Licence Appeal Tribunal
Citation: Palacios v. Definity Insurance Company, 2025 ONLAT 23-009125/AABS Licence Appeal Tribunal File Number: 23-009125/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:
Maria Palacios, Applicant
and
Definity Insurance Company, Respondent
DECISION
Vice-Chair: Tyler Moore
Appearances: For the Applicant: No Submissions For the Respondent: Ainsley Shannon, Counsel
Heard: By Way of Written Submissions
OVERVIEW
1Maria Palacios, the applicant, was involved in an automobile accident on September 17, 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, Definity 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 February 21, 2024, the Tribunal ordered the dispute to proceed to a written hearing. The Tribunal scheduled a written hearing for October 4, 2024. Notice of the written hearing was e-mailed to the parties on February 29, 2024.
3The applicant's submissions were due on September 4, 2024. On September 25, 2024, the Tribunal issued a Motion Order granting that Avneet Kaur be removed as the applicant's representative. The Tribunal sent an email to the applicant on that same date to inquire whether the applicant would be proceeding as self-represented or if she would be obtaining counsel. The email included the case conference report and order and the notice of written hearing. A printed copy of the email was also sent by regular mail to the applicant on September 28, 2024. The applicant has not filed any written submissions with the Tribunal to date, and there has been no motion made to extend the submission deadlines.
4The respondent filed its written submissions on September 20, 2024.
5No further correspondence has been received from the applicant and the Tribunal has not received a Notice of Withdrawal.
ISSUES
6The 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 limit ("MIG")?
ii. Is the applicant entitled to an income replacement benefit in the amount of $400.00 per week from September 24, 2022 and ongoing?
iii. Is the applicant entitled to $1,846.99 ($4,931.63 less $2,768.54 approved) proposed by Total Wellness Clinic for chiropractic treatment in a treatment plan/OCF-18 dated May 26, 2023?
iv. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
v. Is the applicant entitled to interest on any overdue payment of benefits?
ANALYSIS
7Since 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. I find that the applicant had notice of the written hearing.
8The applicant has the onus of demonstrating that she should be removed from the MIG, and that she is entitled to an income replacement benefit, the medical benefit, and award in dispute.
9As 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
10As no submissions or evidence have been filed with the Tribunal by the applicant, I find that the applicant has not demonstrated that she should be removed from the MIG, or that she is entitled to the income replacement benefit, medical benefit, interest, and award in dispute.
11The application is dismissed.
Released: May 5, 2025
Tyler Moore Vice-Chair