Citation: Applicant v. Aviva Insurance Canada, 2025 ONLAT 23-011178/AABS

Licence Appeal Tribunal File Number: 23-011178/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:

Applicant (A minor by their litigation guardian, T.C.C.)

Applicant

and

Aviva Insurance Canada

Respondent

DECISION

VICE-CHAIR: Tyler Moore

APPEARANCES:

For the Applicant: No Submissions

For the Respondent: No Submissions

HEARD: By Way of Written Submissions

OVERVIEW

1The applicant, was involved in an automobile accident on September 15, 2015, and sought benefits pursuant to the Statutory Accident Benefits Schedule - Effective September 1, 2010 (the “Schedule”). The applicant was denied benefits by the respondent, Aviva, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

ISSUES

2The preliminary issues in dispute are:

1. Is the applicant an insured person pursuant to s. 3(1) of the Schedule?

2. Is the applicant barred from proceeding to a hearing for the benefits claimed in this application, except for issues 1(iv.) and 1(vi.), because the applicant failed to dispute their denial within the 2-year limitation period, pursuant to s. 56 of the Schedule?

3. Is the applicant barred from proceeding to a hearing for the benefits claimed in this application because the applicant failed to comply with s. 32 of the Schedule?

3The substantive issues in dispute are:

1. Is the applicant entitled to the treatment plans/OCF-18 (“plan”) proposed by Okell Rehabilitation Services as follows:

i. $1,396.55 ($4,648,95 less $3,242.40 approved) for occupational therapy services dated August 11, 2020;

ii. $748.10 ($4,189.70 less $5,430.94 approved) for occupational therapy services dated July 9, 2021;

iii. $435.00 ($5,865.94 less $3,441.60 approved) for occupational therapy services dated July 9, 2021;

iv. $448.86 for psychological services dated October 6, 2021;

v. $6,660.02 for occupational therapy services dated December 8, 2021;

vi. $4,289.70 for occupational therapy services dated February 17, 2022; and

vii. $1,033.00 ($5,719.32 less $4,686.32 approved) for social rehabilitation counselling dated August 8, 2020?

2. Is the applicant entitled to $1,295.00 ($5,195.00 less $3,900.00 approved) for social rehabilitation counselling proposed by Social Worker Consulting Group in a plan dated December 13, 2019?

3. Is the applicant entitled to $1,599.92 ($1,825.17 less $225.25 approved) for lost educational expenses, submitted on a claim form (OCF-6) dated September 15, 2015?

4. Is the applicant entitled to $6,720.00 for a CAT assessment, proposed by O. Rehabilitation Services Inc. in a plan dated February 17, 2022?

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

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

ANALYSIS

4The applicant has the onus of demonstrating entitlement to the medical benefits, award, and interest in dispute.

5In the case conference report and order released on April 9, 2024, the Tribunal ordered the matter to proceed to a written hearing. The Tribunal scheduled a written hearing for December 6, 2024. Notice of the written hearing was e-mailed to the parties on April 11, 2024, using the contact information they provided.

6The applicant’s initial written submissions were due on November 6, 2024. On September 9, 2024, the applicant e-mailed the Tribunal to advise that an agreement had been reached between the parties, for which the applicant was seeking court approval of the resolution. The applicant also indicated that she would be withdrawing the application in the future.

7On October 29, 2024, the Tribunal e-mailed the parties as a reminder of the upcoming written hearing and to advise that no submissions had been received. There has been no correspondence from the parties since that time, and the applicant has not submitted a Notice of Withdrawal.

8Neither party has filed submissions, and there has been no motion made seeking to extend the initial submissions deadline.

9The applicant’s e-mail dated September 9, 2024 did not request any relief from the Tribunal or indicate when the parties filed an application with the Court for approval of the agreement.

10Given that the parties have notified the Tribunal that an agreement has been reached pending approval by the Court such that a determination on the merits is not required, the parties are directed to notify the Tribunal if the settlement is not approved by the Court. In the interim, the Tribunal’s file will be closed without prejudice.

ORDER

11The parties are directed to notify the Tribunal if the settlement is not approved by the Court.

12The Tribunal’s file is to be closed without prejudice.