request for reconsideration based on the submissions he has presented regarding Rules 18.2(a) and Rule 18.2(b) as noted above.
7The respondent submits that the applicant did not meet his burden in establishing that the Tribunal made any error of law or fact, such that it would likely have reached a different result had the errors not occurred, or that the Tribunal committed a material breach of procedural fairness.
8The applicant does not specifically identify the remedy he is seeking.
RESULT
9I am not satisfied that the applicant established how the decision falls into one or more of the criteria for reconsideration set out in Rule 18.2. The request for reconsideration is dismissed.
ANALYSIS
10The test for reconsideration under Rule 18.2 involves a high threshold. Reconsideration is a limited, error-correcting exercise. It 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(b) – Errors of Law or Fact
11I find the applicant has not established grounds for reconsideration in relation to Rule 18.2(b), that the Tribunal made an error of law or fact, such that it would have reached a different conclusion had the error not been made. The applicant’s alleged errors of law or fact seem to be disagreements with how the Tribunal weighed the evidence before it, which is not, as noted above, a ground for reconsideration.
12The applicant alleges three unique errors of law or fact were committed by the Tribunal:
a. concluding that the applicant was ineligible for IRBs by reason of there being insufficient employment or educational history, and by not meaningfully assessing the content of OCF-3 disability certificates (ground a. of the applicant’s request for reconsideration);
b. finding the treatment plan for an electrophysiological assessment (“TP”) was not reasonable and necessary and was a misapplication of s. 15 and s. 16 of the Schedule (ground c. of the applicant’s request); and
c. dismissing the TP because the applicant did not make submissions on the reasonableness of its cost (ground d. of the applicant’s request).
13My analysis of each allegation follows below.
Eligibility for IRBs and the OCF-3s – alleged error of fact
14I find the applicant has not shown that the Tribunal committed an error of fact in its consideration of the OCF-3s before it.
15The applicant submits that the Tribunal recognized the OCF-3s, but it failed to meaningfully assess their content. He submits that the OCF-3s addressed his functional status, limitations, and inability to work or attend educational programming. The applicant submits that the Tribunal committed an error of fact by concluding that he provided “no evidence” capable of supporting either pre- or post-104 week IRB entitlement.
16At paragraphs 11 to 14 of the decision, the Adjudicator discusses two OCF-3s, dated March 12, 2022 and June 16, 2022. They both reveal the applicant was not working at the time of the accident, and that he had not worked during 26 of the previous 52 weeks prior to the accident. The OCF-3 of June 16, 2022 is said to have identified that the applicant had been enrolled in an English as a Second Language program at the time of the accident, but was unable to attend due to his accident injuries. The Adjudicator notes, at paragraph 13, that the applicant did not make any submissions, nor did he direct her to any evidence, in relation to his education or employment history, or relating to his inability to perform the essential tasks of his employment.
17It appears that the Tribunal had documentary evidence before it, in the form of the OCF-3s, but they did not persuade the Adjudicator that the applicant was entitled to IRBs because he was not working at the time of the accident, had not worked during 26 of 52 weeks prior to the accident, and there was no other evidence to support the applicant’s inability to attend school.
18The decision notes, at paragraph 7, that if the applicant was not employed at the time of the accident, he must have been employed during 26 of the previous 52 weeks, or have been receiving employment insurance benefits, or have been excused from attending school at the time of the accident, and suffer a substantial inability to perform the essential tasks of the employment in which he was engaged for most of the 52 weeks preceding the accident, but the decision noted, at paragraph 13, that the applicant provided no evidence of his school or educational history to establish his eligibility for IRBs in relation to his schooling. It seems that the Adjudicator was not convinced of the applicant’s eligibility for IRBs, in relation to being excused from schooling, because the applicant did not present evidence to establish that fact.
19The applicant alleges the Tribunal erred in stating that he “failed to adduce evidence or make submissions regarding his employment or educational history sufficient to establish entitlement to an IRB”. The operative word here is “sufficient”. The decision seems to recognize that the applicant presented some submissions and documents (namely, the OCF-3s) relating to his entitlement to IRBs, but the Adjudicator was not persuaded that they were sufficient to meet the IRB entitlement threshold.
