Dosreis v. TD General Insurance Company, 2025 CanLII 35941

Citation: Dosreis v. TD General Insurance Company, 2025 ONLAT 24-006795/AABS

Licence Appeal Tribunal File Number: 24-006795/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:

Leonardo Dosreis

Applicant

and

TD General Insurance Company

Respondent

DECISION

ADJUDICATOR:

Tami Cogan

APPEARANCES:

For the Applicant:

Leonardo Dosreis, Self-represented (Did not attend)

For the Respondent:

Nicole De Bartolo, Counsel

Interpreter:

Lubelia Rebelo, Portuguese Language

Hearing Reporter:

Prashanth Thambipillai

HEARD by Videoconference:

March 10, 2025

OVERVIEW

1Leonardo Dosreis, the applicant, was involved in an automobile accident on May 17, 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, TD General Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

PROCEDURAL

2The applicant did not attend the videoconference hearing. No explanation was provided and efforts by the Tribunal to reach the applicant were unsuccessful. After setting the matter down for 30 minutes to allow the applicant an opportunity to join, I proceeded with the hearing without the applicant.

3The Tribunal may proceed with an electronic hearing without the applicant present, pursuant to s. 7(3) of the Statutory Powers Procedure Act, RSO 1990, c. S.22 (“SPPA”), provided that it is satisfied that the absent party received a Notice of Electronic Hearing (“NoEH”) that complies with ss. 6(5)(c) of the SPPA.

4Both parties participated in a case conference that was held on October 22, 2024. This resulted in a Case Conference Report and Order (“CCRO”) dated October 22, 2024, that set this matter down for a videoconference hearing.

5On November 8, 2024, a NoEH was sent via email to the applicant, the applicant’s counsel, the respondent, and the respondent’s counsel setting the videoconference hearing date as March 10, 2025.

6As a result of the timeline established in the CCRO and the NoEH, the parties were ordered to exchange a single PDF copy of the evidence (i.e., document briefs) and authority briefs, indexed, tabbed and consecutively page numbered that they plan to use at the hearing, and file an electronic copy only, with the Tribunal, no later than 21 calendar days before the hearing.

7On January 23, 2025, the applicant’s counsel removed himself from the record pursuant to Rule 24.4 of the Licence Appeal Tribunal Rules, 2023 (“Rules”). The Tribunal sent follow-up correspondence to the applicant on January 23rd, February 26th, March 3rd, 5th, and 7th, 2025 in attempts to determine the applicant’s intentions with the application and scheduled hearing. There is no indication in the Tribunal records that the applicant replied to the Tribunal’s attempts to contact him.

8The applicant did not file evidence in accordance with the dates established by the CCRO and the NoEH.

9Further, there is no indication that the applicant’s contact information was incorrect in Tribunal records. I note that the applicant has an obligation under Rule 4.4 to provide the correct contact information to the Tribunal in writing.

10I heard submissions from the respondent that the applicant had agreed to the hearing dates. Furthermore, the respondent submitted that this is the applicant’s third application regarding these issues in dispute and it wants to proceed to a hearing for a Tribunal decision.

11Given the above, I am satisfied that both parties received notice for this hearing as required by ss. 6(1), 6(2) and 6(5) of the SPPA. I found that the Tribunal has met its notice obligations and I proceeded with the hearing.

ISSUES

12The 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 an income replacement benefit (“IRB”) in the amount of $400.00 per week from June 9, 2022, to date?

iii. Is the applicant entitled to $2,260.00 for a chronic pain assessment, proposed by All Health Medical Centre in a treatment plan/OCF-18 (“plan”), submitted on May 30, 2021?

iv. Is the applicant entitled to $5,119.00 for a vocational assessment, proposed by All Health Medical Centre in a plan submitted on May 30, 2021?

v. Is the applicant entitled to $725.00 for therapy services, proposed by Barrie Sports Medicine and Rehabilitation Centre in an OCF-23 submitted on April 5, 2023?

vi. Is the applicant entitled to $3,168.00 for chiropractic services, proposed by Dr. Oscar Manias, in a plan submitted on January 16, 2024?

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

viii. Is the respondent entitled to costs?

13At the outset of the videoconference hearing, the respondent made an oral motion to add the issue of costs. Pursuant to Rule 19.2 a request for costs may be made at any time before the decision or order is released so it has been added to the issues above.

RESULT

14For the reasons that follow, I find:

i. The applicant remains subject to the MIG limit.

ii. The applicant is not entitled to an income replacement benefit in the amount of $400.00 per week from June 9, 2022, to date.

iii. The applicant is not entitled to the disputed treatment plans.

iv. The respondent is not liable for $725.00 for therapy services, proposed by Barrie Sports Medicine and Rehabilitation Centre, in an OCF-23 submitted on April 5, 2023.

v. No interest is owed.

vi. The applicant shall pay to the respondent $250.00 in costs.

ANALYSIS

15The applicant has not met his onus to prove entitlement to accident benefits.

16The applicant did not make any submissions or file evidence with regard to this application.

17I find that the applicant has not met his evidentiary burden on a balance of probabilities. Therefore, the applicant remains subject to the MIG, is not entitled to IRB, and is not entitled to the treatment plans, and no interest is owing.

Costs

18The applicant shall pay to the respondent $250.00 in costs.

19The respondent submits that this is the third application disputing the same issues. The applicant has failed to attend case conferences for previous applications and when costs were requested the applications were withdrawn. The applicant has not responded to any communication, has not filed any material for this application, and also did not withdraw the application, resulting in unnecessary costs for the respondent. The respondent requests costs against the applicant as a deterrent to filing further applications with these same issues.

20The applicant did not make any submissions.

21Pursuant to Rule 19.1, where a party believes that another party in a proceeding has acted unreasonably, frivolously, vexatiously, or in bad faith, that party may make a request to the Tribunal for costs.

22In deciding whether to order costs, the Tribunal considers all relevant factors including: the seriousness of the misconduct; whether the conduct was in breach of a direction or order issued by the Tribunal, whether or not a party’s behaviour interfered with the Tribunal’s ability to carry out a fair, efficient, and effective process; prejudice to other parties; and the potential impact an order for costs would have on individuals accessing the Tribunal system.

23I am cognizant that the Schedule is consumer protection legislation and have considered that awarding costs may deter individuals from accessing the Tribunal system. Further, I have considered that the applicant was self-represented for this hearing. I have also considered the respondent’s submissions that the applicant did not attend case conferences for previous applications, although his counsel did attend. In my view, repeatedly filing, but not following through with the process, does interfere with the Tribunal’s ability to carry out an efficient and effective process because it causes delay for all others in need of the Tribunal system. In the case at hand, the Tribunal attempted communication with the applicant by email, regular mail, and telephone calls, on numerous occasions to determine his intentions, without reply. Had the applicant withdrawn the application prior to the hearing date, these scheduled hearing dates and resources could have been used for an applicant with intention to seek a decision from the Tribunal. I find that costs in the amount of $250.00 payable by the applicant to the respondent are appropriate.

CONCLUSION and ORDER

24For the reasons outlined above, I find that: