Licence Appeal Tribunal
RECONSIDERATION DECISION
Before: Craig Mazerolle, Vice-Chair
Licence Appeal Tribunal File Number: 24-001779/AABS
Case Name: Conrad F R Wilson v. Coachman Insurance Company
Written Submissions by:
For the Applicant: Sam C Pitaro, Counsel
For the Respondent: Jennifer Cosentino, Counsel
OVERVIEW
1On October 14, 2025, the respondent requested reconsideration of the Tribunal’s decision released September 25, 2025 (“decision”).
2Stemming from an accident on February 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) (the “Schedule”), the parties participated in a written hearing. In the decision, the Tribunal found the applicant was entitled to an income replacement benefit, and it denied his request to cover the costs of chiropractic services and an ambulance.
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 respondent relies on all three criteria under Rule 18.2 to support its request. It is asking the Tribunal to vary the decision to find the applicant does not meet the definition of an “insured person” under the Schedule.
5The applicant opposes the respondent’s request for reconsideration.
RESULT
6The respondent’s request for reconsideration is dismissed.
ANALYSIS
7The 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.
8I find the respondent has not established any grounds for reconsideration.
Decision Under Review
9The applicant was struck as a pedestrian by a third-party driver. Though the Motor Vehicle Accident Report stated that the driver was insured by the respondent, this insurance policy had, in fact, expired several months prior.
10The applicant filed an Application for Accident Benefits (“OCF-1”) with the respondent several weeks after the accident, but the claim was denied based on the driver’s invalid insurance policy. The applicant filed a second OCF-1 with the Motor Vehicle Accident Claims Fund (“MVACF”), but it declined to consider the claim due to the applicant having submitted the first OCF-1 with the respondent (at paragraph 10 of the decision):
By email dated March 22, 2022, the MVACF advised the applicant that it could not consider his claim because pursuant to Ontario Regulation 283/95 - Disputes Between Insurers Regulation (“the Regulation”), the first insurer to receive an OCF-1, is responsible for paying benefits pending resolution of a dispute as to which insurer is required pay under s. 268 of the Insurance Act.
11At the hearing, the respondent argued that, since the driver’s insurance policy had lapsed, it was not required to adjust the applicant’s claim. The applicant challenged this position, claiming that the Regulation makes clear that the first insurer to receive an OCF-1 must adjust the claim.
12Following the Court of Appeal for Ontario’s guidance in Kingsway General Insurance Co. v. Ontario (Minister of Finance), 2007 ONCA 62 (“Kingsway”), the Tribunal found it had the jurisdiction to determine the applicant’s entitlement to accident benefits. Further, it ruled that any priority disputes that may arise in this case are outside of its jurisdiction (at paragraphs 17 – 19 of the decision):
I find that the applicant has proven that there was a nexus between the respondent and himself. Following the accident, the applicant was told that the driver had insurance with the respondent and there was no reason for the applicant to question this information or believe that this information was false. Whether that information was subsequently proven to be incorrect was not the responsibility of the applicant. The applicant followed the proper procedures under the Schedule and applied to the respondent for accident benefits. If the respondent subsequently determined that there was an issue with the policy of insurance and disputed the applicant’s entitlement to benefits on this basis, it was required to commence a priority dispute. The respondent upon receipt of the first OCF-1 was required to adjust the claim and then dispute priority.
I find that the Tribunal has no jurisdiction to consider a priority dispute and arbitrators under the priority regime have the exclusive jurisdiction to determine priority disputes about which insurer is obligated to pay benefits pursuant to the Schedule. The Tribunal has the exclusive jurisdiction to determine entitlement to accident benefits.
I therefore find that the applicant was entitled to claim accident benefits from the respondent and the respondent was required to adjust the claim as it was the first insurer to receive a completed OCF-1.
Rule 18.2(a) – Outside of the Tribunal’s Jurisdiction
13I turn now to address the respondent’s reconsideration arguments.
