Licence Appeal Tribunal
RECONSIDERATION DECISION
Before: Ulana Pahuta, Adjudicator
Licence Appeal Tribunal File Number: 25-005668/AABS
Case Name: Chandrahasan Umbargalsigamany v. Primmum Insurance Company
Written Submissions by:
For the Applicant: Gregory R. Willson, Counsel
For the Respondent: Matthew Nieuwland, Counsel
OVERVIEW
1On December 31, 2025, the applicant requested reconsideration of the Tribunal’s decision dated December 12, 2025 (“decision”).
2In this decision, the Tribunal found that the applicant was barred from proceeding with his claim for accident benefits pursuant to s. 61 of the Statutory Accident Benefits Schedule – Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”), due to his entitlement to benefits under the Workplace Safety and Insurance Act, 1997, S.O. 1997, c. 16, Sched. A (“WSIA”).
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 his request for reconsideration.
5He is seeking an order that the decision be varied, to find that he is only statute-barred under s. 61(1) of the Schedule until such time that he provides an assignment of benefits under the WSIA, that has been approved by the Workplace Safety and Insurance Board (“WSIB”). Further, that pending the resolution or a final decision by the WSIB or the Workplace Safety Insurance Appeals Tribunal (“WSIAT”) in regard to his benefits under the WSIA, if the parties cannot agree as to the applicability of s. 61(1), the applicant may re-apply to the Tribunal for a final determination of the preliminary issue.
6The respondent submits that the Tribunal did not make an error of law or act outside its jurisdiction. It requests that the applicant’s request for reconsideration be denied.
RESULT
7The applicant’s request for reconsideration is granted, pursuant to Rule 18.2(a).
8Pursuant to Rule 18.4, the decision is cancelled. A rehearing will be conducted before a new adjudicator.
9A case conference will be scheduled within 30 days of the release of this reconsideration decision to address this rehearing.
ANALYSIS
10The 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.
11The applicant submits that, in coming to the determination that he was barred from proceeding with his application pursuant to s. 61(1) of the Schedule, the Tribunal made an error of law, and acted outside its jurisdiction in two ways. Firstly, according to the applicant, the Tribunal could not make a determination on the applicability of s. 61(1) until a determination has been made by WSIAT or WSIB as to his entitlement to benefits under the WSIA. Secondly, the applicant argues that, in considering s. 61, the Tribunal does not have the jurisdiction to make a determination as to whether he is entitled to benefits under the WSIA.
12Section 61(1) of the Schedule provides that an insurer is not required to pay accident benefits to an insured person who is entitled to receive benefits under the WSIA. Section 61(2) provides a limited exception. This exception applies to injured workers who elect to seek damages in tort for their injuries, in which case they may also claim benefits under the Schedule, provided their election was not made primarily for the purpose of claiming accident benefits.
13Section 61(5) of the Schedule provides that, despite subsection (1), if there is a dispute about whether subsection (1) applies to a person, the insurer shall pay benefits pursuant to the Schedule pending the resolution of the dispute, if the person made a WSIB assignment, and if the assignment was approved by the WSIB.
14In his reconsideration submissions, the applicant confirms that while he has made a WSIB assignment, it has not yet been approved by the WSIB.
Rule 18.2(a) – Jurisdiction of the Tribunal
15I find that the applicant has demonstrated grounds for reconsideration based on Rule 18.2(a).
Parties’ Positions
16The applicant argues on reconsideration that, until the WSIB or WSIAT has rendered a decision as to his entitlement to benefits under the WSIA, the Tribunal cannot make a determination on the preliminary issue. He cites s. 31(1) and (2) of the WSIA, which states the WSIAT has exclusive jurisdiction to determine whether the applicant is entitled to claim benefits under the WSIA. The applicant further cites s. 118 of the WSIA which states that:
“The [WSIB] has exclusive jurisdiction to examine, hear and decide all matters and questions arising under this Act, except where this Act provides otherwise.”
