Citation: Foreman v. Wawanesa Mutual Insurance Company, 2025 ONLAT 23-011331/AABS

Licence Appeal Tribunal File Number: 23-011331/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:

Betty Foreman

Applicant

and

Wawanesa Mutual Insurance Company

Respondent

DECISION

VICE-CHAIR: Tyler Moore

APPEARANCES:

For the Applicant: No Submissions

For the Respondent: Elizabeth Scott, Counsel

HEARD: By Way of Written Submissions

OVERVIEW

1Betty Foreman, the applicant, was involved in an automobile accident on July 6, 2019, 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, Wawanesa Mutual Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the "Tribunal") for resolution of the dispute.

2At the case conference on March 14, 2024, the Tribunal was advised by the applicant's representative at the time that the applicant had passed away three months earlier. He further advised that the applicant's family members had not been responsive to his efforts to determine the status of the estate or the appointment of an estate trustee.

3In the case conference report and order released on March 21, 2024, the Tribunal ordered that the dispute proceed to a written hearing. The Tribunal scheduled a written hearing for November 8, 2024. Notice of the written hearing was e-mailed to the parties on March 28, 2024.

4On June 17, 2024, the applicant's representative e-mailed the Tribunal asking to be removed as the applicant's legal representative, citing that he was unable to locate anyone that could act on behalf of the applicant's estate to provide instructions to proceed. On June 18, 2024, the Tribunal acknowledged that it granted the request and sought updated contact information with respect to the applicant by e-mail. There is no indication that any updated contact information was provided to the Tribunal.

5On September 11, 2024, the Tribunal released a Motion Order denying the respondent's request that the Tribunal dismiss the application as abandoned or provide notice to the applicant of its intention to dismiss the application without a hearing. The Tribunal found the fact that the applicant's estate had not retained counsel and it was unclear whether an estate trustee had been appointed did not necessarily imply that the applicant's estate had abandoned the application. The Tribunal indicated in the Motion Order that "a hearing adjudicator may decide the application based on the submissions that are filed".

6The applicant's initial submissions were due October 9, 2024, but the Tribunal did not receive any submissions.

7The respondent filed its written submissions on October 25, 2024.

ISSUES

8The issues in dispute are:

i. Has the applicant sustained a catastrophic impairment as defined by the Schedule?

ii. Is the applicant entitled to $802.56 ($2,200.00 less $1,397.50 approved) for an attendant care assessment, proposed by General Med M Inc. in a treatment plan/OCF-18 ("treatment plan") submitted October 3, 2019, and denied October 15, 2019?

iii. Is the applicant entitled to $1,653.23 for occupational therapy services and assistive devices, proposed by General Med M Inc. in a treatment plan submitted February 21, 2020, and denied March 30, 2020?

iv. Is the applicant entitled to $721.21 for other assistive devices, proposed by General Med M Inc. in a treatment plan submitted July 16, 2020, and denied July 24, 2020?

v. Is the applicant entitled to $11,700.00 ($24,020.00 less $12,320.00 approved) for a multi-disciplinary CAT assessment, proposed by All Health Medical Centre in a treatment plan submitted May 28, 2021, and denied June 11, 2021?

vi. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?

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

ANALYSIS

9I accept that the Tribunal made efforts in June 2024 to obtain updated contact information with respect to the applicant, but none has been provided.

10I also acknowledge that the Tribunal has previously issued a Motion Order denying the respondent's request to dismiss the application as abandoned or provide notice to the applicant of its intention to do so without a hearing. However, the Tribunal's Motion Order encouraged the respondent to provide written hearing submissions and it indicated that a hearing adjudicator may decide the application based on the submissions, or lack of submissions, that were filed.

11The Tribunal has not received any correspondence on behalf of the deceased applicant since June 2024. At that time, the applicant's representative requested that he be removed as representative because he had not been able to locate anyone to act on behalf of the applicant's estate. The applicant passed away approximately six months before that request was made.

12Since there has been no Notice of Withdrawal filed with the Tribunal on the applicant's behalf, 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's representative had notice of the written hearing that was e-mailed on March 28, 2024.

13The applicant has the onus of demonstrating that she sustained a catastrophic impairment as defined by the Schedule, as well as entitlement to the medical benefits and assistive devices in dispute.

14As no submissions or evidence have been filed with the Tribunal on behalf of the applicant, I find that the applicant has not met the evidentiary burden to demonstrate a catastrophic impairment, nor entitlement to the medical benefits and assistive devices. I further find that no Notice of Motion has been filed seeking to extend the applicant's submission deadlines.

ORDER

15As no submissions or evidence have been filed with the Tribunal on behalf of the applicant, I find that the applicant has not demonstrated that she sustained a catastrophic impairment, nor entitlement to the medical benefits, assistive devices, interest, and award in dispute.

16The application is dismissed.