Licence Appeal Tribunal File Number: 22-008440/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:
Larine Joachim
Applicant
and
Wawanesa Insurance
Respondent
DECISION
VICE-CHAIR: Craig Mazerolle
APPEARANCES:
For the Applicant: No submissions
For the Respondent: No submissions
HEARD In Writing
OVERVIEW
1Larine Joachim, the applicant, was involved in an automobile accident on October 7, 2020, 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, Wawanesa Insurance, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
2In a case conference report and order (released April 13, 2023), the Tribunal ordered the parties’ dispute to proceed to a written hearing. The Tribunal scheduled a written hearing for January 19, 2024.
3The applicant’s initial submissions were due on December 20, 2023.
4Neither party filed written submissions in accordance with the deadlines from the case conference report and order. Neither party has filed a Notice of Motion seeking to amend these deadlines.
5The Tribunal e-mailed the parties in February 2024 to ask about the status of the hearing. No response was provided by either party.
ISSUES
6As listed in the case conference report and order, the issues in dispute 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 (“MIG”) limit?
ii. Is the applicant entitled to $2,950.72 for a physiotherapy assessment, proposed by Pro Life Wellness Centre Inc. in a treatment plan/OCF-18 (“plan”) dated April 16, 2021?
iii. Is the applicant entitled to $2,950.72 for a chiropractic assessment, proposed by Pro Life Wellness Centre Inc. in a treatment plan dated May 31, 2021?
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?
ANALYSIS
7The applicant has the onus of demonstrating removal from the MIG, as well as entitlement to the medical benefits, award, and interest in dispute. By not filing any submissions or evidence with the Tribunal, I find that the applicant has failed to meet this burden.
8I further find that the applicant did not file a Notice of Motion requesting an extension of the submissions deadlines.
ORDER
9As the applicant has made no submissions and tendered no evidence in support of this claim before the Tribunal, I find the applicant has not met the burden of demonstrating removal from the MIG, nor has the applicant established entitlement to the disputed medical benefits, award, and interest.
10The application is dismissed.
Released: August 6, 2024
Craig Mazerolle
Vice-Chair