17The applicant argues that before a final determination can be made on s. 61(1), the Tribunal must first know whether the applicant is entitled to benefits under the WSIA. The applicant argues that, if a determination is made by the Tribunal on s. 61 before a finding is made by the WSIB or WSIAT as to whether he is entitled to benefits under the WSIA, potentially inconsistent results could be reached. Namely, the Tribunal could find that the applicant was entitled to receive benefits under the WSIA, but the WSIB or WSIAT could ultimately find that he was not entitled to such benefits, leading to an absurd result where he could potentially be without benefits.
18The applicant further submits that, since the Tribunal does not have the jurisdiction to determine WSIA entitlement, its role is confined to “recognizing a dispute’s existence and enforcing the consequences mandated by s. 61(5).” He argues that this means that the decision must be varied to find that the applicant “is only statute-barred under s. 61(1)…until such time that the Applicant provides an assignment of benefits under the WSIA, that has been approved by the WSIB”, in order for s. 61(5) to be engaged.
19In his reconsideration reply submissions, the applicant for the first time submits that there is an open question as to whether he is entitled to receive benefits under the WSIA, since he had submitted an application to the WSIB, but it was denied pending further information and investigation. The applicant also included a letter from the WSIB dated December 23, 2025. This letter states that the applicant’s WSIB claim had been denied due to lack of information regarding the applicant’s injuries or the circumstances of the accident. Accordingly, the applicant argues that given the “uncertainty” as to whether he is entitled to benefits under the WSIA, the Tribunal lacks the jurisdiction to make a determination under s. 61(1), until the WSIB makes a final determination of entitlement to benefits under the WSIA.
20The respondent submits that the applicant’s position on reconsideration is inconsistent. It argues that at the initial hearing, the applicant had argued that s. 61 was not applicable, as he was an independent contractor and was not entitled to WSIB benefits. He, therefore, invited the Tribunal to make the determination that he was not entitled to benefits under the WSIA. The respondent submits that the applicant cannot now argue on reconsideration, after receiving an unfavourable ruling, that the Tribunal lacks the jurisdiction to consider this same issue.
21The respondent further submits that, in order to make a determination on s. 61, the Tribunal must consider, on the evidence before it, whether the applicant is entitled to benefits under the WSIA. The respondent claims this determination is not an infringement on the WSIB’s or WSIAT’s exclusive jurisdiction. Rather, it is a finding made solely in the context of the dispute under the Schedule, and it would not be binding on the WSIB or WSIAT or preclude the applicant from pursuing WSIA benefits. The respondent argues that the Tribunal has consistently affirmed this authority to consider WSIB eligibility.
22The respondent was granted leave to file sur-reply reconsideration submissions to address the letter from the WSIB, dated December 23, 2025, as well as the applicant’s arguments raised in his reply reconsideration submissions relating to his entitlement to benefits under the WSIA. In its sur-reply submissions, the respondent argues that the December 23, 2025 letter does not establish that the issue of the applicant’s entitlement to WSIA benefits is “live” and that the Tribunal must defer its decision. Rather, it argues that the WSIB letter simply advised that the WSIB was unable to determine entitlement due to insufficient information provided by the applicant. It argues that the applicant cannot rely on a deficient and incomplete WSIB claim to avoid the application of s. 61(1).
Analysis
23The applicant acknowledges that his position on reconsideration is different from that advanced at the preliminary issue hearing. He argues that he has retained new counsel, and is now advancing the argument that the WSIB and WSIAT have exclusive jurisdiction to determine entitlement to benefits under the WSIA, and that, given the issue of his entitlement to WSIA benefits is ”uncertain”, the Tribunal lacks the jurisdiction to apply s. 61(1) and s. 61(2) of the Schedule.
