Licence Appeal Tribunal
Licence Appeal Tribunal File Number: 24-007138/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:
Patricia Rojas
Applicant
and
Pembridge Insurance Company
Respondent
DECISION
VICE-CHAIR: Tyler Moore
APPEARANCES:
For the Applicant: No Submissions
For the Respondent: No Submissions
HEARD: By Way of Written Submissions
OVERVIEW
1Patricia Rojas, the applicant, was involved in an automobile accident on October 31, 2023, 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, Pembridge Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
ISSUES
2The issues in dispute are:
i. 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?
ii. Is the applicant entitled to non-earner benefits in the amount of $185.00 per week from 4 weeks post-MVA to date and ongoing?
iii. Is the applicant entitled to $2,144.93 for psychological services, proposed by Dr. Pilowsky in a treatment plan/OCF-18 (“plan”) dated March 1, 2024?
iv. Is the applicant entitled to $1,995.51 for occupational therapy services, proposed by Functionability in a plan dated February 20, 2024?
v. Is the applicant entitled to $3,591.55 for occupational therapy services, proposed by Functionability in a plan dated March 8, 2024?
vi. Is the applicant entitled to $710.00 for physiotherapy services, proposed by PhysioRehab Group Bolton in a plan dated January 30, 2024?
vii. Is the applicant entitled to $998.00 for physiotherapy services, proposed by PhysioRehab Group Bolton in a plan dated March 6, 2024?
viii. Is the applicant entitled to $3,409.09 for psychological services, proposed by Dr. Pilowsky in a plan dated September 5, 2024?
ix. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
x. Is the applicant entitled to interest on any overdue payment of benefits?
ANALYSIS
3In the case conference report and order released on October 7, 2024, the Tribunal ordered the dispute to proceed to a written hearing. The Tribunal scheduled a written hearing for June 13, 2025. Notice of the written hearing was e-mailed to the parties on October 15, 2024, using the contact information provided.
4On April 29, 2025, the Tribunal e-mailed the applicant to request that she file a Notice of Withdrawal if the matter had been settled.
5The applicant’s initial submissions were due on May 14, 2025.
6Neither party has filed submissions. There has been no motion made seeking to extend the submission deadlines, and the Tribunal has not received a Notice of Withdrawal from the applicant.
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 hearing pursuant to s. 7(2) of the Statutory Powers Procedure Act. I find that the applicant had notice of the written hearing by way on e-mail on October 15, 2024.
8The applicant has the onus of demonstrating that she should be removed from the MIG and that she is entitled to the non-earner benefit, medical benefits, and award in dispute.
9As 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 substantive issues in dispute.
ORDER
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 that she should be removed from the MIG, and that she is entitled to a non-earner benefit, medical benefits, an award, and interest.
11The application is dismissed.
Released: June 30, 2025
__________________________
Tyler Moore
Vice-Chair