Bartlett-Springer v. BelairDirect Insurance Company
Licence Appeal Tribunal File Number: 21-010077/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:
Elijah Bartlett-Springer
Applicant
and
BelairDirect Insurance Company
Respondent
DECISION
VICE-CHAIR: Jeffery Campbell
APPEARANCES:
FFor the Applicant: Elijah Bartlett-Springer, Self-represented
For the Respondent: Jesse Braun, Counsel
HEARD: In Writing August 31, 2023
OVERVIEW
1Elijah Bartlett-Springer, the applicant, was injured in a motor vehicle accident on July 21, 2017 and sought benefits from the respondent, BelairDirect Insurance Company, pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2020 (including amendments effective June 1, 2016) (the “Schedule”). The applicant was denied benefits by the respondent, Belairdirect Insurance Company, and applied to the Licence Appeal Tribunal – Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
ISSUES
2The issues in dispute are 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 $1,080.00 for chiropractic treatment, proposed by Dr. Tommy Wong in a treatment plan/OCF-18 (“plan”) dated November 15, 2021?
iii. Is the applicant entitled to interest on any overdue payment of benefits?
iv. Is the respondent liable to pay an award under s. 10 of O. Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
RESULT
3The applicant did not provide evidence to the Tribunal in support of his claim. As a result, he has not satisfied his burden to demonstrate entitlement to the benefits in dispute.
ANALYSIS
The applicant’s application is dismissed.
4I find that the applicant’s injuries are predominantly minor as defined by s. 3 of the Schedule and he is not entitled to the chiropractic treatment, nor interest or an award.
5Section 18(1) of the Schedule provides that medical and rehabilitation benefits are limited to $3,500.00 if the insured sustains impairments that are predominantly a minor injury in accordance with the MIG. Section 3(1) defines a “minor injury” as “one or more of a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and includes any clinically associated sequelae to such an injury.” An insured may be removed from the MIG if they can establish that their accident-related injuries fall outside of the MIG. The Tribunal has also determined that chronic pain with functional impairment or a psychological impairment warrant removal from the MIG. In all cases, the burden of proof lies with the applicant.
6Although the applicant was provided with a Notice of Written Hearing dated August 19, 2022, as well as three urgent reminders from the Tribunal for the applicant to submit their written submissions, the applicant failed to present a case via written submissions. As it is the applicant’s burden to prove on a balance of probabilities that he is not within the MIG and that the treatment he seeks is reasonable and necessary, and where the Tribunal was not presented with evidence from the applicant in support of his application, it follows that the applicant cannot be successful with his claim.
7I find that the applicant has not established that their accident-related injuries fall outside of the MIG. The applicant is therefore not removed from the MIG. Accordingly, the applicant is not entitled to any of the benefits claimed.
ORDER
8The applicant is not removed from the MIG nor is he entitled to the benefits in dispute, as he failed to make submissions to support his application.
9The application is dismissed.
Released: October 12, 2023
Jeffery Campbell Vice-Chair