24I find that the applicant’s submissions on reconsideration and the December 23, 2025 WSIB letter raise a question of whether the applicant is entitled to receive benefits under the WSIA. Entitlement to WSIA benefits is a prerequisite for the application of s. 61(1) of the Schedule. This also calls into question whether the Tribunal has the jurisdiction to make a determination on s. 61(1) and (2) before the WSIB has made its determination on WSIA entitlement. These arguments and the December 23, 2025 letter had not been raised at the preliminary issue hearing, and accordingly, the decision did not consider the issue of the Tribunal’s jurisdiction to consider s. 61(1) in such circumstances.
25While I agree with the respondent that the applicant’s position on reconsideration is inconsistent with his position at first instance, I further agree with the applicant that the issue of the Tribunal acting outside its jurisdiction can be raised at any point, including for the first time on reconsideration. A Tribunal’s jurisdiction is fundamental to its ability to act. Regardless of when jurisdiction is raised as an issue, if a decision-maker does not have the jurisdiction to decide a particular dispute, it cannot proceed with the dispute.
26Further, it is well-established that a primary purpose of the Schedule is consumer protection, the goal of which is to “reduce the economic dislocation and hardship of motor vehicle accident victims”, Clouthier v. Co-Operators General Insurance, 2025 ONSC 6798. Given that the applicant has provided submissions and evidence on reconsideration that question whether he is entitled to benefits under the WSIA, I find that it would not be in keeping with the consumer protection mandate of the Schedule to deny the applicant the ability to pursue accident benefits pursuant to s. 61(1) of the Schedule, without a fulsome consideration of whether he is, in fact, entitled to WSIA benefits, or whether there is a proceeding pending before the WSIB.
27Accordingly, I find that the applicant has demonstrated grounds for reconsideration based on Rule 18.2(a). As I have found that the applicant has established grounds for reconsideration, I do not need to consider his other reconsideration arguments.
Rule 18.4 – Outcome of the Reconsideration
28Rule 18.4(b) provides that upon reconsidering a decision, the Tribunal may confirm, vary, or cancel the decision or order, or order a rehearing on all or part of the matter.
29As noted above, the applicant is requesting that the Tribunal vary the decision, to find that he is only statute-barred under s. 61(1) of the Schedule until such time that he provides an assignment of benefits approved by the WSIB, and that pending the resolution or a final decision by the WSIB or WSIAT in regard to his benefits under the WSIA, that he may re-apply to the Tribunal for a final determination of the preliminary issue.
30I am ordering a rehearing of the preliminary issue in dispute, by a different adjudicator. The applicant has raised new arguments and has provided new evidence with respect to his entitlement to WSIA benefits. The respondent has further raised arguments disputing that the December 23, 2025 letter establishes that the issue of the applicant’s entitlement to WSIA benefits is a “live” issue, as the WSIB letter only advised that the WSIB was unable to determine entitlement due to insufficient information provided by the applicant. In his reconsideration submissions, the applicant did not provide details as to whether he had rectified these deficiencies and what further steps, if any, are being taken by the applicant to pursue a determination on entitlement from the WSIB. Accordingly, it is not possible to order a rehearing based on the preliminary issue hearing submissions tendered at the initial hearing (even with the benefit of the parties’ reconsideration submissions).
31This rehearing will take place before a new adjudicator. A case conference will be scheduled to allow the Tribunal to issue procedural and administrative directions as necessary for the conduct of this rehearing.
CONCLUSION & ORDER
32The applicant’s request for reconsideration is granted.
33Pursuant to Rule 18.4 the decision is cancelled. I am ordering a rehearing of the preliminary issue in dispute. The rehearing will be conducted by a different adjudicator.
34A case conference will be scheduled within 30 days of the release of this reconsideration decision so that the Tribunal may issue procedural and administrative directions as necessary for the conduct of the rehearing. The Tribunal shall reach out to the parties to canvass dates for this case conference.
35I am not seized.
Ulana Pahuta
Adjudicator
Released: April 29, 2026