Licence Appeal Tribunal File Number: 22-011684/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:
Hamidreza Dodangeh
Applicant
and
Intact Insurance Company
Respondent
DECISION
ADJUDICATOR: Laura Goulet
APPEARANCES:
For the Applicant:
Hamidreza Dodangeh, Applicant (did not attend)
For the Respondent:
Brad Grenke, Claims Representative
Riley McIntyre, Counsel
Hearing Reporter: Stephanie Penman
Interpreter (Farsi language): Sorour Azizi
HEARD: by Videoconference:
January 2, 2024
OVERVIEW
1Hamidreza Dodangeh, the applicant, was involved in an automobile accident on May 30, 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, Intact 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:
a) Has the applicant sustained a catastrophic impairment as defined by the Schedule?
b) Is the applicant entitled to an income replacement benefit (“IRB”) in the amount of $155.71 per week from October 28, 2020 to date and ongoing?
c) Is the applicant entitled to $4,403.40 for chiropractic services, proposed by Gibson Wellness Centre in a treatment plan/OCF-18 (“plan”) dated July 31, 2019?
d) Is the applicant entitled to $2,173.00 for the completion of a Form 1, proposed by Gibson Wellness Centre in plan dated July 31, 2019?
e) Is the applicant entitled to $4,403.40 for physical therapy, proposed by Gibson Wellness Centre in a plan dated July 31, 2019?
f) Is the applicant entitled to $50.39 for a psychological assessment, proposed by Gibson Wellness Centre in a plan dated November 2, 2020?
g) Is the applicant entitled to $1,275.65 for the completion of a Form 1, proposed by Gibson Wellness Centre in a plan dated November 6, 2020?
h) Is the applicant entitled to $7,425.36 for chiropractic services, proposed by Gibson Wellness Centre in a plan dated November 22, 2020?
i) Is the applicant entitled to $2,914.80 for assistive devices, proposed by Gibson Wellness Centre in a plan dated November 22, 2020?
j) Is the applicant entitled to $10,031.58 for psychological services, proposed by Gibson Wellness Centre in a plan dated November 22, 2020?
k) Is the applicant entitled to $2,144.93 for psychological services, proposed by Gibson Wellness Centre in a plan dated December 21, 2020?
l) Is the applicant entitled to $6,868.97 for other goods and services, proposed by Gibson Wellness Centre in a plan dated May 14, 2021?
m) Is the applicant entitled to $3,401.78 for physiotherapy services, proposed by HealthMax St. Clair in a plan dated June 16, 2021?
n) Is the applicant entitled to $11,888.04 for physiotherapy services, proposed by Gibson Wellness Centre in a plan dated May 6, 2021?
o) Is the applicant entitled to $7,326.49 for psychological services, proposed by Gibson Wellness Centre in a plan dated March 2, 2021?
p) Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
q) Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
3The applicant has not met his burden to demonstrate that he sustained a catastrophic impairment as defined by the Schedule.
4The respondent advised that issue ii has been resolved.
5The applicant is not entitled to the treatment plans proposed as he failed to present a case supporting entitlement.
6The respondent is not liable to pay an award.
7The applicant is not entitled to interest.
ANALYSIS
8A case conference was held by teleconference on June 6, 2023. The applicant was in attendance with his then counsel Michael Greco. In the Case Conference Report and Order dated June 13, 2023, the Tribunal ordered that document briefs be exchanged between the parties and filed no later than 10 calendar days before the hearing.
9A 10-day videoconference hearing was scheduled to commence on Tuesday, January 2, 2024 at 9:30 a.m. On June 23, 2023, the applicant was served with the Notice of Videoconference Hearing at his last known address. Pursuant to Rule 4 of the Common Rules of Practice and Procedure, parties have an obligation to notify the Tribunal if there is a change in their contact information, and there is no record of the applicant doing so. As such, I find that the applicant was properly served with the Notice of Videoconference Hearing.
10On July 19, 2023, Mr. Greco advised the Tribunal by email that he no longer represented the applicant. The applicant was copied on this to the same email that has been used by the Tribunal to communicate with the applicant, and the only email that the Tribunal has on file.
11The applicant did not serve or file any documents in support of his appeal. The respondent served and filed its document brief on December 14, 2023.
12The applicant did not attend the hearing on January 2, 2024 at 9:30 a.m. The respondent and its counsel were in attendance.
13The Case Management Officer (“CMO”) tried to reach the applicant. The CMO left a voicemail for the applicant and sent him an email. The applicant did not respond by 10:00 a.m. No reasons were provided for his non-attendance.
14Rule s.3.7.1 of the Licence Appeal Tribunal Rules states that if a party who has been given notice of a hearing in accordance with the SPPA (i.e. Statutory Powers Procedure Act) does not attend their electronic hearing within 30 minutes of the scheduled start time as stated in the hearing notice, the Tribunal may:
a) Proceed with the hearing in the absence of that party; and/or
b) Make any order it considers appropriate in the circumstances.
15Further, Rule 3.7.1 states that in determining whether to proceed with the hearing in the absence of a non-attending party, the Tribunal will consider the reasons for non-attendance, if any.
16In the circumstances of this case, the Tribunal proceeded with the hearing in the absence of the applicant.
17The respondent pointed out that the applicant has not filed any documentary evidence to support his claims, and he has failed to attend for the hearing. In the circumstances, with the exception of the issue of IRBs, which has been resolved, the respondent submitted that the application should be dismissed.
18I agree. It is the applicant’s burden to demonstrate entitlement to the benefits in dispute. Since the applicant failed to attend and did not present any evidence, the applicant did not meet their burden of proof with respect to any of the claims. Accordingly, I find that the applicant is not entitled to any of the benefits claimed and has not demonstrated that he is catastrophically impaired.
The applicant is not entitled to an award
19The applicant sought an award under s. 10 of Reg. 664. Under s. 10, the Tribunal may grant an award of up to 50 per cent of the total benefits payable if it finds that an insurer unreasonably withheld or delayed the payment of benefits. No evidence was presented in this regard by the applicant. As such, the applicant is not entitled to an award.
The applicant is not entitled to interest
20Interest applies on the payment of any overdue benefits pursuant to s. 51 of the Schedule. Since the applicant did not demonstrate that there are any overdue benefits owing, the applicant is not entitled to any interest.
ORDER
21The applicant has not demonstrated that he sustained a catastrophic impairment as defined by the Schedule.
22The applicant not entitled to the treatment plans proposed as he failed to present a case for entitlement.
23The respondent is not liable to pay an award.
24The applicant is not entitled to interest.
25With the exception of issue ii, which has been resolved, the application is dismissed.
Released: January 18, 2024
Laura Goulet
Adjudicator