Licence Appeal Tribunal File Number: 24-007798/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:
Paul Aderito Santos
Applicant
and
Wawanesa Mutual Insurance Company
Respondent
DECISION
VICE-CHAIR: Tyler Moore
APPEARANCES:
For the Applicant: No Submissions
For the Respondent: Morgan A. MacDonald, Counsel
HEARD: By Way of Written Submissions
OVERVIEW
1Paul Aderito Santos, the applicant, was involved in an automobile accident on March 7, 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, Wawanesa Mutual 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:
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 Minot Injury Guideline ("MIG") limit?
ii. Is the applicant entitled to $2,154.48 for chiropractic services, proposed by Alma Rehab in a treatment plan/OCF-18 ("plan") dated July 11, 2022?
iii. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
iv. Is the applicant entitled to interest on any overdue payment of benefits?
ANALYSIS
3In the case conference report and order that was released on October 22, 2024, the Tribunal ordered the dispute proceed to a written hearing. The Tribunal scheduled a written hearing on July 11, 2025. Notice of the written hearing was e-mailed to the parties and mailed to the applicant directly on October 29, 2024, using the contact information provided.
4On October 21, 2024, the applicant's representative at the time filed a Removal of Representative form with the Tribunal.
5On December 9, 2024, the Tribunal acknowledged the Removal of Representative request by e-mail and confirmed that the applicant's updated contact information had been received on October 21, 2024.
6The applicant's initial submissions were due on June 11, 2025.
7The respondent filed its written submissions on June 24, 2025.
8The Tribunal has not received any further correspondence from the applicant. There has been no indication that the applicant has obtained new representation, or that he has taken the steps to do so. I find that no Notice of Motion has been filed seeking to extend the applicant's submission deadlines, and no Notice of Withdrawal has been filed with the Tribunal.
9Since 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 e-mail on October 29, 2024, and by regular mail after it was mailed to him that same day.
10The applicant has the onus of demonstrating that he should be removed from the MIG and that he is entitled to the medical benefit and award in dispute.
11As 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 benefit, award, and interest in dispute.
ORDER
12The applicant remains in the MIG and is not entitled to the treatment plan in dispute.
13As no benefits are owing, the applicant is not entitled to interest or an award.
14The application is dismissed.
Released: October 10, 2025
Tyler Moore
Vice-Chair