Leslie Coleman v. TD General Insurance Company, 2023 CanLII 40114

Licence Appeal Tribunal

File Number: 20-009964/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:

Leslie Coleman

Applicant

and

TD General Insurance Company

Respondent

DECISION

ADJUDICATOR: Ulana Pahuta

APPEARANCES:

For the Applicant: No submissions provided

For the Respondent: No submissions provided

HEARD: By Way of Written Submissions

OVERVIEW

1Leslie Coleman, the applicant, was involved in an automobile accident on March 18, 2017, 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, TD General Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

2A case conference was conducted on March 3, 2022, with both parties in attendance. A written hearing was scheduled for October 31, 2022 and specific written hearing submission deadlines were set. According to the Case Conference Report and Order (“CCRO”), the applicant was required to provide initial written submissions by September 19, 2022 and written reply submissions by October 17, 2022.

3The applicant failed to comply with the CCRO by failing to provide any submissions by the deadlines imposed by the Tribunal.

4On September 16, 2022, the applicant’s legal representative sent an email communication to the Tribunal indicating that the matter had been resolved and that a Notice of Withdrawal would follow shortly. On September 22, 2022 and on March 30, 2023, the Tribunal sent email reminders, requesting that a Notice of Withdrawal be filed.

5No further response was received from the applicant or her legal representative and no Notice of Withdrawal has been filed to date. The applicant has been given multiple opportunities to provide submissions, a Notice of Withdrawal or any procedural update regarding her application, and has failed to do so.

ISSUES

6The issues in dispute are:

i. Is the applicant entitled to $1,819.10 for physiotherapy, proposed by Shawn Roy in a treatment plan denied on September 17, 2019?

ii. Is the applicant entitled to $6,186.42 for a chronic pain program, proposed by Joseph Csumrik in a treatment plan denied on November 26, 2019?

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

RESULT

7The application is dismissed. The applicant has not provided any submissions, nor met her evidentiary burden to establish that the treatment plans in dispute are reasonable and necessary.

ANALYSIS

8The onus is on the applicant to demonstrate that she is entitled to the benefits claimed. She made no submissions and tendered no evidence in support of her claims before the Tribunal.

9Given the applicant’s failure to provide a Notice of Withdrawal and failure to provide any hearing submissions or evidence, I find that the applicant has not met her evidentiary burden with regard to the issues in dispute. The application shall be dismissed.

ORDER

10The applicant has not met her evidentiary burden to establish that the treatment plans in dispute are reasonable and necessary pursuant to the Schedule. As a result, she is not entitled to these benefits, nor applicable interest.

11The application is dismissed.