Licence Appeal Tribunal File Number: 21-005523/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:
James Maikuri
Applicant
and
Intact Insurance Company
Respondent
DECISION
ADJUDICATOR:
Tanjoyt Deol
APPEARANCES:
For the Applicant:
Marc Golding, Paralegal
For the Respondent:
Nickola Haddad, Counsel
HEARD:
By way of written submissions
OVERVIEW
1James Maikuri (“the applicant”) was involved in an automobile accident on December 12, 2018 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 Intact Insurance Company, (“the respondent”) and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
PRELIMINARY ISSUE
2As per the Case Conference Order of Vice Chair Aquilina, the below preliminary issue is in dispute:
i. Is the applicant barred from proceeding with his claim for a non-earner benefit and the cost of examinations as he failed to notify the respondent of the circumstances giving rise to the benefits pursuant to section 55 of the Schedule?
SUBSTANTIVE ISSUES
3The issues in dispute are:
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”)?
Is the applicant entitled to a non-earner benefit of $185.00 per week from January 12, 2018 to December 12, 2020?
Is the applicant entitled to cost of examinations proposed by Princeton Hills Medical Assessments, as follows:
(i) $2,520.00 for an Orthopaedic Assessment, in a treatment plan submitted on February 11, 2019; and
(ii) $2,204.92 for a Psychological Assessment, in a treatment plan submitted on February 11, 2019?
- Is the applicant entitled to medical benefits proposed by Mackenzie Medical Rehabilitation Centre, as follows:
(i) $1,977.05 for chiropractic treatment, in a treatment plan submitted on April 24, 2019;
(ii) $3,696.50 for chiropractic treatment, in a treatment plan submitted on March 28, 2019; and
(iii) $1,977.05 for chiropractic treatment, in a treatment plan submitted on July 4, 2019?
- Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
4The application is dismissed. The applicant has not met his evidentiary burden to establish his entitlement to the benefits in dispute. The applicant has further failed to address the preliminary issue of whether he is barred from proceeding with his non-earner benefit claim or cost of examinations with respect to this application. Given there are no benefits payable, he is not entitled to any applicable interest.
ANALYSIS
5The onus is on the applicant to demonstrate that he is entitled to the benefits claimed. He made no submissions and tendered no evidence in support of his claim before the Tribunal. Therefore, I find that the applicant has failed to meet his onus and dismiss the application.
6Both parties were in attendance for the case conference conducted on April 20, 2022. Subsequently, the written hearing was scheduled for January 20, 2023.
7On January 18, 2023, the Tribunal contacted the parties and advised that no submissions had been received. On January 19, 2023, the respondent advised the Tribunal that the parties had reached a settlement on a full and final basis and that the applicant would be filing a Notice of Withdrawal to the Tribunal. On February 1, 2023, February 15, 2023, and July 26, 2023, the Tribunal followed up with both parties for the Notice of Withdrawal.
8More than 6 months have now elapsed since the date of the written hearing.
The parties have been afforded ample time to provide submissions, or file a Notice of Withdrawal, and have failed to do so.
9Given the applicant’s failure to provide any hearing submissions or evidence, it is clear the applicant has not met his evidentiary burden with regard to the issues in dispute. This application shall be dismissed.
ORDER
10The applicant has not met his evidentiary burden to establish his entitlement to the benefits in dispute.
11Given there are no benefits payable, the applicant is not entitled to an award, nor applicable interest.
12The application is dismissed.
Released: August 9, 2023
Tanjoyt Deol
Adjudicator