Citation: Sonnet Insurance Company v. Botan, 2025 ONLAT 23-005362/AABS
Licence Appeal Tribunal File Number: 23-005362/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:
Sonnet Insurance Company
Applicant
and
Sehaam Botan
Respondent
DECISION
ADJUDICATOR: Tanjoyt Deol
APPEARANCES:
For the Applicant: Pina Carusone, Counsel
For the Respondent: Sehaam Botan, respondent, No submissions provided
HEARD: By way of written submissions
OVERVIEW
1Sehaam Botan, (the “respondent”), alleges that she was involved in an automobile accident on October 28, 2020, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (including amendments effective June 1, 2016) (the “Schedule”). Sonnet Insurance Company (“the applicant”) has applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) as it takes the position that the respondent was not involved in an accident, wilfully misrepresented material facts, and seeks a repayment, interest, and costs.
ISSUES
2The issues in dispute are:
i. Was the respondent involved in an “accident” as defined in section 3(1) of the Schedule?
ii. Is the applicant entitled to terminate the payment of benefits because the respondent wilfully misrepresented material facts with respect to the “accident” and her application for benefits under s. 53 of the Schedule?
iii. Is the applicant entitled to a repayment of $200.00 relating to its payment for the completion of an OCF-3 submitted on November 16, 2020?
iv. Is the applicant entitled to a repayment of $34.50 relating to its payment for clinical notes and records submitted on November 16, 2020?
v. Is the applicant entitled to interest on any overdue payment of benefits?
vi. Is the respondent liable to pay costs pursuant to Rule 19 of the Licence Appeal Tribunal Rules, 2023, (the “Rules”)?
3I note that both in the Case Conference Report and Order (“CCRO”) released on January 8, 2024, and in the applicant’s written submissions, it submits that one of the issues in dispute is whether the respondent is barred from proceeding to a hearing because she made fraudulent and/or wilful misrepresentations to the applicant and received accident benefits payments because of these misrepresentations. Confusingly, the applicant refers to section 52 of the Schedule when seeking this relief. However, as acknowledged by the applicant in its submissions, s. 52 pertains to repayments by insured persons