Licence Appeal Tribunal File Number: 24-004138/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:
Ravinder Samra
Applicant
and
Zenith Insurance Company
Respondent
DECISION
VICE-CHAIR: Henry Harris
APPEARANCES:
For the Applicant: Ravinder Samra, Self-Represented (Did not attend)
For the Respondent: Mitchell Barber, Counsel
HEARD by Videoconference: April 7, 2025
OVERVIEW
1Ravinder Samra (the “applicant”) was involved in an automobile accident on November 27, 2017, 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 Zenith Insurance Company (the “respondent”) and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
2This matter was scheduled for a 3-day videoconference hearing, set to being at 9:30am on April 7, 2025. At the start of the hearing at 9:30 am, the respondent was the only party to join the proceeding. I held the matter down for 30 minutes and asked the Tribunal’s Case Management Officer (“CMO”) to reach out to the applicant and ask him to join the hearing. The CMO attempted to reach the applicant by email and phone from the contact information provided by the applicant but received no response. The hearing resumed before me at 10:00 am. The applicant was still not in attendance, and no reason was provided for his continued absence.
3Having satisfied myself that the applicant had received notice of the hearing as required by s. 6(5) of the Statutory Powers Procedure Act (the “SPPA”), I decided to proceed with the hearing in the applicant’s absence.
4Rule 3.7.1 of the Licence Appeal Tribunal Rules, 2023 (“Rules”) provides the Tribunal with the authority (pursuant to s. 7(3) of the SPPA) to proceed with the hearing in the absence of a party if that party does not arrive at the hearing within 30 minutes of the scheduled start time and if that party received proper notice.
5When considering the issue of proper notice, Rules 6.1 and 6.2 further set out the process by which the Tribunal may serve a document on a party by email and that it is deemed to be received on the day sent if sent by 5:00 pm that day. Lastly, Rule 4.4 requires an applicant to notify the Tribunal promptly of any change in their contact information.
6I am satisfied that the applicant had proper notice of the hearing for the following reasons:
i. On August 14, 2024, the applicant attended the case conference with his counsel;
ii. On September 13, 2024, the Notice of Hearing was emailed to the applicant’s counsel;
iii. On January 13, 2025, the applicant’s counsel removed himself as representative of record and provided the Tribunal with the applicant’s contact information, including email and phone number;
iv. On March 18, 2025, a reminder and hearing status request was emailed directly to the applicant;
v. On April 1, 2025, the Tribunal emailed the applicant the link to the Request for an Adjournment form which appears to be in follow up with a conversation that the applicant had with a representative of the Tribunal. The applicant did not subsequently submit the form to the Tribunal; and
vi. On April 4, 2025, a further reminder of the hearing, including the Zoom link, was emailed directly to the applicant.
7Further, as noted above, when the applicant did not appear at the hearing, the CMO attempted to reach the applicant by email and phone but was unsuccessful in reaching him.
8As the applicant had notice of the hearing, pursuant to s. 7(3) of the SPPA, I proceeded with the hearing.
PRELIMINARY ISSUE
9The preliminary issue to be decided is:
i. Is the applicant barred from proceeding to a hearing for all of the benefits claimed in this application because the applicant failed to dispute their denial within the 2-year limitation period?
SUBSTANTIVE ISSUES
10The substantive issues in dispute are:
i. Is the applicant entitled to an income replacement benefit in the amount of $400.00 per week from July 15, 2020, to date and ongoing?
ii. Is the applicant entitled to $9,622.27 for nursing services, proposed by Gibson Wellness in a treatment plan/OCF-18 (“plan”) submitted March 21, 2022, and denied April 5, 2022?
iii. Is the applicant entitled to $10,995.56 for a registered social worker, proposed by Gibson Wellness in a plan submitted March 21, 2022, and denied April 5, 2022?
iv. Is the applicant entitled to $2,486.00 for a cardiology assessment, proposed by Dr. Kenneth Melvin of Integra Medical in a plan submitted December 30, 2020, and denied January 14, 2021?
v. Is the applicant entitled to $23,267.00 ($29,467.00 less $6,200.00 approved) for a multidisciplinary assessment, proposed by Dr. Hashi of HAL Disability in a plan submitted September 23, 2020, and partially denied May 13, 2021?
vi. Is the applicant entitled to $2,486.00 for a CAT pre-screen assessment, proposed by Dr. Kessie of Canadian Medical Assessment Centre in a plan submitted October 18, 2021, and denied December 13, 2021?
vii. Is the applicant entitled to $14,690.00 for a CAT assessment, proposed by Dr. Kessie of Canadian Medical Assessment Centre in a plan submitted December 14, 2021, and denied December 31, 2021?
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?
x. Is the respondent entitled to costs pursuant to Rule 19?
11Added Issue: At the end of its closing submissions, the respondent raised the issue of costs, which I have added as issue x above.