20I find no error of fact committed by the Tribunal in concluding there was insufficient evidence to establish eligibility for IRBs. It seems the Adjudicator considered the OCF-3s and concluded they did not establish the applicant’s entitlement to IRBs. The applicant’s allegation is one of disagreement with the weight the Tribunal assigned to the OCF-3s, which is not grounds for reconsideration.
21I find the Tribunal committed no error of law or fact in its analysis of the treatment plan for an electrophysiological assessment, referred to below as the TP.
22The applicant alleges that the Tribunal erred in law and fact by improperly evaluating the findings of his Emergency Department visit and assigning more weight to those findings than the judgment of the physician who authored the TP, Dr. Jamsheed Desai.
23The applicant alleges that the Tribunal misunderstood the purpose of diagnostic assessments. He submits that the Tribunal’s finding, i.e., the assessment was not warranted on the basis that earlier neurological testing was within normal limits, constitutes an error in the application of s. 15 and s. 16 of the Schedule.
24The respondent submits the Tribunal comments on both the applicant’s and the respondent’s positions regarding the reasonableness and necessity of the TP at paragraphs 17 to 21. It states that the applicant’s allegation on this point is a disagreement with the Tribunal’s findings, not an issue of law or fact.
25I find the applicant has not established that the Tribunal committed an error of law or fact regarding its determination of the reasonableness and necessity of the TP.
26The decision, at paragraphs 17 to 22, discusses how the Tribunal weighed the evidence before it, and why it concluded the applicant did not meet his burden in demonstrating the TP was reasonable and necessary.
27The Adjudicator provided the basis for her determination in paragraph 17 of the decision, noting that an assessment is for determining if a condition exists, and an insured must establish there are grounds to believe a condition exists, such that it warrants further investigation or assessment.
28At paragraph 21, the Adjudicator explained that the TP lacked detail and specificity, and it was not corroborated by contemporaneous medical evidence. She noted, at paragraph 22, that the applicant attended Trillium Health Centre (approximately two weeks prior to the date of the TP), and that the neurological testing conducted at that visit showed the applicant was within defined limits, and that further neurological investigation was not recommended. This fact seems to support the Adjudicator’s finding that the applicant did not demonstrate the TP was necessary.
29It is not clear what the applicant means by s. 15 and s. 16 of the Schedule not being applied correctly and that this constitutes an error of law. At paragraph 16, the Adjudicator describes how s. 15 and s. 16 apply, and that the applicant has the burden of showing, on a balance of probabilities, that the TP is reasonable and necessary as a result of the accident. She goes on to cite the practical aspects of demonstrating that burden, in that an 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 is reasonable.
30The applicant’s submissions on his request for reconsideration do not elaborate on how or why the Tribunal’s finding on entitlement to the TP reflects a misunderstanding of s. 15 and s. 16.
31I find that the Adjudicator properly stated the reasons for assessments at paragraph 17, reiterated the test for reasonableness and necessity at paragraphs 16 and 24, and her analysis engages these elements at paragraphs 18, 19, 21, 22 and 23. Specifically, she discussed why she was not persuaded of the TP’s reasonableness and necessity.
32It appears that the Adjudicator engaged with the evidence and submissions of the parties on this issue, and she was ultimately not persuaded that the applicant met his burden. As noted above, disagreements with how the Tribunal weighed evidence are not grounds for reconsideration under Rule 18.2.
33I find the applicant has not established that the Tribunal erred in law or fact by concluding he did not meet his burden in establishing entitlement to the TP.
The Tribunal dismissed the TP for lack of submissions on the reasonableness of the proposed cost – alleged error of law
34I find the Tribunal committed no error of law in respect to its consideration of the reasonableness of the cost of the TP.
35The applicant submits that the TP was dismissed, in part, because he did not make submissions regarding why the cost of the TP was reasonable. He submits the Tribunal took an overly technical approach to considering this part of the reasonable and necessary test that is inconsistent with the remedial purposes of the Schedule.
