Licence Appeal Tribunal File Number: 23-011081/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 Muli
Applicant
and
The Commonwell Mutual Insurance Group
Respondent
DECISION
VICE-CHAIR: Tyler Moore
APPEARANCES:
For the Applicant: No Submissions
For the Respondent: No Submissions
HEARD: By Way of Written Submissions
OVERVIEW
1Michael Muli, the applicant, was involved in an automobile accident on February 14, 2018, 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, The Commonwell Mutual Insurance Company, 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 (“CCRO”) released on April 10, 2024, the Tribunal ordered the dispute to proceed to a written hearing. The Tribunal scheduled a written hearing for November 22, 2024. Notice of the written hearing was e-mailed to the parties on April 18, 2024.
3The applicant’s initial submissions were due on October 23, 2024. On November 14, 2024 and November 29, 2024, the Tribunal e-mailed the parties because no submissions had been received. There has been no response to the Tribunal’s e-mails, and the Tribunal has not received a Notice of Withdrawal.
ISSUES
4The issues in dispute are:
i. Is the applicant entitled to $13,786.00 for a chiropractic assessment, proposed by Omega Medical Assessments in a treatment plan submitted August 26, 2021 and denied September 16, 2021?
ii. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
iii. Is the applicant entitled to interest on any overdue payment of benefits?
ANALYSIS
5Since 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 of e-mail on April 18, 2024.
6The case conference adjudicator indicated in the CCRO dated April 10, 2024 that the chiropractic assessment, listed as issue i., was previously approved by the respondent by way of letter on September 28, 2021. The adjudicator also indicated that the full amount of the proposed assessment was paid to the provider, Omega Medical Assessments. According to the CCRO, the respondent provided e-mail confirmation of the treatment plan approval and payment to the applicant’s representative during the case conference.
7The Tribunal takes notice of its own records. I accept that the case conference adjudicator properly diarized that confirmation of the chiropractic assessment approval and payment was exchanged between the parties during the case conference. Since the applicant has not filed any submissions or evidence with the Tribunal and based on the strength of the CCRO, I find that issue i. is not an issue in dispute before the Tribunal under s. 280 of the Insurance Act. It follows, that no interest in payable.
8In terms of the award in dispute, the applicant has the onus of demonstrating entitlement. As no submissions or evidence have been filed with the Tribunal, I find that the applicant has not demonstrated that he is entitled to an award. I find further that no Notice of Motion has been filed seeking to extend the applicant’s submission deadlines.
ORDER
9As no submissions or evidence have been filed with the Tribunal by the applicant, I find that the applicant has not demonstrated entitlement to the award in dispute.
10The application is dismissed.
Released: June 27, 2025
__________________________
Tyler Moore
Vice-Chair