Licence Appeal Tribunal File Number: 24-003367/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:
Emiliano Ramirez
Applicant
and
Intact Insurance Company
Respondent
DECISION
VICE-CHAIR:
Tyler Moore
APPEARANCES:
For the Applicant:
No Submissions
For the Respondent:
Theomarcus Giannou, Counsel
HEARD:
By Way of Written Submissions
OVERVIEW
1Emiliano Ramirez, the applicant, was involved in an automobile accident on August 27, 2021, 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 preliminary issue in dispute is:
i. Is the applicant barred from proceeding to a hearing for all of the benefits claimed in this application because the applicant failed to attend an insurer’s examination under s. 44 of the Schedule?
3The substantive 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 $2,144.93 for psychological services, proposed by Pilowsky Psychology Professional Corporation in a treatment plan/OCF-18 (“plan”) submitted March 17, 2022 and denied April 1, 2022?
iii. Is the applicant entitled to $2,460.00 for an orthopaedic assessment, proposed by All Health Medical Centre in a plan submitted June 6, 2022 and denied June 23, 2022?
iv. Is the applicant entitled to $3,410.35 for psychological services, proposed by Sayu Inc. in a plan submitted May 12, 2022 and denied July 22, 2022?
v. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
vi. Is the applicant entitled to interest on any overdue payment of benefits?
ANALYSIS
4In the case conference report and order released on August 13, 2024, the Tribunal ordered the dispute to proceed to a written hearing. The Tribunal scheduled a written hearing for May 16, 2025. Notice of the written hearing was e-mailed to the parties on August 15, 2024, using the contact information provided.
5On April 9, 2025, the Tribunal issued an Adjournment Order denying the applicant’s adjournment request pending completion of a s. 44 IE.
6On April 10, 2025, the Tribunal e-mailed the parties as a reminder that the due date for their written submissions was approaching. The Tribunal included the Notice of Written Hearing.
7On April 28, 2025, the applicant filed a request for adjournment with the Tribunal.
8On April 29, 2025, the Tribunal acknowledged the request for adjournment and advised the parties that the request was incomplete. The parties were directed to correct the request for adjournment and re-submit it to the Tribunal.
9The Tribunal has not received any further communication from the applicant. I further find that no Notice of Motion has been filed with the Tribunal seeking to extend the applicant’s submission deadlines.
10The applicant’s initial submissions were due on April 16, 2025.
11The respondent filed its written submissions on April 30, 2025.
12Since the applicant did not file a Notice of Withdrawal with the Tribunal, the parties’ file was not closed, and I will proceed with the hearing pursuant to s. 7(2) of the Statutory Powers Procedure Act. I find that the applicant had notice of the written hearing by way of e-mail on August 15, 2024 and April 10, 2025.
13The applicant has the onus of demonstrating that he should be removed from the MIG and that he is entitled to the medical benefits and award in dispute.
14As no submissions or evidence have been filed with the Tribunal by the applicant, I find that the applicant has not demonstrated that he should be removed from the MIG, and that he is entitled to the medical benefits, award, and interest in dispute.
ORDER
15The applicant remains in the MIG and is not entitled to the medical benefits in dispute.
16As no benefits are owing, the applicant is not entitled to interest or an award.
17The application is dismissed.
Released: October 6, 2025
Tyler Moore
Vice-Chair