RECONSIDERATION DECISION
Before: Craig Mazerolle, Vice-Chair
Licence Appeal Tribunal File Number: 23-015468/AABS
Case Name: Bishnu Bisnauth v. Jevco Insurance
Written Submissions by:
For the Applicant: No submissions received
For the Respondent: Asal Karimi, Counsel
OVERVIEW
1On December 24, 2025, the respondent requested reconsideration of the Tribunal’s decision released December 8, 2025 (“decision”).
2Stemming from an accident on June 30, 2019 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 remained within the Minor Injury Guideline (“MIG”). However, it further determined that he was entitled to payment, plus interest, of the disputed treatment plans due to s. 38 of the Schedule. The award claim was denied.
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 Rule 18.2(a) and Rule 18.2(b) to support its request. It is seeking an order finding the applicant is not entitled to payment of the plans.
RESULT
5The respondent’s request for reconsideration is dismissed.
PROCEDURAL ISSUE – APPLICANT’S SUBMISSIONS
6The applicant did not file any responding submissions in accordance with the deadline set out by the Tribunal.
7Following this deadline, applicant’s counsel wrote to inform the Tribunal that its order asking for submissions “was initially sent to a lawyer at our firm who is not associated with this claim” (e-mail dated March 12, 2026). Counsel asked for permission to file responding submissions.
8In response, the Tribunal informed the applicant that a Notice of Motion was needed to process his request.
9To date, the applicant has not submitted a Notice of Motion, nor has he filed any reconsideration submissions. In light of the opportunities that the Tribunal has provided the applicant to participate in this stage of the proceeding, I have decided to proceed with my review of the reconsideration request without the benefit of his response.
ANALYSIS
10The 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.
Rule 18.2(a) – Procedural Fairness
11The respondent claims the Tribunal breached its right to procedural fairness by relying on a case “without affording either party the opportunity to make submissions on its applicability.” Specifically, the respondent takes issue with the comment made at paragraph 92 of the decision: “While the parties did not raise Aviva Insurance Company of Canada v Danay Suarez, 2021 ONSC 6200 in this proceeding, it is a decision of the Divisional Court and is binding upon me.” According to the respondent, the Tribunal should have reached out to the parties for clarification or further submissions if it believed Suarez was determinative.
12I do not agree. As the Tribunal correctly stated in the decision, Suarez is binding on its assessment of alleged breaches of s. 38(8), as well as the potential remedies flowing from these breaches. Regardless of whether the parties cited this case, it was imperative for the Tribunal to follow this ruling that directly applies to the subject matter in dispute. Moreover, this case was released several years prior to this written hearing, and it is now a well-established part of the case law involving s. 38 denials. Parties are expected to know the current state of the law, so I see no reason why the respondent could not have commented on this case in its written hearing submissions.
13Taken together, the respondent has not shown how the Tribunal breached its right to procedural fairness by relying on this binding decision.
Rule 18.2(b) – Error of Fact or Law
14The respondent raises two errors with the Tribunal’s assessment of its denials. I will address them in turn.
15First, by highlighting how the decision was released following the 260-week mark post-accident, the respondent claims the Tribunal erred in finding that any payment of these plans is owing based on s. 38(11) of the Schedule. Since there is no evidence that these plans were incurred prior to the 260-week mark, the respondent argues that s. 20(1)(a) is a bar to any payment that could be ordered under s. 38(11).
16I do not find the respondent has shown how the Tribunal erred by ordering that payment of these plans will be owing if the services and items contained therein are incurred after the 260-week mark.
17First, it is unclear whether this argument was raised as part of the respondent’s written hearing submissions. Parties are expected to put their best foot forward during the hearing, as the reconsideration process is not a venue for presenting new arguments that could have been reasonably raised at an earlier stage.
