A Licence Appeal Tribunal reconsideration has sent a Gore Mutual accident benefits case back for a new hearing over unaddressed medical evidence.
The Tribunal has granted a claimant's request for reconsideration of a decision that held him to the Minor Injury Guideline, finding it failed to address his family physician's evidence of a psychological impairment. Vice-Chair E. Louise Logan cancelled the original findings on the guideline, the disputed treatment plans and interest, and ordered a rehearing before a different adjudicator.
In the underlying decision, dated June 4, 2026, the Tribunal held the claimant subject to the Minor Injury Guideline, found the disputed treatment plans not payable, and denied interest and an award. The claimant requested reconsideration on June 8, 2026, arguing the Tribunal made an error of law or fact that would likely have changed the outcome.
The claimant had argued a psychological impairment, including adjustment disorder with mixed anxiety and depressed mood and a specific phobia related to being a passenger, should remove him from the guideline. He pointed to his family physician's clinical notes, which included a November 6, 2024 referral for counselling following a depression screening that the Tribunal's reasons describe as indicating clinically significant symptoms, along with a psychological assessment conducted under section 25.
The original decision's findings relied on a psychological assessment obtained by Gore Mutual, which found the claimant's self-reported symptoms overstated and inconsistent with his functioning, and concluded he remained subject to the guideline. Vice-Chair Logan found the Tribunal's reasons did not mention the family physician's records anywhere in that findings section, even though the claimant had relied on them.
Gore Mutual argued the claimant was attempting to re-litigate the case, and that the Tribunal had referenced the family physician's evidence elsewhere in the decision, in a summary of the parties' submissions. Vice-Chair Logan rejected that argument, pointing to the Supreme Court of Canada's guidance in Vavilov that a decision-maker's reasons must meaningfully grapple with the key issues a party raises. Referencing a submission while summarizing positions was not enough, she found, when the Tribunal's actual findings never returned to it.
The insurer also argued the claimant should have resubmitted the family physician's records with his reconsideration request. Vice-Chair Logan disagreed, noting the evidence was already part of the original hearing record. The reconsideration decision, released September 1, 2026, cancels the findings on the guideline, the treatment plans and interest, and sends those issues back for a rehearing based on the existing record. The claimant's earlier request for an award was not part of the reconsideration and will not be reheard.
