RECONSIDERATION DECISION
Before: Craig Mazerolle, Vice-Chair
Licence Appeal Tribunal File Number: 24-010267/AABS
Case Name: TORYALAI SHIKH MATI v. Definity Insurance Company
Written Submissions by:
For the Applicant: Slavko Ristich, Counsel
For the Respondent: Maia Abbas, Counsel
OVERVIEW
1On March 25, 2026, the applicant requested reconsideration of the Tribunal’s decision released March 4, 2026 (“decision”).
2Stemming from an accident on January 26, 2024, 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.
3In his initial written submissions, the applicant informed the Tribunal that he was withdrawing all the substantive benefits in dispute, including a request for an attendant care benefit (“ACB”). As such, the only issues remaining were the requests for interest and an award. The Tribunal found he was not entitled to any interest or an award.
4The 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.
5Though he checked off all three criteria under Rule 18.2 on his Request for Reconsideration form, the applicant’s supporting submissions focused on Rule 18.2(b) and Rule 18.2(c). He is asking the Tribunal to find the “Respondent is liable to pay the maximum Award and interest on the Attendant Care benefit to the Applicant to date”.
6The respondent asks the Tribunal to dismiss the request for reconsideration.
RESULT
7The applicant’s request for reconsideration is dismissed.
ANALYSIS
8The 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(b) – Errors of Fact or Law
9The applicant has not established any errors that would trigger Rule 18.2(b).
10The applicant claims the Tribunal incorrectly found he “did not provide sufficient particulars of the Attendant Care services rendered”. Not only did he provide OCF-6s, but the applicant sent a letter to the respondent indicating that his wife was providing this care. Additionally, the applicant claims the Tribunal erred by concluding the respondent had asked for these particulars in its letters from 2024 and 2025. Finally, the applicant takes issue with the Tribunal’s statement at paragraph 20 of the decision that “the Applicant has not shown that the ACBs are payable”.
11In reply, the applicant made a finer point about the focus of these initial reconsideration submissions by claiming that the respondent “knows, or should know, that ACBs are payable in this case”.
12The core of the Tribunal’s analysis about the award is found at paragraphs 19 and 20:
I agree that an award requires, at a minimum, a foundation that benefits were payable and that the insurer’s non‑payment was unreasonable or delayed. The applicant has withdrawn his request for entitlement to ACBs, and on the record before me, the respondent determined that the “incurred” requirement was not met. It found that the OCF‑6 submissions did not sufficiently identify which attendant care services were provided, by whom, on which dates, and for how long, to establish receipt of the services and an incurred expense under section 3(7)(e), or to permit calculation of any economic‑loss cap under section 19.
Accordingly, even if jurisdiction were established under Vivekanantham, the applicant has not shown that the ACBs are payable and, in any event, has withdrawn the ACBs as an issue in dispute. As a result, I have no evidence before me that the respondent acted in an excessive, imprudent, stubborn, inflexible, unyielding, or otherwise immoderate manner in the handling of any benefits that were payable. The applicant has therefore not met the burden of proving that the respondent unreasonably withheld or delayed benefits and is not entitled to an award under section 10.
13Similar reasoning was relied upon to deny payment of interest, i.e., if there are no benefits owing, there can be no interest: see paragraph 21.
14Put another way, the applicant had to establish that payment of the ACB was owing before an award and interest could be granted. The respondent found it did not have sufficient particulars to satisfy itself that attendant care services had been incurred, so it did not issue any payment. Despite this ongoing disagreement between the parties, the applicant withdrew the ACB as an issue in dispute. Without any payment owing to the applicant (and without any payment that could be found as owing based on the issues remaining in dispute), the Tribunal dismissed his claims for an award and interest.