18There is a reference to the age of the claim at paragraph 40 of the respondent’s submissions: “The Applicant has not led any evidence that any of the treatments plans in dispute have been incurred over 5.5 years post-Accident…”. However, this comment was not connected to the limit on payments pursuant to s. 20(1)(a). Rather, it seems the respondent was highlighting this lack of evidence to counter the applicant’s argument for immediate payment. It was not arguing that he was barred from ever incurring these plans due to s. 20(1)(a).
19I also note that this comment does not appear to have been an argument about s. 20(1)(a), since the respondent submits on reconsideration that allowing for payment under s. 38(11) in these circumstances unfairly deprived the parties the ability to argue about s. 20(1)(a). Not only was this argument open to the respondent to make during the written hearing, but this submission is further confirmation that it did not present any arguments during the written hearing about s. 20(1)(a) as a potential bar to payments under s. 38(11).
20Regardless, I am not satisfied that the respondent has established that s. 20(1)(a) is a barrier to payments under s. 38(11). This interpretation is narrow and not in line with the consumer protection mandate underpinning the Schedule.
21Section 20(1)(a) sets the following limit on payments for insured persons who have not sustained a catastrophic impairment or who have not purchased optional benefits:
Subject to subsection (2), no medical, rehabilitation and attendant care benefit is payable for expenses incurred,
(a) more than 260 weeks after the accident, in the case of an insured person who was at least 18 years of age at the time of the accident…
22Section 38(11) sets out the remedies if an insurer has breached s. 38(8):
If the insurer fails to give a notice in accordance with subsection (8) in connection with a treatment and assessment plan, the following rules apply:
The insurer is prohibited from taking the position that the insured person has an impairment to which the Minor Injury Guideline applies.
The insurer shall pay for all goods, services, assessments and examinations described in the treatment and assessment plan that relate to the period starting on the 11th business day after the day the insurer received the application and ending on the day the insurer gives a notice described in subsection (8).
23Interpretation of the Schedule is guided by the modern principle of statutory interpretation. This principle is best articulated by the Supreme Court of Canada in Rizzo & Rizzo Shoes Ltd. (Re), 1998 CanLII 837 (SCC), at para. 21:
Today there is only one principle or approach, namely, the words of an Act are to be read in their entire context and in their grammatical and ordinary sense harmoniously with the scheme of the Act, the object of the Act, and the intention of Parliament.
24It is not enough to look at the words before you. You must engage with the context, scheme, object, and legislative intent behind the statute. It is well established that consumer protection sits at the heart of the Schedule, so any interpretation must consider this goal: see, for example, Kellerman-Bernard v. Unica Insurance Company, 2023 ONSC 4423. I also note that the courts have instructed decision-makers to ensure that the Schedule is not interpreted in a manner that would produce absurd results: see Tomec v. Economical Mutual Insurance Company, 2019 ONCA 882 (“Tomec”), at para. 46.
25Starting with the wording, there are two rules that apply to the remedies under s. 38(11). First, the MIG does not apply to the denial of the plan at issue. Second, the insurer “shall pay for all” goods and services “that relate to” the period laid out in this provision. Section 38(11) does not contain any reference to s. 20(1)(a), and the use of mandatory language (like “shall pay”) alongside expansive wording (like “for all” and “that relate to”) suggest the Legislature intended this remedy to apply with few limits.
26This reading also aligns with the role of s. 38(11) within the larger context of the Schedule. First, s. 38(11) is a remedial avenue for insured persons to access medical/rehabilitation funding. It falls outside of the normal scope of how these funds are allocated, as it seeks to ensure that requests are addressed in a timely and justifiable manner. This expediency and justification are closely aligned with the object of the Schedule, i.e., “provide fair compensation and minimize economic disruption in the lives of accident victims”: see Tomec, at para. 43.
27Taken together, it makes sense that the application of s. 38(11) would stand outside of the normal course of adjusting a claim for benefits, as a widely applicable remedy for s. 38(8) breaches is necessary to meet the purpose of the Schedule. In other words, interpreting this remedy to be constrained by s. 20(1)(a) would frustrate this object.