RESULT
12The applicant did not provide any evidence to the Tribunal in support of his claim for accident benefits. As a result, I find on a balance of probabilities that he has not satisfied his burden to demonstrate entitlement to the benefits in dispute. As there are no benefits payable, the applicant is not entitled to interest nor an award.
13The respondent is not entitled to costs.
14The application is dismissed.
PROCEDURAL ISSUE
Respondent’s motion to dismiss the applicant’s application as abandoned is denied
15Under Rule 3.4, the Tribunal may dismiss an application without a hearing if the applicant is found to have abandoned the proceeding. Before doing so, the Tribunal is required under Rule 3.5 to give the parties notice of its intention to dismiss, the reasons for the Tribunal’s intention, inform the parties of the right to make written submissions, and consider any written submissions provided.
16Prior to the hearing, the respondent filed a motion dated March 27, 2025 seeking an order to dismiss the applicant’s application as abandoned. At the hearing, the respondent requested to address this motion before proceeding to closing submissions.
17I deny the respondent’s request. Rule 3.5 requires that the Tribunal provide the parties with notice of its intention to dismiss and an opportunity to make submissions before dismissing it without a hearing. I find that no such notice was provided to the parties.
18For this reason, the respondent’s motion is denied. In any event, for the reasons set out below, the motion is moot as I have found that the applicant has not satisfied his burden to demonstrate entitlement to the benefits in dispute.
ANALYSIS
The applicant is not entitled to any of the benefits in dispute
19I find that the applicant is not entitled to any of the benefits claimed. Given this finding, it is not necessary to consider the preliminary issue raised by the respondent.
20The applicant failed to attend the hearing and did not present evidence or make submissions. As it is the applicant’s burden to demonstrate entitlement to the benefits in dispute, and where the Tribunal was not presented with evidence from the applicant in support of his application, it follows that the applicant cannot be successful with his claim.
The respondent is not entitled to costs
21I find that the respondent is not entitled to costs against the applicant for the following reasons.
22Rule 19.1 provides that a party may request costs if it believes the other party acted unreasonably, frivolously, vexatiously or in bad faith. Rule 19.4 further sets out the requirements for that request, which must include the reasons for the request and the particulars of the alleged conduct. The purpose of this rule is to deter conduct by parties that is unreasonable, frivolous, vexatious, or in bad faith. This is a high bar for conduct to attract a costs award and is an exceptional remedy. Rule 19.6 sets out the maximum amount of costs, which shall not exceed $1,000 for each full day of attendance at a hearing.
23The respondent orally requested costs in its closing submissions. The respondent argued that five of the issues in dispute are statute-barred and that these claims are thus frivolous and vexatious. Further, the respondent submitted that the applicant showed bad faith due to his lack of participation in the hearing process, having not filed any materials and not attending the hearing. The respondent submitted that it incurred substantial cost as it had to prepare for the hearing as if it was going forward.
24In considering this request, I look to Rule 19.5, which sets out factors that adjudicators shall consider in assessing an order for costs, including: the seriousness of the alleged misconduct; whether the conduct was in breach of a direction or order issued by the Tribunal; whether the party’s behaviour interfered with the Tribunal’s ability to carry out a fair, efficient and effective process; and the prejudice to other parties.
25When considering these factors, the Tribunal must consider the totality of a party’s conduct and behaviour in the proceeding and whether it interfered with the Tribunal’s ability to conduct a fair and efficient process. I note that the applicant was self-represented as he ceased to have counsel as of January 13, 2025. The alleged behaviour of failing to participate in the hearing process prejudiced the applicant’s case, not the respondent’s position. In the circumstances here, the applicant’s decision to not participate in the hearing is not conduct that prevented the Tribunal from conducting a fair and efficient process. If an applicant chooses not to provide submissions or evidence when they have the onus to prove their case, then their claim will fail. Failing to notify the other side or the Tribunal that they do not intend to proceed with their Tribunal application is not, on its own, conduct that would warrant an order for costs. There must be a course of conduct that frustrates the Tribunal’s ability to carry out a fair and efficient hearing.
26Further, by failing to provide any submissions or evidence, the applicant has failed to satisfy his onus. If anything, it made the submissions by the respondent more efficient and the outcome is that the applicant failed in his request for accident benefits. Therefore, the applicant’s claim is now closed providing finality to the respondent.
27For these reasons, I am not persuaded of the presence of any behaviour that interfered with the Tribunal’s ability to carry out a fair, efficient and effective process, and there was no prejudice to the respondent. Therefore, the respondent’s request for costs is denied.
ORDER
28The applicant is not entitled to any of the benefits in dispute, as he failed to attend the hearing and failed to present evidence or make submissions to the Tribunal to support his application. As there are no benefits payable, the applicant is not entitled to interest nor an award.
29The respondent’s claim for costs is dismissed.
30The application is dismissed.
Released: May 16, 2025
__________________________
Henry Harris
Vice-Chair