Licence Appeal Tribunal File Number: 21-002260/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:
Trina Gallimore
Applicant
and
The Personal Insurance Company
Respondent
DECISION
ADJUDICATOR:
Taivi Lobu
APPEARANCES:
For the Applicant:
Trina Gallimore, Self-Represented (Did not attend)
For the Respondent:
April Dearing, Adjuster
Samuel Davies, Counsel
Court Reporter:
Cathy Petrou
HEARD: by Teleconference:
December 11, 2023
OVERVIEW
1Trina Gallimore, the applicant, was involved in an automobile accident on August 28, 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, The Personal Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
2This application to the Tribunal was filed by the applicant on February 24, 2021. It was initially scheduled for a six-day videoconference hearing, to start on July 17, 2023. One week before the July hearing was to begin, the applicant requested an adjournment because her lawyer had recently withdrawn and she needed time to retain another one. The Tribunal granted the adjournment. Based on dates that the parties said they were available the Tribunal re-scheduled the hearing for December 11-15 and 18, 2023.
3The Adjournment Order dated July 13, 2023 stated that the next scheduled hearing date would proceed whether the applicant had retained new counsel or not. The Order of July 13, 2023 specified that no further adjournments would be considered unless there were unforeseen and exceptional circumstances.
4On December 6, 2023, the applicant brought a request to adjourn the six-day hearing that was to start on December 11, 2023. Her request for an adjournment was denied by the Tribunal by Order dated December 7, 2023. The adjournment was denied for the following reasons:
a. The application is exceptionally old and has been adjourned multiple times;
b. The Tribunal adjourned the hearing for almost five months to give the applicant time to hire a new lawyer. It granted the adjournment on a peremptory basis, meaning that it would not grant another adjournment because the applicant had not retained legal counsel or for any other reason absent unforeseen and exceptional circumstances;
c. The Tribunal canvassed the parties’ availability and scheduled the hearing for December 11-15 and 18, 2023 on consent;
d. The Tribunal gave the parties almost four months’ notice of the hearing;
e. The applicant has requested the adjournment only five days in advance of the hearing; and
f. The December 6, 2023 Request for an Adjournment was identical to the July 10, 2023 Request for an Adjournment, referring only to the July hearing and does not give a reason why the December hearing should be adjourned.
5The Tribunal issued the notice of the videoconference hearing on August 15, 2023 and provided the videoconference hearing link to the parties on December 8, 2023. At the scheduled hearing start time of 9:30 a.m. on December 11, 2023, the respondent was in attendance but not the applicant.
6Section 7(3) of the SPPA provides that where notice of an electronic hearing has been given to a party in a proceeding and the party neither requests that the hearing proceed as an oral in-person hearing pursuant to s. 6(5)(c) nor participates in the hearing in accordance with the notice, the Tribunal may proceed without the party’s participation and the party is not entitled to any further notice in the proceeding. The applicant had received notice of the hearing and there is no record that she requested an oral in-person hearing pursuant to section 6(5)(c). After waiting an additional 30 minutes, the hearing proceeded at 10:00 a.m. on December 11, 2023 without the applicant’s participation.
ISSUES
7The issues in dispute are as follows:
Has the applicant sustained a catastrophic impairment as defined by the Schedule?
Is the applicant entitled to the assessments proposed by Medex Assessments, as follows:
(i) $2,147.00 for an attendant care assessment, in a treatment plan dated March 19, 2019, denied April 2, 2019; and
(ii) $2,010.65 for a functional ability assessment, in a treatment plan dated April 12, 2019, denied April 24, 2019, and
(iii) $2,260.00 for an orthopedic assessment, in a treatment plan dated April 5, 2019 and denied April 11, 2019?
- Is the applicant entitled to interest on any overdue payment of benefits?
RESULT
8The application is dismissed.
ANALYSIS
9The onus is on the applicant to prove that she has sustained a catastrophic impairment and is entitled to the assessments sought. As the applicant did not produce any evidence, she has not satisfied her burden to demonstrate catastrophic impairment status and entitlement to the assessments in dispute.
ORDER
10The application is dismissed.
Released: January 5, 2024
Taivi Lobu
Adjudicator