21-002201/AABS

Licence Appeal Tribunal File Number: 21-002201/AABS

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:

Basir Ahmad

Applicant

and

Economical Insurance Company

Respondent

DECISION

ADJUDICATOR:

Ulana Pahuta

APPEARANCES:

For the Applicant:

Arvin A Gupta, Counsel

For the Respondent:

Suzanne Armstrong, Counsel

HEARD:

BY WAY OF WRITTEN SUBMISSIONS

OVERVIEW

1Basir Ahmad, the applicant, was involved in an automobile accident on December 6, 2019, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”). The applicant was denied benefits by the respondent, Economical Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

2A case conference was held on August 11, 2021 and a written hearing was scheduled for April 29, 2022. Pursuant to the Case Conference Report and Order dated August 12, 2021 (“CCRO”), the applicant’s submissions and evidence were due March 18, 2022. His reply submissions were due April 15, 2022. The applicant did not file any initial or reply submissions prior to the written hearing date. The respondent filed its submissions for the hearing in accordance with the deadlines prescribed by the CCRO.

3On May 6, 2022, approximately one week after the written hearing date, the applicant filed his written hearing submissions. The respondent objected to the applicant’s late filing of his submissions.

ISSUES

4The issues in dispute were identified in the CCRO as follows:

i. Are the applicant’s injuries predominantly minor as defined in s. 3 of the Schedule and therefore subject to treatment within the $3,500.00 limit and in the Minor Injury Guideline (“MIG)?

ii. Is the applicant entitled to $1,302.19 for chiropractic treatment, proposed by Reddy’s Physio and Rehab in a treatment plan (“OCF-18”) denied on March 17, 2020?

iii. Is the applicant entitled to interest on any overdue payment of benefits?

RESULT

5The applicant has not met his onus to prove that his accident-related impairments warrant removal from the MIG or that the treatment plan in dispute is reasonable and necessary.

6As no benefits are owing, no interest is payable.

7The application is dismissed.

ANALYSIS

No Submissions or Evidence Filed by the Applicant Prior to the Written Hearing

8The parties agreed at the August 11, 2021 case conference that the applicant would file his written hearing submissions and evidence with the Tribunal by March 18, 2022 and any reply submissions by April 15, 2022.

9The Tribunal did not receive any submissions or evidence from the applicant prior to these deadlines. The respondent filed its submissions on April 1, 2022 in accordance with the deadline set in the CCRO. The applicant did not contact the Tribunal to request an extension of time for filing his written submissions, even after receiving the respondent’s written submissions on April 1, 2022. The applicant further did not file any Motion to request an adjournment or rescheduling of the written hearing date.

10The date of the written hearing was identified in the CCRO as being April 29, 2022. Further, the Tribunal sent a Notice of Written hearing on February 1, 2022 reminding the parties of the written hearing date and the deadlines for their respective submissions. As such, the applicant was clearly aware of the deadlines for submissions and the written hearing date.

11On May 6, 2022, approximately one week after the written hearing date, the applicant filed his written submissions. No explanation was provided by the applicant as to the late filing. The respondent objected to the late filing of the applicant’s submissions, by letter dated May 6, 2022, noting that the written hearing date had already passed. The respondent submitted that it had been forced to provide its own submissions on April 1, 2022 in accordance with the deadline contained in the CCRO, without having the benefit of reviewing the applicant’s submissions. The applicant did not provide the Tribunal with any reply or rebuttal to the respondent’s objection to the late filing.

12To date, the applicant has not given any reason why he should be allowed to provide submissions and evidence after the written hearing date. The applicant could have sought an Order from the Tribunal to permit the late filing of his submissions before the hearing was held but did not do so.

13I find the respondent was prejudiced in its ability to properly mount a defense by the late filing of the applicant’s submissions and evidence. To consider the applicant’s submissions provided after the written hearing, would be unduly prejudicial to the respondent and contrary to procedural fairness, as required under Rule 3.1(a) of the Tribunal’s Common Rules of Practice & Procedure. Tribunal orders, including those to which the parties agreed and were summarized in the CCRO, are not merely suggestions; they are orders to be complied with, failing which a noncompliant party risks a result that they may not like. Therefore, the applicant’s written submissions were not considered as part of the written hearing.

14Since the applicant failed to provide any written submissions and evidence for this written hearing by the hearing date of April 29, 2022, there was no evidence to support the applicant’s application at the written hearing. The applicant bears the onus of proving that his injuries are not minor and that the proposed treatment plan is reasonable and necessary on a balance of probabilities.

15Given the absence of any evidence, I find that the applicant has not met his burden to prove that his injuries require treatment beyond the MIG or that the disputed treatment plan is reasonable and necessary.

Interest

16Section 51 of the Schedule states that interest is due on a benefit that is overdue if the insurer does not pay the benefit within the time stated by the Schedule.

17As no benefits are overdue, no interest is payable under s.51.

ORDER

18The applicant has failed to prove on a balance of probabilities that his accident-related impairments warrant removal from the MIG or that he is entitled to the treatment plan in dispute. As no benefits are owing, no interest is payable.

19The application is dismissed.

Released: April 26, 2023

__________________________

Ulana Pahuta

Adjudicator