Lozano v. TD General Insurance Company, 2024 CanLII 113008

Licence Appeal Tribunal

Citation: Lozano v. TD General Insurance Company, 2024 ONLAT 22-005367/AABS

Licence Appeal Tribunal File Number: 22-005367/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:

Mirasol Lozano Applicant

and

TD General Insurance Company Respondent

Decision

Vice-Chair: Craig Mazerolle

Appearances:

For the Applicant: No submissions

For the Respondent: No submissions

Heard: By way of written submissions

Overview

1Mirasol Lozano, the applicant, was involved in an automobile accident on September 16, 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.

Issues

2The issues in dispute are:

i. Is the applicant entitled to attendant care benefits in the amount of $901.84 per month from December 6, 2020 to date and ongoing?

ii. Is the applicant entitled to the following medical benefits:

a. $900.00 ($1,530.00 less $630.00 approved) for assistive devices, proposed by Success Rehab Clinic in a treatment plan/OCF-18 ("plan") dated July 20, 2020;

b. $994.44 ($1,604.00 less $609.98 approved) for assistive devices, proposed by MediAssess Evaluations in a plan dated December 16, 2020; and

c. $2,750.19 ($8,298.90 less $5,548.71 approved) for psychological services, proposed by Alliance Diagnostics and Treatment in a plan dated November 5, 2020?

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

Analysis

3The applicant has the onus of demonstrating entitlement to the attendant care benefit, medical benefits, and interest in dispute.

4In the case conference report and order released on May 17, 2023, the Tribunal ordered the dispute to proceed to a written hearing. The Tribunal scheduled a written hearing for February 16, 2024. Notice of this written hearing was e-mailed to the parties on May 26, 2023.

5The applicant's initial written submissions were due on January 17, 2024.

6Neither party has filed submissions. As no submissions or evidence have been filed with the Tribunal by the applicant, I find that the applicant has not met the evidentiary burden. I further find that no Notice of Motion has been filed seeking to extend the applicant's initial submissions deadline.

7The respondent filed a Notice of Motion (dated February 5, 2024) claiming it never received submissions from the applicant. As such, it is seeking dismissal of the application. Due to my dismissal of the application, I find this motion is moot.

Order

8As no submissions or evidence have been filed with the Tribunal by the applicant, I find that the applicant has not demonstrated entitlement to the attendant care benefit, medical benefits, and interest in dispute.

9The respondent's motion (dated February 5, 2024) is dismissed.

10The application is dismissed.