RECONSIDERATION DECISION
Before: Craig Mazerolle, Vice-Chair
Licence Appeal Tribunal File Number: 24-012487/AABS
Case Name: Sylvie Chayer - Charron v. Definity Insurance Company
Written Submissions by:
For the Applicant: Matthew J. Gervan, Counsel
For the Respondent: Joshua Vickery, Counsel
OVERVIEW
1On April 28, 2026, the respondent requested reconsideration of the Tribunal’s decision released April 8, 2026 (“decision”).
2Stemming from an accident on April 1, 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 payment of a chiropractic services treatment plan, plus interest. It further concluded that the applicant was entitled to an award based on this plan. The Tribunal dismissed the applicant’s request for a non-earner benefit (“NEB”).
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(b) to support its request. This request is limited to the award, as the respondent is asking the Tribunal to set aside this part of the decision.
5The applicant asks the Tribunal to dismiss the 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.
8The core of the Tribunal’s award analysis is found at paragraphs 72 – 75 of the decision (emphasis added):
The applicant submitted that the respondent unreasonably delayed payment of benefits because the insurer’s assessors confirmed her physical condition and the denial of benefits prolonged her hardship. The respondent made no submissions in respect to an award.
I find that the applicant is entitled to an award in the amount of $1,300.00 because the respondent unreasonably withheld approval of the chiropractic treatment plan. Pursuant to section 10 of Reg. 664, an award of up to 50% of the amounts withheld may be payable by the respondent if it is determined that it unreasonably withheld or delayed payment of a benefit. Awards are determined on an individual basis and generally depend on a finding that the respondent’s withholding or delay was excessive, imprudent, stubborn, inflexible, unyielding, or immoderate.
I note the respondent commissioned the assessment that provided the evidentiary basis the chiropractic treatment plan was reasonable and necessary. I find this assessment was completed by the insurer’s assessor and was within the knowledge and control of the insurer at all relevant times. I find that the insurer is deemed to know the contents of its s.44 reports and must adjust accordingly on an ongoing basis. Mr. Iyengar’s OT report in July 2024 found there was pain relief from chiropractic treatment. I find that the insurer neglected its duty to continually adjust its file on a good faith basis. Accordingly, I find that the insurer held within its knowledge its own s.44 report that provided evidence that the chiropractic treatment plan was reasonable and necessary and that the insurer was derelict in its duty to continuously adjust the file; for these reasons I find that the respondent’s withholding or delay was excessive, imprudent, stubborn, inflexible, unyielding, or immoderate.
I find an award of 50% is appropriate in these circumstances, as the insurer had full knowledge and control of information on the determination of the benefit. I assess the respondent’s liability for an award to be $1,300.00 payable to the applicant.
Misapprehension of the Evidence
9First, the respondent claims the Tribunal misinterpreted the results of Mr. Iyengar’s report. Not only was this assessment commissioned to review the NEB, but the respondent disputes the Tribunal’s determination that Mr. Iyengar “found there was pain relief from chiropractic treatment”. The respondent submits that this assessor only reported the applicant’s subjective belief that this treatment provides her with symptom relief. Further, the respondent highlights how this report only formed a part of the documentary basis that its assessor, Dr. Vidya Sreenivasan, used to assess the reasonable and necessary nature of the chiropractic services treatment plan. As such, it appropriately followed Dr. Sreenivasan’s conclusion that this plan was not reasonable and necessary.
10I do not accept this ground for reconsideration. Though the respondent may disagree with the Tribunal’s reading of the medical evidence (and, in turn, the adjusting of the plan), this submission is, in effect, a request to re-weigh the parties’ evidence. Adjudicators are entitled to consider different aspects of the hearing record when assessing the relative weight it will assign to specific pieces of evidence. Unless a requesting party can show that a factor is legally impermissible (or that a finding is factually incorrect), these evidentiary assessments will not be disrupted on reconsideration.
11Further, when the Tribunal was addressing Mr. Iyengar’s report at an earlier section of the decision, it is clear that it understood this claim of pain relief to be something that was “noted”, not “opined” upon by the assessor (at paragraph 66, emphasis added): “… I have reviewed the report of Mr. Iyengar, OT, dated July 12, 2024 detailing that rest and chiropractic therapy was noted to relieve pain, although without sustained improvement since the accident.”
12Finally, even if I accepted the respondent’s position that a more accurate reading of Mr. Iyengar’s report was to say, something like, he “recorded” the applicant’s claim of pain relief, I do not see how correcting this error would likely have altered the outcome. The Tribunal’s reasons show it took issue with what it found to be the respondent’s disregard of the medical evidence it had in its possession. Therefore, even if the Tribunal listed the OT report as a subjective account of pain relief, I am not satisfied that this change would likely have altered its understanding of the respondent’s adjusting practices. Instead, it is likely that the Tribunal’s overarching concerns with the respondent’s handling of the available medical evidence would have persisted.
Application of the Award Standard and Reasons
13Second, the respondent contends that the Tribunal improperly granted an award in these circumstances. As opposed to identifying any misconduct or inflexibility on its part, the respondent argues that the Tribunal incorrectly focused on the finding that it should not have denied the treatment plan. According to the respondent, disagreement with an insurer’s adjusting choices is not sufficient to establish an award.
14Again, I find these grounds for reconsideration are a dispute with the Tribunal’s weighing of the evidence. The Tribunal understood the legal test for granting an award, and it assessed the parties’ evidence and arguments when determining whether the applicant had met this test. The respondent may disagree with this weighing of the evidence, but disagreement alone is not sufficient to trigger Rule 18.2(b).
15I also note that, as the Tribunal itself observed at paragraph 72 of the decision, the respondent did not address the award request in its written hearing submissions. Parties are expected to put their best foot forward during the hearing, as reconsideration is not a venue for presenting new arguments that could have been reasonably raised at an earlier stage.
16Further, it is important to recognize that awards are highly discretionary in nature. Both the wording of s. 10 of O. Reg. 664, as well as their purpose within the larger accident benefits regime, both indicate that awards are meant to be flexible remedies that the Tribunal can use to address concerns with an insurer’s adjusting practices. Therefore, though I accept that the standard under s. 10 is a high one, I also recognize that adjudicators are entitled to a high level of deference when they choose to engage with this discretionary remedy.
17As a final note, the respondent briefly mentioned at the end of its initial reconsideration submissions that “no reasons were given by the Tribunal” to explain why the maximum 50% award was merited. It reiterated this point in its reply, claiming there is not “sufficient analysis explaining why the maximum available award was warranted in the circumstances”.
18Beyond the fact that the Tribunal did provide a justification for this quantum (i.e., the knowledge that the respondent had when it made its determination about the treatment plan), this reading of the decision is overly narrow. Though the quantum was only directly addressed at paragraph 75, I find the Tribunal provided a more detailed account of the available medical evidence when it assessed the applicant’s entitlement to the chiropractic services treatment plan from paragraphs 64 – 68. When these reasons are read in tandem with the specific section of the decision involving the award, I am satisfied that the Tribunal provided an adequate explanation for why the award was granted, as well as the 50% quantum.
19Taken together, I find the respondent has not established an error that meets the standard of Rule 18.2(b).
CONCLUSION & ORDER
20The respondent’s request for reconsideration is dismissed.
Craig Mazerolle
Vice-Chair
Released: June 15, 2026