Sumatheeswary Ganesharatnam v. Certas Home and Auto Insurance Company, 2025 CanLII 13560

Citation: Ganesharatnam v. Certas Home and Auto Insurance Company, 2025 ONLAT 23-004835/AABS

Licence Appeal Tribunal File Number: 23-004835/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:

Sumatheeswary Ganesharatnam

Applicant

and

Certas Home and Auto Insurance Company

Respondent

DECISION

VICE-CHAIR: Tyler Moore

APPEARANCES:

For the Applicant: No Submissions

For the Respondent: John Justin, Counsel

HEARD: In Writing

OVERVIEW

1Sumatheeswary Ganesharatnam, the applicant, was involved in an automobile accident on June 6, 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, Certas Home and Auto Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

2In the case conference report and order released on November 23, 2023, the Tribunal ordered the dispute to proceed to a preliminary issue hearing and subsequent substantive issue written hearing. In a decision released on July 5, 2024, the Tribunal found that the applicant was barred from proceeding to a hearing for treatment plans dated September 26, 2018 in the amount of $1,190.00, and January 3, 2020 in the amount of $2,200.00. The Tribunal’s decision concluded that the applicant may proceed to the substantive issue hearing with the remaining issues in dispute. The Tribunal scheduled a substantive issue written hearing for July 5, 2024. Notice of this written hearing was e-mailed to the parties on November 30, 2023 at the addresses on file with the Tribunal.

3The applicant’s initial written submissions were due on June 5, 2024. The applicant has not filed any written submissions with the Tribunal related to this substantive issue hearing and there has been no motion filed to extend the applicant’s submission deadlines. The respondent filed submissions on June 20, 2024.

4On September 25, 2024, the Tribunal e-mailed the parties indicating that no submissions had been received from the applicant. The Tribunal has not received a response from the applicant to date. No further correspondence has been received from the applicant.

ISSUES

5The 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 the medical services proposed by Scarborough Rehabilitation Clinic Inc., as follows:

a. $985.22 for chiropractic services, in a treatment plan/OCF-18 (“plan”) submitted January 22, 2019;

b. $1,790.60 for chiropractic services, in a plan submitted September 24, 2019;

c. $2,289.85 for a total body assessment, in a plan submitted May 23, 2019; and

d. $2,220.53 for a psychological assessment, in a plan submitted October 12, 2018?

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

6As noted above, the applicant has not made submissions for the substantive issues hearing. I find the applicant had notice of the hearing because it was sent to the parties on November 30, 2023. The Tribunal’s case management system indicates that it was sent to the applicant’s representative of record at the email address they provided to the Tribunal. Further, the applicant has not responded to the Tribunal’s correspondence dated September 25, 2024. Pursuant to LAT Rule 4.4, the parties have the responsibility to update their contact information with the Tribunal and no updates have been received.

7The applicant did not file a Notice of Motion to extend the submissions deadline nor a Notice of Withdrawal with the Tribunal, I will therefore proceed with the written hearing pursuant to s. 7(2) of the Statutory Powers Procedure Act.

8The applicant has the onus of demonstrating removal from the MIG. The applicant also has the onus of demonstrating entitlement to the treatment plans, award, and interest in dispute.

9As no submissions or evidence has been filed with the Tribunal by the applicant related to the substantive issues in dispute, I find that the applicant has not met their evidentiary burden to demonstrate entitlement to these benefits or removal from the MIG.

ORDER

10As no submissions or evidence have been filed with the Tribunal by the applicant related to the substantive issues in dispute, I find that the applicant has not demonstrated removal from the MIG, nor has the applicant demonstrated entitlement to the treatment plans, award, or interest.

11The application is dismissed.