Licence Appeal Tribunal
Licence Appeal Tribunal File Number: 21-011349/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:
Seyed-Meysam Seyed-Alian Applicant
and
TD General Insurance Company Respondent
DECISION
ADJUDICATOR: Matthew Frontini
APPEARANCES:
For the Applicant: No submissions filed.
For the Respondent: Mariam Abdel Hadi, Counsel
HEARD: In Writing January 19, 2024
OVERVIEW
1Seyed-Meysam Seyed-Alian, the applicant, was involved in an automobile accident on June 3 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, TD General Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
ISSUES
2The issue(s) in dispute is/are:
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 Minor Injury Guideline limit (“MIG”)?
ii. Is the applicant entitled to $1,982.26 for psychological services, proposed by Doctor Med Rehabilitation Centre in a treatment plan/OCF-18 (“plan”) dated August 16, 2019?
iii. Is the applicant entitled to $3,594.92 for physiotherapy services, proposed by Doctor Med Rehabilitation Centre in a plan dated January 6, 2020?
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?
v. Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The application is dismissed. As the applicant has made no submissions for this hearing, I find that they have not met their evidentiary burden with regard to the MIG determination, nor have they established entitlement to the treatment plans and benefits in dispute, interest or an award.
ANALYSIS
4Proceeding with a written hearing where a party fails to participate, under s. 7(2) of the Statutory Powers Procedure Act, RSO 1990, c. S.22 (“SPPA”), requires the Tribunal to be satisfied that the absent party received notice of the written hearing that complies with ss. 6(1) and 6(4) of the SPPA.
5I find that the applicant received notice for this hearing as required by ss. 6(1) and 6(4) of the SPPA. I am also satisfied that the applicant did not request a change of format from a written hearing under s. 6(4)(b) of the SPPA. Therefore, I may proceed with this written hearing pursuant to s. 7(2) of the SPPA.
6The Tribunal met its reasonable notice obligations in this application. The Tribunal sent notice to the applicant’s representative on February 16, 2023 that a written hearing date had been set for September 22, 2023. This was the result of a case conference held on this matter on November 21, 2022, which the applicant attended. The resulting Case Conference Report and Order (“CCRO”), dated January 19, 2023, specified that the applicant’s submissions were to be filed 30 days prior to the scheduled hearing, with respondent submissions due 14 days prior to the hearing, and applicant reply submissions due 7 days prior to the hearing.
7On May 16, 2023, the applicant’s paralegal filed a motion to withdraw from representing the applicant on the basis that the applicant was no longer communicating and providing instructions. The motion included evidence of the paralegal’s attempts to contact the applicant regarding the next steps in preparing the application for the hearing by both email and telephone.
8The applicant did not deliver their submissions and evidence by the ordered deadline. The respondent served its submissions by mail on the applicant at the address listed in the application as well as on the applicant’s former representative.
9The respondent provided its hearing submissions in accordance with the provisions established in the January 19, 2023 CCRO and the original hearing date set for September 22, 2023. These submissions included a request that the application be dismissed for the applicant’s failure to comply with the production and submission deadlines of the January 19, 2023 CCRO. In the alternative, the respondent requested that the application be dismissed because the applicant in failing to provide any submissions, had not met their evidentiary burden to substantiate their MIG claim or that the treatment plans in issue are reasonable and necessary.
10For the above reasons, I find that the applicant has failed to meet their burden. Although they were without legal representation, their former law firm sent notice of withdrawal on May 16, 2023—four months before this matter proceeded to the written hearing that had been agreed upon at the case conference (which, as noted above, the applicant attended). The applicant had time to secure new representation, prepare submissions if they chose to represent themself, or make a request to the Tribunal to extend deadlines for submissions or reschedule hearing dates. The applicant did not pursue any of these options.
11Given the applicant’s failure to provide submissions, they have not met their evidentiary burden with regard to the issues in dispute.
12Accordingly, this application shall be dismissed.
ORDER
13As the applicant has failed to provide any submissions, it follows that they have not met their evidentiary burden.
14The application is dismissed.
Released: February 16, 2024
Matthew Frontini Adjudicator