14First, the respondent argues that the Tribunal acted outside of its jurisdiction when it made a determination about the applicant’s entitlement to benefits as it, in effect, decided the parties’ priority dispute. While the Tribunal noted that these disputes are outside of its jurisdiction, the respondent argues that it still made a ruling on priority as a means of determining the applicant’s entitlement to the disputed benefits. The respondent cites Wais v. Coachman Insurance Company, 2024 CanLII 102120 (ON LAT) (“Wais”), to support its position. It also notes that this case was raised during the hearing, but it was not mentioned in the decision.
15In my view, while there are references in the decision to priority disputes and the Regulation, it is clear that the Tribunal focused on the core question of whether the applicant was entitled to accident benefits—a question squarely within the Tribunal’s jurisdiction. Also, though the respondent may claim that the question before the Tribunal was whether the applicant was an “insured person” under the Schedule, which is a question that requires a determination of priority, I am not convinced.
16The main thrust of the Tribunal’s analysis on this point can be found at paragraphs 15 – 17 of the decision:
Pursuant to the Regulation, the first insurance company to receive a completed application for accident benefits is obligated to pay benefits. The Regulation sets out a mandatory process for private arbitrations of all disputes between insurers over which insurer is liable to pay accident benefits to a claimant. This regulation is intended to ensure that claimants receive accident benefits in a timely fashion while these disputes are being resolved. The regulation requires the first insurer that receives a completed OCF-1 application to pay the accidents benefits as long as the insured meets the requirements of the Schedule. Although an insurer may believe that it is not responsible for paying accident benefits under the priority rules, the process to transfer, dispute and recover paid benefits is set out in the Regulation.
I am bound by, and agree with the findings in the decision of [Kingsway], at paragraph 20…
I find that the applicant has proven that there was a nexus between the respondent and himself. Following the accident, the applicant was told that the driver had insurance with the respondent and there was no reason for the applicant to question this information or believe that this information was false. Whether that information was subsequently proven to be incorrect was not the responsibility of the applicant. The applicant followed the proper procedures under the Schedule and applied to the respondent for accident benefits. If the respondent subsequently determined that there was an issue with the policy of insurance and disputed the applicant’s entitlement to benefits on this basis, it was required to commence a priority dispute. The respondent upon receipt of the first OCF-1 was required to adjust the claim and then dispute priority.
17The Tribunal found the applicant was told that the third-party driver had a valid insurance policy with the respondent, and he relied on that information to file his first OCF-1. Based on this set of facts, the Tribunal determined that the “nexus” between the parties was sufficient to require the respondent to adjust the applicant’s claim, so his claim was allowed to proceed.
18This chain of reasoning follows the binding logic from Kingsway, a case that the Tribunal cited in the passage above. Specifically, at paragraphs 19 and 20 of this earlier case, the Court of Appeal discusses the purpose of s. 2 of the Regulation, as well as the need for this “nexus” to exist between the parties:
Section 2 of [the Regulation] is critically important in the timely delivery of benefits to victims of car accidents. The principle that underlies section 2 is that the first insurer to receive an application for benefits must pay now and dispute later. The rationale for this principle is obvious: persons injured in car accidents should receive statutorily mandated benefits promptly; they should not be prejudiced by being caught in the middle of a dispute between insurers over who should pay, or as in this case, by an insurer’s claim that no policy of insurance existed at the time.
Insurers cannot avoid their obligation under section 2 by claiming that another insurer should pay or that an insurance policy was cancelled shortly before the accident. If they could deny an application for accident benefits on either of these grounds, section 2 would be rendered meaningless. Thus, arbitrators and the courts have developed a nexus test for triggering an insurer’s obligation under section 2. As long as there is some nexus – some connection – between the insurer receiving an application for benefits and the insured, the insurer must pay pending the determination of its obligation to do so…
19It is clear from the Tribunal’s decision that it followed this chain of reasoning.
20Taken together, even though the respondent argues the Tribunal had to decide a priority dispute to reach its conclusion on jurisdiction, I am satisfied that the Tribunal properly focused on whether there was an active claim for accident benefits with the respondent. In accordance with the Court of Appeal’s guidance, this determination required the Tribunal to find a “nexus” between the parties. With such a connection, the Tribunal determined there was an active claim, and, by extension, it established jurisdiction over the dispute.
