Rutledge v. Traders General Insurance Company, 2025 CanLII 25848

Citation: Rutledge v. Traders General Insurance Company, 2025 ONLAT 23-009042/AABS

Licence Appeal Tribunal File Number: 23-009042/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:

Edward N Rutledge (A minor their litigation guardian, Tracey C Cole)

Applicant

and

Traders General Insurance Company

Respondent

DECISION

VICE-CHAIR: Tyler Moore

APPEARANCES:

For the Applicant: No Submissions

For the Respondent: No Submissions

HEARD: By way of written submissions

OVERVIEW

1Edward Rutledge, the applicant, was involved in an automobile accident on September 15, 2015, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (the "Schedule"). The applicant was denied benefits by the respondent, Insurer, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the "Tribunal") for resolution of the dispute.

ISSUES

2The preliminary issues in dispute are:

i. Is the applicant an insured person pursuant to 2.3(1) of the Schedule?

ii. Is the applicant barred from proceeding to a hearing for the benefits claimed in this application because the applicant failed to dispute their denial within the 2-year limitation period, pursuant to s. 56 of the Schedule?

iii. Is the applicant barred from proceeding to a hearing for the benefits claimed in this application because the applicant failed to comply with s. 32 of the Schedule?

3The substantive issues in dispute are:

i. Is the applicant entitled to $1,295.00 ($5,195.00 less $3,900.00 approved) for social rehab counseling, proposed by Social Worker Consulting Group in a treatment plan/OCF-18 ("plan") dated December 13, 2019 and submitted December 18, 2019?

ii. Is the applicant entitled to $1,396.55 ($4,638.95 less $3,242.40 approved) for occupational therapy services, proposed by Orkell Rehabilitation Services in a plan submitted August 12, 2020?

iii. Is the applicant entitled to $1,599.92 for other goods and services (tutoring repayment) submitted on an OCF-21/auto-insurance standard invoice September 25, 2020?

iv. Is the applicant entitled to $748.10 ($4,189.70 less $3,441.60 approved) for occupational therapy services, proposed by Orkell Rehabilitation in a plan submitted February 16, 2021?

v. Is the applicant entitled to $448.86 for psychological services, proposed by Dr. Diana Velikonja in a plan submitted October 6, 2021?

vi. Is the applicant entitled to $6,720.00 for a catastrophic determination assessment, proposed by Orkell Rehabilitation Services in a plan submitted February 23, 2022?

vii. Is the applicant entitled to $4,952.52 for other goods and services (disbursements) submitted to the respondent on June 2, 2022?

viii. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?

ix. Is the applicant entitled to interest on any overdue payment of benefits?

ANALYSIS

4The applicant has the onus of demonstrating entitlement to the social rehab counseling, occupational therapy services, catastrophic determination assessment, disbursements, award, and interest in dispute.

5In the case conference report and order released on January 17, 2024, the Tribunal ordered to proceed to a written hearing. The Tribunal scheduled a written hearing for September 6, 2024.

6The applicant's initial written submissions were due on August 6, 2024. On September 26, 2024, the Tribunal e-mailed the parties to advise that no submissions had been received. On September 30, 2024, the applicant replied to the Tribunal by e-mail indicating that there had been an agreement reached between the parties, for which the applicant was seeking court approval of the resolution. The applicant also indicated that that he would be withdrawing the application in the future. No further correspondence has been received from either party.

7No Notice of Withdrawal has been received by the Tribunal from the applicant to date.

8Since the applicant did not file a Notice of Withdrawal with the Tribunal, the parties' file was not closed, and I will proceed with the written hearing pursuant to s. 7(2) of the Statutory Powers Procedure Act. I find that the applicant had notice of the written hearing.

9Neither party has filed submissions, and there has been no motion made seeking to extend the initial submissions deadline. In the absence of the parties' submissions, the Tribunal is not in a position to be able to make findings regarding the preliminary issues.

10I also find that the applicant has not met his evidentiary burden to demonstrate entitlement to the substantive issues in dispute, and that no Notice of Motion has been filed seeking to extend the applicant's initial submissions deadline.

ORDER

11As no submissions or evidence have been filed with the Tribunal, I find that the Tribunal is not in a position to make findings on the preliminary issues, and the applicant has not demonstrated entitlement to the substantive social rehab counseling, occupational therapy services, catastrophic determination assessment, disbursements, award, and interest in dispute.

12The application is dismissed.