People injured in motor vehicle collisions in Ontario may be entitled to various Accident Benefits through their own insurance companies, even if they were at fault for the collision. This ‘Accident Benefits’ system is governed by the Insurance Act and the regulations under it, including the Statutory Accident Benefits Schedule.
Insurers regularly deny various accident benefits claims such as income replacement benefits, medical and rehabilitation benefits, and non-earner benefits, among others. Many times, these denials are not reasonable, which would then lead the injured person to dispute the denials. These denials are not disputed in the regular court system, but in the Licence Appeal Tribunal (LAT). If the dispute is not settled, the LAT will look at all the evidence submitted by the injured person and the responding insurer and make a decision as to whether the denial was reasonable and should be maintained, or if it was unreasonable and should be overturned. The LAT holds hearings in writing, orally, or in a hybrid manner to determine these issues.
Once the LAT provides its decision, you should review the decision and the reasons provided within it to see if the decision itself was reasonably arrived at. Sometimes the LAT makes a mistake in its decision-making process, such as overlooking a key piece of evidence or failing to apply the correct law.
If you believe the LAT made a mistake which led to the wrong decision being made, you have the right to ask for a “Reconsideration” of their decision.
Reconsideration constitutes a discretionary authority, and Rule 18 of the LAT Rules establishes a the standard for the Tribunal to exercise this authority. It is a limited, error-correcting process rather than a whole new hearing or an appeal. The purpose is to rectify significant errors or fundamental evidentiary concerns.
A request for reconsideration will not be granted merely because a party disagrees with the decision and wants to re-argue their case.
To initiate a Request for Reconsideration:
- The requesting party must complete the prescribed form available on the Tribunal's website.
- Supporting submissions, limited to ten (10) double-spaced pages, must be provided, demonstrating how the decision falls within the categories specified in Rule 18.2.
Requests for reconsideration must be in writing, unless a party can prove that a written format would cause significant prejudice or has an approved accommodation request under the Human Rights Code.
The request form and accompanying submissions must be filed with the Tribunal and served on other parties within 21 days of the decision date, as per Rule 5.
Rule 18.1 specifies that requests for reconsideration are accepted only for Tribunal decisions that ultimately conclude an appeal. Decisions and orders related to ongoing proceedings, such as production orders and adjournment orders, are not eligible for reconsideration.
The Reconsideration Process involves two steps:
- Screening the Reconsideration Request: The Tribunal assesses whether it will adjudicate the request based on Rule 18.1 requirements, its relevance to a decision concluding an appeal, and how it aligns with the criteria in Rule 18.2. If these requirements are not met, the request is dismissed, and the parties receive confirmation of the dismissal.
- Adjudicating the Reconsideration Request: If the screening stage is satisfied, the Tribunal reviews the merits of the reconsideration request. The Tribunal Chair or delegate may assign it to the original member or a different one, and the decision is made through a written hearing. Before making an order under Rule 18.4(b), the Tribunal seeks responding submissions and/or reply from the parties. The Tribunal may dismiss a request under Rule 18.4(a) without requesting submissions.
If you are dealing with the LAT and need the assistance of an experienced lawyer, please contact our team at JEWELL RADIMISIS JORGE LLP for a free initial consultation at 1 (855) 546-2525.