Sinclair v. Primmum Insurance Company, 2025 CanLII 111795

Licence Appeal Tribunal

Citation: Sinclair v. Primmum Insurance Company, 2025 ONLAT 24-009529/AABS-A

Licence Appeal Tribunal File Number: 24-009529/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:

Fifena Sinclair

Applicant

and

Primmum Insurance Company

Respondent

AMENDED DECISION

ADJUDICATOR: Melanie Malach

APPEARANCES:

For the Applicant: No Submissions

For the Respondent: No Submissions

HEARD: By way of written submissions

OVERVIEW

1Fifena Sinclair, the applicant, was involved in an automobile accident on August 5, 2023, 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, Primmum 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. Is the applicant entitled to the treatment plans proposed by Prime Health Care as follows: (a) $6,149.68 for other assistive devices in a treatment plan dated May 8, 2024; (b) $3,042.65 for driving counselling in a treatment plan dated August 2, 2024; and (c) $8,882.79 for chronic pain treatment in a treatment plan dated October 28, 2024?

ii. Is the applicant entitled to $4,495.80 for chiropractic services proposed by Central Health Rehabilitation and Wellness Centre in a treatment plan dated August 29, 2024?

iii. Is the applicant entitled to the assessments proposed by Prime Health Care, as follows: (a) $3,598.81 for a neurology assessment, in a treatment plan dated February 8, 2024; and (b) $1,800.00 for an attendant care assessment, in a treatment plan dated June 27, 2024?

iv. Is the respondent liable to pay an award under s. 10 of Reb. 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

3In the Case Conference Report and Order ("CCRO"), released on December 2, 2024, the Tribunal ordered the dispute to proceed to a written hearing. The Tribunal scheduled a written hearing for August 8, 2025. Notice of this written hearing was emailed to the parties on December 10, 2024, using the contact information provided.

4The applicant's initial written submissions were due on July 9, 2025. The respondent's submissions were due on July 25, 2025. On October 15, 2025, the Tribunal wrote to both parties and advised that it had not received submissions from either party.

5The Tribunal has not received any further correspondence from either party. 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 by the applicant.

6Since the applicant did not file a Notice of Withdrawal with the Tribunal, the parties' file was not closed. I will therefore proceed with the hearing pursuant to s. 7(2) of the Statutory Powers Procedure Act. I find that the parties had notice of the written hearing by way of email on December 10, 2024.

7The applicant has the onus of demonstrating entitlement to the treatment plans in dispute, an award and interest. As no submissions or evidence have been filed with the Tribunal by the applicant, I find that the applicant has not met the burden of demonstrating entitlement to the treatment plans, award or interest in dispute.

ORDER

8I find that the applicant is not entitled to the treatment plans, award or interest in dispute. The application is dismissed.