21Turning to the respondent’s reconsideration argument about Wais, I accept that the Tribunal did not mention this case in the decision. However, this is not grounds for reconsideration as the facts in Wais are not analogous to the situation considered by the Tribunal in the present case. While the present case involves an applicant who was told that the driver had an insurance policy with the respondent, the applicant in Wais had taken steps before the accident to ensure that his own insurance policy was active. As noted in Wais at paragraph 13:
The applicant submits that he believed that he had a valid automobile policy with the respondent at the time of the accident. He argues that he did not fully understand the relationship between a broker and insurance company or that his policy with the respondent was no longer in effect. Email correspondence from the applicant’s broker, Zeus Insurance Brokers, establishes that in June and July, 2021 the applicant’s wife reached out to the broker multiple times in an effort to renew their insurance policy when she realized that insurance payments were no longer being withdrawn from their account by the respondent.
22I agree that it would have been helpful if the Tribunal had made this distinction clear in the decision. However, the Tribunal was clear that it was following the ruling in Kingsway, and it is well-established that the Tribunal is not required to address every argument raised by the parties in the decision. In the present case, I find the Tribunal had a sufficient evidentiary basis to conclude there was a “nexus” between these parties, namely, the applicant’s belief that there was a valid insurance policy. This connection does not exist in Wais. Taken together, even though the Tribunal did not mention Wais, I do not find this case supports the argument that it acted outside of its jurisdiction.
23I find the respondent has not demonstrated grounds for reconsideration based on Rule 18.2(a).
Rule 18.2(c) – Evidence Not Before the Tribunal
24In a related vein, the respondent highlights the reconsideration decision and Divisional Court ruling that upheld Wais: i.e., Wais v. Coachman Insurance Company, 2025 CanLII 8016 (ON LAT) and Wais v. Coachman Insurance Company, 2025 ONSC 5595, respectively. Citing Rule 18.2(c), the respondent argues these recent cases should be considered new evidence.
25These legal authorities are not new evidence. However, I accept that the Divisional Court case is binding on the Tribunal, and so I will consider whether it would have changed the outcome of the decision.
26I do not find the respondent has shown how the Divisional Court ruling in Wais would likely impact the outcome of the present decision. As detailed above, the facts are not analogous to the present case. In the present case, the Tribunal determined that the applicant was advised that the third-party driver had a valid insurance policy with the respondent—a finding that allowed it to find a necessary nexus between the parties.
27Further, due to this “nexus”, I am satisfied that the Tribunal’s decision to rule on this accident benefits claim would not lead to the “unacceptable” result that the Divisional Court warned against in Wais at paragraph 11:
…The appellant is asking this court to endorse a novel interpretation of the [Schedule] that would lead to an unacceptable result where anyone involved in a motor vehicle accident in Ontario could apply to any auto insurance provider and, regardless of whether the person had motor vehicle insurance with, or any nexus to, that provider, the company would have to pay benefits under the [Schedule], subject to a subsequent priority dispute and determination. The Tribunal rejected such an interpretation and was correct in doing so.
28I find the respondent has not demonstrated grounds for reconsideration based on Rule 18.2(c).
Rule 18.2(b) – Error of Fact or Law
29Finally, turning to Rule 18.2(b), the respondent argues the Tribunal erred in finding the applicant was an “insured person”, as this conclusion required it to make a finding about priority. Further, the respondent claims that there is no reference in the decision to what part of the definition of “insured person” the applicant meets under s. 3 of the Schedule.
30I do not agree. As I found above, the Tribunal did not make a finding about priority. Rather, it concluded that the respondent had an obligation under the Regulation to respond to the applicant’s OCF-1. This is the finding that allowed the Tribunal to conclude it had jurisdiction over the disputed accident benefits.
31Therefore, even if the respondent believes the Tribunal erred in finding the applicant was an “insured person” (or, rather, that it did not address this part of its submissions), I am not satisfied that correcting these “errors” would likely impact the outcome. Questions about whether the applicant is considered an “insured person” for the purposes of a possible priority dispute fell outside the scope of this decision. Instead, the Tribunal followed the binding framework from Kingsway, and the respondent has not shown an error in this chain of reasoning.
CONCLUSION & ORDER
32The respondent’s request for reconsideration is dismissed.
Craig Mazerolle Vice-Chair
Released: January 22, 2026