RECONSIDERATION DECISION
Before:
Craig Mazerolle, Vice-Chair
Licence Appeal Tribunal File Number:
23-015311/AABS
Case Name:
Michael Kireev v. Certas Home and Auto Insurance Company
Written Submissions by:
For the Applicant:
Sherilyn Pickering, Counsel
For the Respondent:
Stacey Karellas, Counsel
OVERVIEW
1On October 16, 2025, the applicant requested reconsideration of the Tribunal’s decision released September 25, 2025 (“decision”).
2Stemming from an accident on September 25, 2020 and a request for benefits made pursuant to the Statutory Accident Benefits Schedule – Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”), the parties participated in a written hearing. In the decision, the Tribunal found the applicant was entitled to a treatment plan for medical services submitted on June 13, 2022, as well as the outstanding amount from a series of OCF-6s. The Tribunal denied the three other treatment plans in dispute, i.e., a psychological services plan (submitted January 5, 2022); an OT services plan (submitted March 10, 2022); and the medical services plan that was submitted on June 22, 2022. The Tribunal also dismissed the applicant’s award claim.
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 his request.
5The respondent claims the Tribunal correctly dismissed the applicant’s claims for the three disputed treatment plans and an award.
RESULT
6The applicant’s request for reconsideration is dismissed.
ANALYSIS
7To start, the applicant challenges the Tribunal’s determination that he did not provide evidence and submissions to show how the treatment goals listed in the psychological services and medical services plans would be met to a reasonable degree. The applicant points to various sections of his submissions, as well as his affidavit, to dispute this finding. The applicant also contends that the Tribunal incorrectly required him to show how these treatments would assist him in the future, as opposed to looking at the benefit they were currently providing.
8The Tribunal canvassed the applicant’s evidence and arguments for the psychological services plan at paragraphs 15 – 19 of the decision, and it reviewed his case for this medical services plan at paragraphs 38 – 41. These reviews included an assessment of the OCF-18 forms, e.g., the proposed treatment goals and modalities. The Tribunal also considered the applicant’s affidavit at paragraph 18 of the decision:
The applicant’s affidavit sworn on May 1, 2024 was put into evidence. In the affidavit, he indicates that he participated in group sessions to help treat insomnia and was provided with tools to help him, such as being advised to avoid screens, avoid coffee, to do meditation and take melatonin.
9After reviewing this evidence, the Tribunal reached the following conclusions about the psychological services treatment plan at paragraph 19:
The applicant pointed to evidence of his accident-related impairments and directed me to the goals of the treatment plan which included a description of what the group counselling would entail. However, I find that the applicant did not provide evidence or make submissions with respect to how the goals of the plan would be met to a reasonable degree and how the overall costs of achieving them are reasonable.
10Similar reasons were provided at paragraph 41 about the medical services plan.
11The test for reconsideration under Rule 18.2 involves a high threshold, and the requesting party must show how or why the decision falls into one of the categories in Rule 18.2. 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.
12Though the applicant may contend that the Tribunal erred by finding he did not provide evidence and arguments to show how the goals of the plan would be met, the decision clearly demonstrates that the Tribunal conducted an extensive review of the available evidence and arguments. The applicant is entitled to disagree with the outcome of this review, but for a requesting party to engage Rule 18.2(b), they must show that a legal or factual error took place. I do not find the applicant has met this onus.
13I also note that, even if I accepted the applicant’s position that the Tribunal erred in its consideration of these two plans, I am not satisfied that he has established that this error would likely have impacted the outcome. While the applicant’s reconsideration submissions focused on the assessment of the proposed treatment goals, the Tribunal also denied these plans based on the finding that he did not present evidence about whether the overall costs of the plan were reasonable. Therefore, even if the Tribunal had accepted the applicant’s position about the proposed treatment goals, there would still likely be lasting questions about the reasonableness of the proposed expenses.
14Turning to the partially approved plan for OT services, the applicant disputes the Tribunal’s findings about the denied section of this plan, i.e., funding for case note documentation, consultation and correspondence with the client, and collaboration of clinical practices and activities. The applicant argues that the evidence he presented to the Tribunal shows his occupational therapist spent time doing these activities, e.g., sending correspondence about his file. As such, the applicant claims the Tribunal erred by finding he did not demonstrate the reasonableness of these denied expenses.
15After summarizing the six clinical notes and records the applicant submitted from the occupational therapist who prepared the plan, the Tribunal concluded at paragraphs 33 and 34:
I note that there is only one entry detailing notes from an OT session, and that the notes were made 50 minutes from the time the planning notes were taken. The respondent has approved six 1.5-hour OT sessions. The applicant has made various submissions to support his argument that the case note documentation, consultation and correspondence with the client, and collaboration of clinical practices and activities portions of the proposed plan, are reasonable and necessary. However, submissions are not evidence. The only evidence that the applicant relies on in support of his position are the CNRs of Ms. Saad.
I find that the CNRs that were put into evidence do not provide any insight with respect to why the time approved by the respondent for the OT sessions, progress reports, as well as preparation and planning is not sufficient to cover the denied items. The applicant does not direct me to evidence to justify that six, half-hour sessions of case note documentation, one hour of time for consult and correspondence with the applicant, and 1.5 hours for collaboration of clinical practices and activities are reasonable and necessary.
16Once again, I find the applicant is asking the Tribunal to re-weigh evidence that was considered at first instance. Though he argues that the six clinical notes and records show time spent doing activities that fall within the scope of the denied expenses, the Tribunal was entitled to review these records and reach a different conclusion. There is no specific error being referenced by the applicant, but rather he takes issue with the conclusions the Tribunal drew from its evidentiary review. Disagreement alone will not trigger Rule 18.2(b).
Award Claim
17Finally, the applicant challenges the Tribunal’s finding that an award was not merited due to a lack of submissions. The applicant disputes this finding by highlighting paragraph 32 of his initial submissions from the written hearing:
The Respondent unreasonably withheld medical rehabilitation benefits that are reasonable and necessary, including assessments to investigate [the applicant’s] impairments and treatments that had reasonable goals and were making reasonable progress. A special award is appropriate.
18The Tribunal assessed the award claim at paragraphs 62 and 63 of the decision:
The applicant submits that an award is appropriate because the respondent unreasonably withheld reasonable and necessary medical rehabilitation benefits, including assessments to investigate his impairments and treatments that had reasonable goals and were making reasonable progress.
It is well settled that an award should not be ordered simply because an insurer made an incorrect decision. Rather, to attract an award under Reg. 664, the insurer’s conduct must be excessive, imprudent, stubborn, inflexible, unyielding, or immoderate. The applicant does not direct me to any such conduct on the part of the respondent in this case. For these reasons, I find that there is no basis for ordering an award.
19Considering the sparse details provided about the respondent’s alleged misconduct, as well as the fact that the Tribunal’s reasons show it assessed the applicant’s brief award submissions in full, I see no error in this part of the decision.
CONCLUSION & ORDER
20The applicant’s request for reconsideration is dismissed.
Craig Mazerolle
Vice-Chair
Released: January 5, 2026