Citation: Arapoglou v. Intact Insurance Company, 2025 ONLAT 23-009108/AABS

Licence Appeal Tribunal File Number: 23-009108/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:

Michael Arapoglou

Applicant

and

Intact Insurance Company

Respondent

DECISION

VICE-CHAIR: Tyler Moore

APPEARANCES:

For the Applicant: No Submissions

For the Respondent: Eluxmeenah Rishihesan, Counsel

HEARD: By Way Of Written Submissions

OVERVIEW

1Michael Arapoglou, the applicant, was involved in an automobile accident on January 5, 2022, 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, Insurer, 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 March 1, 2024, the Tribunal ordered the dispute to proceed to a written hearing. The parties and their representatives attended that case conference. The Tribunal scheduled a written hearing for October 18, 2024. Notice of the written hearing was emailed to the parties on March 7, 2024.

3The applicant's initial submissions were due on September 18, 2024. The applicant has not filed any submissions with the Tribunal to date, and there has been no motion made to extend the submission deadline.

4The respondent filed its written submissions on October 9, 2024.

5No further correspondence has been received from either party and the Tribunal has not received a Notice of Withdrawal.

ISSUES

6The preliminary issue in dispute is:

i. Is the applicant barred from proceeding to a hearing for substantive issues 3, 4, and 5 below because the applicant failed to attend an insurer's examination under s. 44 of the Schedule?

7The 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 attendant care benefits in the amount of $1,396.50 per month from March 1, 2022 to date and ongoing?

iii. Is the applicant entitled to $6,004.05 for other assistive devices, proposed by Hannah Pape, occupational therapist, in a treatment plan/OCF-18 ("plan") submitted January 10, 2024 and denied January 15, 2024?

iv. Is the applicant entitled to $2,266.33 for attendant care needs assessment (Form 1), proposed by Hannah Pape, occupational therapist, in a plan submitted October 17, 2023 and denied December 14, 2024?

v. Is the applicant entitled to a psychological assessment, proposed by Health Bound Health Network in a plan submitted January 10, 2024 and denied January 15, 2024?

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

ANALYSIS

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 hearing pursuant to s. 7(2) of the Statutory Powers Procedure Act. While I recognize that the applicant's representative removed themselves on August 12, 2024, I find that the applicant had notice of the written hearing on March 7, 2024, which was well in advance of that date. I also accept that the respondent's submissions were served on the applicant by way of regular mail, as confirmed by way of the respondent's certificate of service dated October 4, 2024. Unfortunately, the Tribunal has not received any further correspondence from the applicant.

9The applicant has the onus of demonstrating that he should be removed from the MIG, and that he is entitled to attendant care as well as the other medical benefits and interest.

10As no submissions or evidence have been filed with the Tribunal by the applicant, I find that the applicant has not met the evidentiary burden to demonstrate entitlement to the benefits in dispute. I further find that no Notice of Motion has been filed seeking to extend the applicant's submission deadlines.

ORDER

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, or that he is entitled to the medical benefits, attendant care, and interest in dispute.

12The application is dismissed.