A.R. v. Aviva General Insurance
Release date: 2021/03/16
In the matter of an Application pursuant to subsection 280(2) of the *Insurance Act*, RSO 1990, c I.8., in relation to statutory accident benefits.
Between:
[AR]
Applicant
and
Aviva General Insurance
Respondent
DECISION
ADJUDICATOR:
Jesse A. Boyce, Vice-Chair
APPEARANCES:
For the Applicant:
No submissions
For the Respondent:
Ramandeep Pandher, Counsel
HEARD:
by way of Written Submissions
OVERVIEW
1The applicant was involved in an automobile accident on January 14, 2017, and sought benefits from the respondent, Aviva, pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (the ''Schedule'').1
2The Case Conference Order dated September 16, 2019 scheduled a written hearing for March 30, 2020. A Notice of Written Hearing was provided to the applicant and his representative outlining submission dates. The applicant’s initial written submissions were to be filed on February 18, 2020. However, the applicant never filed written submissions and, despite several attempts by the Tribunal to contact him—as well as several inquiries for same from Aviva—the applicant has not participated in the proceedings and has not presented a case.
ISSUES IN DISPUTE
3The issues in dispute were identified as follows:
i. Is the applicant entitled to a medical benefit in the amount of $2,723.44 for chiropractic treatment recommended by [a Health Centre] in a treatment plan submitted on July 26, 2017 and denied on October 26, 2017?
ii. Is the applicant entitled to a cost of examination in the amount of $1,598 for fluoroscopy assessment recommended by [Central Diagnostics] in a treatment and assessment plan submitted on July 10, 2017 and denied on October 26, 2017?
iii. Is the applicant entitled to a cost of examination in the amount of $2,000 for attendant care assessment recommended by [Central Diagnostics] in a treatment and assessment plan submitted on March 5, 2017 and denied on July 24, 2017 and denied on October 26, 2017?
iv. Is the applicant entitled to a cost of examination in the amount of $2,150 for psychological assessment recommended by [Central Diagnostics] in a treatment and assessment plan submitted on March 24, 2017 and denied on March 27, 2017?
v. Is the applicant entitled to a cost of examination in the amount of $2,000 for chronic pain assessment recommended by [Central Diagnostics] in a treatment and assessment plan submitted on December 19, 2017 and denied on January 10, 2018?
vi. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
4The application is dismissed, as the applicant has abandoned his application.
ANALYSIS
5It has been nearly one year since the written hearing was scheduled to proceed. The applicant did not file written submissions or a reply by his deadline and did not present a case. He did not respond to communications from the Tribunal. Aviva requests that the application be dismissed as abandoned.
6I agree and find that the applicant has abandoned his application. Despite proper notice and multiple attempts to prompt his participation, the applicant has not taken any steps to demonstrate that he intends to proceed. Further, and in any case, it is well-settled that the applicant bears the burden of demonstrating entitlement to the benefits he seeks on a balance of probabilities. As he has not made submissions or filed evidence, he has also failed to meet his burden. Accordingly, he is not entitled to payment for the benefits in dispute.
7In its motion, Aviva requested an opportunity to make submissions on costs pursuant to Rule 19 of the Tribunal’s Common Rules of Practice and Procedure. If it elects to do so, Aviva shall provide its costs submissions to the Tribunal within 10 business days. Submissions should not exceed two pages in length and shall set out the reasons for its request and the particulars of the applicant’s conduct that are alleged to be unreasonable, frivolous, vexatious, or in bad faith.
ORDER
8The application is dismissed. Aviva shall provide its costs submissions, if any, to the Tribunal within 10 business days.
Date of Issue: March 16, 2021
Jesse A. Boyce, Vice Chair
Footnotes
- O. Reg. 34/10, as amended.