28I also note that there is no reference to s. 38(11) in s. 20(1)(a). This silence is further support for the position that this limit does not apply to s. 38(11).
29Finally, though this outcome may not quite reach the level of absurdity that the Court warned against in Tomec, allowing insurers to ignore their s. 38(8) obligations for claims made in and around the 260-week mark would result in an outcome that is strongly at odds with the consumer protection mandate.
30Taken together, I do not find the respondent has shown the Tribunal erred by not applying the limit from s. 20(1)(a) to the remedy available under s. 38(11).
31Second, the respondent takes issue with the Tribunal’s interpretation of its denials. It claims the Tribunal erred by finding they did not meet the obligation under s. 38(8) for “medical and any other reasons”. According to the respondent, this finding is not in line with other cases where referencing the MIG was sufficient: see Lawrence v. Intact Insurance Company, 2025 CanLII 55810 (ON LAT) (“Lawrence”). Moreover, the respondent points out that the Tribunal concluded in this present decision that the applicant remained in the MIG, a determination that “supports the sufficiency of the Respondent’s reliance on this reason”.
32I find this ground is an attempt to have the Tribunal re-weigh evidence that was considered at first instance. The reconsideration process is not a venue for parties to seek a different weighing of the evidence from the hearing. Rather, they must show there was a factual or legal error in this evidentiary assessment.
33In this case, the Tribunal provided a comprehensive assessment of the denial letters at issue, and it explained why it preferred the applicant’s position. This analysis also considered case law that focused on the use of the MIG as a reason for the denial. For instance, at paragraphs 53 and 54, the Tribunal found:
The respondent relies on Fernandez v Certas 2023 CanLII 65812. It submitted that in this case, the adjudicator agreed that a notice under section 38(8) was sufficient if it said that an insurer was maintaining a claimant was in the MIG in the absence of medical documentation it had requested. I do not agree that this is a correct interpretation of sufficient notice under the Schedule.
Firstly, the Fernandez case did not analyze any of the factors in B.H. and T.F. to determine whether there was sufficient notice given. I have confirmed I am persuaded by the factors in these cases. Second, the respondent in this case did not tell the applicant in this case that it would be maintaining its denial in the absence of medical documentation as occurred in the Fernandez case. Third, even if the respondent had made that statement, it would not satisfy the elements of sufficient reasons outlined in B.H. and T.F. And finally, even when the respondent did receive the clinical notes and records of the applicant, it did not confirm it had read and considered them, or make any reference to their contents, when reiterating its denials.
34The respondent may disagree with this approach, but this complaint appears to be a disagreement with the Tribunal’s assessment of the denials and its application of the case law. Adjudicators are empowered to assess different aspects of the evidentiary record to see how they fit within (and compare to) the relevant legal tests. Unless a requesting party can show that a part of this analysis is legally impermissible or factually incorrect, these findings will not be disrupted on reconsideration.
35Further, though the respondent may claim the decision is not in line with other cases (such as Lawrence), the analytical exercise at play when assessing the reasons for a denial is highly fact-specific. The nature of these assessments necessarily requires an adjudicator to consider the sufficiency of the reasons in the specific context of the case at hand. For instance, one of the elements that the Tribunal considered when assessing the sufficiency of the respondent’s denial letters was the documents that the parties had exchanged—a set of facts that is highly specific to this case: see, e.g., at paragraphs 31 and 37. Therefore, in addition to the fact that Tribunal cases are not binding, I find there is little guidance that other cases may provide an adjudicator who is considering a specific set of denial letters.
36Taken together, I find the respondent has not established any errors that would trigger Rule 18.2(b).
CONCLUSION & ORDER
37The respondent’s request for reconsideration is dismissed.
Craig Mazerolle
Vice-Chair
Released: June 3, 2026