15I see no error in this approach. Section 280 of the Insurance Act, R.S.O. 1990, c. I.8, provides the Tribunal with the jurisdiction to address any “disputes” related to accident benefits. If there was no dispute over the ACB itself before the Tribunal, the Tribunal, in turn, did not have the jurisdiction to assess whether any ACB payment was owing to the applicant. Therefore, without any payment owing, the Tribunal correctly concluded there was no basis for either an award or interest.
16Further, even if I accepted the applicant’s claim that there was sufficient evidence to show the respondent unreasonably withheld payment of the ACB, the fact would remain that he had not established any ACB payment was owing. As such, even if the applicant could show the Tribunal erred in its approach to the ACB, the respondent’s document requests, etc., these alleged errors would likely not have impacted the outcome, because there was no issue in dispute that could establish that any such payment was owing.
17For instance, in reviewing his initial submissions from the written hearing, it is clear the applicant wanted the Tribunal to find the respondent should have accepted the financial disclosure from his wife as sufficient for the purpose of establishing these services had been incurred. He also challenged the reasonableness of the document requests the respondent made in its correspondence during this period.
18It is clear the Tribunal turned its mind to these financial records and arguments, as it commented on this part of the applicant’s written hearing submissions at paragraph 11 of the decision. However, despite this evidence, the Tribunal correctly returned to the fact that the respondent did not accept that any ACB amount was owing, and the applicant had removed this issue from the dispute. Once again, I see no error in this approach.
19In a similar vein, the applicant adds that the Tribunal erred by not mentioning the definition of “incurred” under s. 3(7)(e) of the Schedule. If there was no live dispute concerning whether any attendant care services had been incurred, there was no need for the Tribunal to address this legal definition.
20Finally, the applicant claims the Tribunal “disregarded the findings” from Vivekanantham v. Certas Direct Insurance Company, 2024 ONSC 6198. Though I accept that this case is binding (and that one of the principles laid out by the Court is that an award can be addressed as a stand-alone issue without any related entitlement findings), the facts of this dispute are not analogous.
21In Vivekanantham, the respondent found the applicant was entitled to certain benefits prior to the hearing. In the case at hand, the respondent accepted the applicant’s claim for an ACB, but it found there was no payment owing due to its conclusions about incurred services. While Vivekanantham addressed the Tribunal’s jurisdiction to issue an award based on delayed payments, the applicant has not established that there are any ACB payments owing.
22The applicant has not established grounds for reconsideration under Rule 18.2(b).
Rule 18.2(c) – Evidence Not Before the Tribunal
23The applicant has not established any grounds for reconsideration under Rule 18.2(c).
24To trigger Rule 18.2(c), a party must meet the following three-part test:
There is “evidence that was not before the Tribunal when rendering its decision”.
This evidence “could not have been obtained previously by the party now seeking to introduce it”; and,
This evidence “would likely have affected the result”.
26According to the applicant, the respondent did not raise “the issue of particulars to the ACBs” until after he had filed his initial written hearing submissions. As such, he was “not allotted a proper response”. He has included a series of attendant care invoices with his reconsideration request. They cover the period from January 26, 2024, to May 25, 2025. The final invoice was signed on August 3, 2025.
27I accept that these invoices were not before the Tribunal when it rendered its decision, but I am not satisfied that the applicant has met the other two parts of the Rule 18.2(c) test. Not only do most of these invoices predate the filing of his initial and reply submissions, but the applicant has the onus to demonstrate entitlement to an award and interest. It is not the role of the respondent to inform him of what documents he might need to meet his onus. Further, and following on the reasons detailed above, it is not clear how the invoices would likely have impacted the outcome of the decision. Once again, by removing the ACB as an issue in dispute, the Tribunal did not have the jurisdiction to assess whether the applicant was owed payment of this benefit, and, by extension, payment of an award and interest.
28Taken together, the applicant has not satisfied me that any of his grounds for reconsideration meet the standard under Rule 18.2.
CONCLUSION & ORDER
29The applicant’s request for reconsideration is dismissed.
Craig Mazerolle
Vice-Chair
Released: June 4, 2026