Licence Appeal Tribunal
Licence Appeal Tribunal File Number: 23-004800/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:
Michael Shea Applicant
and
Motor Vehicle Accident Claims Fund (MVACF) Respondent
DECISION
VICE-CHAIR: Craig Mazerolle
APPEARANCES:
For the Applicant: No submissions
For the Respondent: No submissions
HEARD: By way of Written Submissions
OVERVIEW
1Michael Shea, the applicant, was involved in an automobile accident on October 20, 2016, 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, Motor Vehicle Accident Claims Fund, 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 December 19, 2023, the Tribunal ordered the dispute to proceed to a written hearing. The Tribunal scheduled a written hearing for July 26, 2024. Notice of this written hearing was e-mailed to the parties on December 27, 2023.
3The applicant’s initial written submissions were due on June 26, 2024, while the respondent’s submissions were due on July 12, 2024. Neither party has filed any written submissions with the Tribunal, and there has been no motion made to extend the parties’ submission deadlines.
4Following the written hearing, the respondent wrote to the Tribunal on August 2, 2024 stating the parties’ dispute had resolved. No Notice of Withdrawal was received by the Tribunal from the applicant following this correspondence.
5No further correspondence has been received from either party since August 2, 2024.
ISSUES
6According to the case conference report and order, the issues in dispute are:
i. Is the applicant entitled to $2,858.24 ($4,477.16 less $1,618.92 approved) for physiotherapy services, proposed by Physio In Motion in a treatment plan/OCF-18 (“plan”) submitted February 25, 2021 and partially approved May 5, 2021?
ii. Is the applicant entitled to $768.81 ($1,108.20 less $339.39 approved) for medications, submitted on a claim form (OCF-6) dated October 1, 2021?
iii. Is the applicant entitled to $372.90 ($3,847.65 less $3,474.75 approved) for rehabilitation support worker treatment, proposed by ABI Counselling in a plan submitted January 26, 2022 and denied February 9, 2022?
iv. Is the applicant entitled to $80.08 ($7,152.94 less $7,072.86 approved) for in-home occupational therapy services, proposed by Entwistle Power in a plan submitted October 19, 2022 and denied November 3, 2022?
v. Is the applicant entitled to $18,794.39 for an attendant care needs assessment, proposed by Entwistle Power in a plan submitted November 4, 2022 and denied November 4, 2022?
vi. Is the applicant entitled to $16.28 ($3,200.72 less $3,184.44 approved) for occupational therapy services, proposed by Entwistle Power in a plan submitted November 23, 2022 and denied November 28, 2022?
vii. Is the applicant entitled to $3,132.93 ($17,652.85 less $14,519.92 approved) for an independent living trial, proposed by Entwistle Power in a plan submitted October 13, 2022 and denied November 3, 2022?
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?
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 written hearing.
8Section 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. I am satisfied that both parties received notice of the written hearing, so I shall proceed without their submissions.
9The applicant has the onus of demonstrating entitlement to the medical benefits, award, and interest in dispute.
10As 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 issues in dispute. I further find that no Notice of Motion has been filed seeking to extend the parties’ submission deadlines.
ORDER
11As no submissions or evidence have been filed with the Tribunal by the applicant, I find that the applicant has not demonstrated entitlement to the medical benefits, award, and interest in dispute.
12The application is dismissed.
Released: January 29, 2025
Craig Mazerolle Vice-Chair