Licence Appeal Tribunal File Number: 22-008493/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:
Saadaq Jaama
Applicant
and
Certas Home and Auto Insurance Company
Respondent
DECISION
VICE-CHAIR: Craig Mazerolle
APPEARANCES:
For the Applicant: No submissions
For the Respondent: Nikhita Bhasin, Counsel
HEARD: In Writing
OVERVIEW
1Saadaq Jaama, the applicant, was involved in an automobile accident on March 3, 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, Certas Home and Auto Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
2In a case conference report and order released on April 11, 2023, the Tribunal ordered the dispute to proceed to a written hearing. The Tribunal scheduled a written hearing for January 19, 2024, with the Notice of Written Hearing e-mailed to the parties on May 10, 2023.
3The applicant’s initial submissions were due on December 20, 2023. The applicant has not provided any written submissions to the Tribunal. There has also been no Notice of Motion filed seeking to extend the applicant’s initial submissions deadline, nor has there been an adjournment request made seeking to reschedule the written hearing.
ISSUES
4As listed in the case conference report and order, the issues in dispute are:
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?
Is the applicant entitled to a non-earner benefit of $185.00 per week from April 1, 2021 to April 1, 2023?
Is the applicant entitled to the treatment proposed by Alliance Diagnostics and Treatments Inc. as follows:
i. $1,995.55 for the cost of an attendant care assessment submitted by treatment plan on March 16, 2021 and denied April 8, 2021?
ii. $2,200.00 for the cost of a neurological assessment submitted by treatment plan on March 16, 2021 and denied November 9, 2021?
iii. $1,760.20 for chiropractic services submitted by treatment plan on March 16, 2021 and denied April 22, 2021?
iv. $3,018.53 for chiropractic services submitted by treatment plan on August 17, 2021 and denied September 3, 2021?
v. $3,329.05 for chiropractic services submitted by treatment plan on May 11, 2021 and denied June 21, 2021?
vi. $2,175.91 for the cost of a psychological assessment submitted by treatment plan on November 18, 2021 and denied December 7, 2021?
Is the applicant entitled to interest on any overdue payment of benefits?
ANALYSIS
5Section 7(2) of the Statutory Powers Procedure Act, R.S.O. 1990, c. S.22 states that, if notice of a written hearing has been given to a party who does not then participate in the hearing in accordance with the notice, the Tribunal may proceed with the hearing in the absence of that party’s participation.
6The applicant’s representative filed a Removal of Representative form prior to the initial submission deadline (submitted December 7, 2023). Rule 24.4 of the Licence Appeal Tribunal Rules, 2023 states that a representative seeking to remove themselves as a party’s representative more than 30 days before the next scheduled adjudicative event must submit a completed Removal of Representative form. According to Rule 24.4, the withdrawing representative must confirm that:
a. the party they were representing has been advised of their withdrawal as representative; and
b. the representative has complied with the Law Society Act and applicable guidelines and codes of conduct when withdrawing as the party's representative.
7This withdrawal and the date of the written hearing were communicated to the applicant through an e-mail from the Tribunal (dated December 15, 2023). The applicant wrote an e-mail back to the Tribunal later that same day stating the applicant has been trying to contact the lawyer. To date, no further communication has been received from the applicant.
8Taken together, I am satisfied that both parties received notice of the written hearing, so I shall proceed without submissions from the applicant.
9The applicant has the onus of demonstrating removal from the MIG, as well as entitlement to the non-earner benefit, medical benefits, and interest in dispute. By not filing any submissions or evidence with the Tribunal, I find that the applicant has not met this burden.
10I further find that the applicant did not file a Notice of Motion requesting an extension of the initial submission deadline, nor has there been an adjournment request made seeking to reschedule the written hearing.
ORDER
11As the applicant has made no submissions and tendered no evidence in support of the claims before the Tribunal, the applicant has not demonstrated removal from the MIG, nor has the applicant demonstrated entitlement to the non-earner benefit, medical benefits, and interest in dispute.
12The application is dismissed.
Released: January 27, 2025
Craig Mazerolle
Vice-Chair