Licence Appeal Tribunal
Licence Appeal Tribunal File Number: 23-001971/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:
Pooja Joshi
Applicant
and
Traders General Insurance Company
Respondent
DECISION
ADJUDICATOR: Sam Moini
APPEARANCES:
For the Applicant: Pooja Joshi, Applicant (Did not attend)
For the Respondent: Christopher Lupis, Counsel
HEARD by videoconference: July 11, 2024
OVERVIEW
1Pooja Joshi, the applicant, was involved in an automobile accident on June 25, 2018, 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, Insurer, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
2This matter was scheduled for a 1-day videoconference hearing. The applicant did not attend the hearing and a reason was not provided for their absence. The respondent appeared with counsel. We waited 30 minutes for the applicant. I requested that the case management officer (CMO) to reach out to the applicant. The applicant did not appear.
3The parties were notified of the option of a pre-hearing settlement conference, if both parties agreed, on May 17, 2024. The applicant declined the offer, suggesting to re-schedule any pre-hearing settlement conference, 5 to 6 months from their email dated July 8, 2024. The Tribunal responded on July 9, 2024, stating, any pre-settlement conference was optional and that if they wished to reschedule the hearing, they would need to file a Request for an Adjournment form in order to reschedule the hearing at a later date. No reply was given by the applicant.
4I decided to proceed in the absence of the applicant. Section 7(1) of the Statutory Powers and Procedures Act provides that a tribunal may proceed with a hearing in the absence of a party. In this case, I find that the applicant received notice of the videoconference hearing on January 12, 2024. The Tribunal confirmed the applicant’s contact information prior to the dissemination of the notice and according to the Tribunal’s case management records, it was sent to the contact the applicant had provided to the Tribunal. I find that proceeding with the hearing is an efficient and proportional resolution of this dispute.
ISSUES
5The issues in dispute are:
i. Is the applicant entitled to $1,163.80 ($3,054.56 less $1,890.76 approved) for psychological services, proposed by Mediaassess Evaluation in a treatment plan/OCF-18 (“plan”) submitted November 1, 2021, and partially denied November 15, 2021?
ii. Is the applicant entitled to $1,347.38 ($2,547.38 less $1,200.00 approved) for psychological services, proposed by Mediaassess Evaluation in a plan submitted May 30, 2022, and partially denied June 14, 2022?
iii. Is the applicant entitled to $2,460.00 for a chronic pain assessment proposed by Mediaassess Evaluation in a plan submitted November 15, 2022, and denied November 30, 2022?
RESULT
6The applicant did not provide any evidence to the Tribunal in support of their claim. As a result, the applicant has not satisfied their burden to demonstrate entitlement to the following benefits:
(i) $1,163.80 ($3,054.56 less $1,890.76 approved) for psychological services, proposed by Mediaassess Evaluation in a plan submitted November 1, 2021, and partially denied November 15, 2021;
(ii) $1,347.38 ($2,547.38 less $1,200.00 approved) for psychological services, proposed by Mediaassess Evaluation in a plan submitted May 30, 2022, and partially denied June 14, 2022; and
(iii) $2,460.00 for a chronic pain assessment proposed by Mediaassess Evaluation in a plan submitted November 15, 2022, and denied November 30, 2022.
ANALYSIS
7The applicant did not to attend the hearing and did not present evidence or make submissions. It is the applicant’s burden to demonstrate, on a balance of probabilities, that they are entitled to the treatment plans in dispute, I find that the applicant has not met their burden as the Tribunal was not presented with evidence to show that the treatment plans are reasonable and necessary.
8As the applicant has not made submissions or presented evidence in support of her application, it follows that the applicant has not met her burden of proof. I find that the applicant is not entitled to any of the treatment plans in dispute.
ORDER
i. The applicant is not entitled to the following benefits:
(a) $1,163.80 ($3,054.56 less $1,890.76 approved) for psychological services, proposed by Mediaassess Evaluation in a plan submitted November 1, 2021, and partially denied November 15, 2021;
(b) $1,347.38 ($2,547.38 less $1,200.00 approved) for psychological services, proposed by Mediaassess Evaluation in a plan submitted May 30, 2022, and partially denied June 14, 2022; and
(c) $2,460.00 for a chronic pain assessment proposed by Mediaassess Evaluation in a plan submitted November 15, 2022, and denied November 30, 2022.
ii. The application is dismissed.
Released: October 3, 2024
__________________________
Sam Moini
Adjudicator