Licence Appeal Tribunal
Licence Appeal Tribunal File Number: 23-007842/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:
Mario Maldonado
Applicant
and
Aviva General Insurance
Respondent
DECISION
VICE-CHAIR: Craig Mazerolle
APPEARANCES:
For the Applicant: No submissions
For the Respondent: Maggie Morgan, Counsel
HEARD: By way of Written Submissions
OVERVIEW
1Mario Maldonado, the applicant, was involved in an automobile accident on July 28, 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, Aviva General Insurance, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
2In a case conference report and order released on October 30, 2023, the Tribunal ordered the dispute to proceed to a written hearing. The Tribunal scheduled a written hearing for June 14, 2024, with the Notice of Written Hearing e-mailed to the parties on November 2, 2023.
3The applicant’s representative removed himself from the record, by way of a Removal of Representative form filed with the Tribunal on April 23, 2024.
4The applicant’s initial submissions were due on May 15, 2024. The applicant has not provided any written submissions to the Tribunal. There has also been no Notice of Motion filed by the applicant seeking to extend the initial submissions deadline.
5The respondent filed submissions with the Tribunal stating it has not received submissions from the applicant. It couriered these submissions to the applicant on May 31, 2024.
6The respondent is seeking a dismissal of the application.
ISSUES
7As ordered in the case conference report and order, this file is a combined file with File No. 23-002531/AABS and File No. 23-007842/AABS. File No. 23-002531/AABS has been closed.
8The issues in dispute from the now closed File No. 23-002531/AABS are:
i. Are the applicant’s injuries predominantly minor as defined in section 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 $2,629.50 for a chronic pain assessment, proposed by HydroHealth Evaluations Inc., in a treatment plan/OCF-18 (“plan”) submitted June 16, 2021?
iii. Is the applicant entitled to $3,379.86 for chiropractic services, proposed by Hydroactive Aquatherapy and Rehabilitation Inc. in a treatment plan dated June 16, 2021?
iv. Is the applicant entitled to $3,795.50 for chiropractic services, proposed by Mackenzie Medical Rehabilitation Centre in a treatment plan dated August 4, 2021?
v. Is the applicant entitled to interest on any overdue payment of benefits?
9The issues in dispute from File No. 23-007842/AABS are:
i. Is the applicant entitled to a non-earner benefit (“NEB”) of $185.00 per week from to December 30, 2021 ongoing?
ii. Is the applicant entitled to attendant care benefits (“ACB”) in the amount of $1,985.34 per month from March 15, 2023 ongoing?
iii. Is the applicant entitled to $2,026.55 for physiotherapy services proposed by Mackenzie Medical Rehabilitation Centre, in a treatment plan submitted January 15, 2022?
iv. Is the applicant entitled to $2,200.00 for a psychological assessment, proposed by Prime Healthcare Inc., in a treatment plan submitted January 28, 2022?
v. Is the applicant entitled to interest on any overdue payment of benefits?
ANALYSIS
10Section 7(2) of the Statutory Powers Procedure Act, R.S.O. 1990, c. S.22 states that, if notice of a written hearing has been given to a party who does not then participate in the hearing in accordance with the notice, the Tribunal may proceed with the hearing in the absence of that party’s participation.
11As the applicant was represented at the time that the Notice of Written Hearing was sent out by the Tribunal to the applicant’s former representative, I am satisfied that both parties received notice of the written hearing. I shall proceed without submissions from the applicant.
12The applicant has the onus of demonstrating removal from the MIG, as well as establishing entitlement to the NEB, ACB, medical benefits, and interest in dispute. By not filing any submissions or evidence with the Tribunal, I find that the applicant has not met this burden.
13I further find that the applicant did not file a Notice of Motion requesting an extension of the initial submission deadline.
ORDER
14As the applicant has made no submissions and tendered no evidence in support of the claims before the Tribunal, I find the applicant has not demonstrated removal from the MIG, nor has he established entitlement to the NEB, ACB, medical benefits, and interest in dispute.
15The application is dismissed.
Released: February 14, 2025
Craig Mazerolle
Vice-Chair