36The applicant seems to be referring to paragraph 23 of the decision, which notes that he did not make any submissions regarding the reasonableness of the cost of the assessment set out in the TP. The Adjudicator notes that the proposed cost of $2,630.00 exceeds the maximum for assessments of $2,000.00, plus HST, as stipulated in s. 25(2) of the Schedule.
37I find no error of law regarding how the Tribunal determined the applicant was not entitled to the TP. The Adjudicator articulated the threshold an applicant must meet in order to be entitled to a disputed treatment plan, including that they must speak to why the costs proposed in a treatment plan are reasonable. Considering that proving a treatment plan is reasonable and necessary involves a discussion of why the costs are reasonable, I find that any lack or absence of such submissions or evidence would be an appropriate omission for an adjudicator to consider. The Adjudicator’s mention of this absence is not an error of law.
38I find no error of law in how the Tribunal applied the reasonable and necessary test to the applicant’s evidence and submissions regarding the cost of the TP.
Rule 18.2 (a) – Material Breach of Procedural Fairness
39I find the applicant has not established that the Tribunal committed a material breach of procedural fairness in its analysis of his entitlement to IRBs.
40The applicant alleges that the Tribunal did not conduct an appropriate analysis of his entitlement to IRBs, as is required under s. 5 and s. 6 of the Schedule (ground item b. of the applicant’s request). As such, it denied him a fair adjudication of his claim. He submits that the Tribunal ought to have assessed the evidence before it, and then determined if it met the statutory test, rather than dismissing the claim on the basis that his submissions were inadequate.
41The respondent submits that procedural fairness is premised on the parties having proper notice of the case they must meet, and the opportunity to present their case fully and fairly. It submits the hearing proceeded in a fair manner, and the applicant had the opportunity to present his case, even when some of his documentary evidence did not comply with the Case Conference Report and Order.
42I find the applicant has not established a material breach of procedural fairness. His allegation seems more akin to a disagreement with how the Tribunal analysed and weighed the evidence.
43The applicant’s submissions do not refer me to the part of the decision that informs his allegation. However, it seems he is referring to paragraph 13, in which the Adjudicator reflected on the absence of submissions or evidence of both the applicant’s employment or education history, as well as his inability to perform the essential tasks of his employment (i.e., the pre-104 week IRB test). Paragraph 13 also notes the absence of submissions or evidence regarding his entitlement to post-104 week IRBs. I take note that, in paragraph 10 of the decision, the applicant is seeking entitlement to IRBs beyond the 104 week mark post-accident, so the test for post-104 week IRBs also applies.
44The decision sets out the test for both pre- and post-104 week IRBs at paragraphs 6 through 9. Paragraph 8 reiterates the practical basis for an insured person to establish their entitlement to pre-104 week IRBs, namely, that an applicant must identify the essential tasks of their employment, which tasks they are unable to perform, and to what extent they are unable to perform them. This standard is broadly accepted by the Tribunal.
45I find the Adjudicator’s conclusion in paragraph 13 describes how and why she believes the applicant’s evidence and submissions came short of the threshold for entitlement to IRBs, which is what adjudicating a dispute such as this entails. The Adjudicator applied the evidence and facts before her to the statutory test, and, in this case, she was unconvinced the applicant reached the statutory threshold for entitlement.
46It is the applicant’s onus to demonstrate entitlement to the disputed IRBs, and I find that he has not identified any material breach of procedural fairness that prevented him from presenting his case fairly.
47It seems the applicant’s allegation of procedural unfairness is more a disagreement with the Tribunal’s assessment of the evidence before it, which is not a ground for reconsideration under Rule 18.2.
CONCLUSION & ORDER
48I am not satisfied that the applicant has established how the decision falls into the criteria for reconsideration stipulated in Rule 18.2.
49For the reasons discussed above, I dismiss the applicant’s request for reconsideration.
Bruce Stanton
Adjudicator
Released: March 13, 2026