Parker-Berube v. Desjardins General Insurance Group, 2025 CanLII 75779

Parker-Berube v. Desjardins General Insurance Group

Citation: Parker-Berube v. Desjardins General Insurance Group, 2025 ONLAT 24-015797/AABS-PI

Licence Appeal Tribunal File Number: 24-015797/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:

Sarah Parker-Berube

Applicant

and

Desjardins General Insurance Group

Respondent

PRELIMINARY ISSUE HEARING DECISION AND ORDER

ADJUDICATOR: Laura Goulet

APPEARANCES:

For the Applicant: Sarah Parker-Berube, Applicant

For the Respondent: Ayda Choupani, Counsel

HEARD: By way of written submissions

OVERVIEW

1Sarah Parker-Berube, the applicant, was involved in an automobile accident on May 18, 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, Desjardins General Insurance Group, and applied to the Licence Appeal Tribunal – Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

PRELIMINARY ISSUES

2The preliminary issues to be decided are:

i. Does the Tribunal have jurisdiction under s. 280 of the Insurance Act, RSO 1990 in this matter?

ii. Was the applicant involved in an “accident” as defined in s. 3(1) of the Schedule?

iii. Is the applicant barred from proceeding to a hearing as they failed to notify the respondent of the circumstances giving rise to a claim for benefits no later than the seventh day after the circumstances arose or as soon as practicable after that day?

iv. Is the applicant barred from proceeding with their claim for benefits as they failed to submit the application for benefits (OCF-1) within the time prescribed in the Schedule?

v. Is the applicant barred from proceeding to a hearing for all the benefits claimed in this application because the applicant failed to dispute their denial within the 2-year limitation period?

RESULT

3The Tribunal does not have jurisdiction under s. 280 of the Insurance Act.

4The application is dismissed.

ANALYSIS

The Tribunal does not have jurisdiction under s. 280 of the Insurance Act

5For the following reasons, I find that the Tribunal does not have jurisdiction under s. 280 of the Insurance Act.

6Section 280(1) of the Insurance Act states that the Tribunal has jurisdiction to resolve “disputes in respect of an insured person’s entitlement of statutory accident benefits or in respect of the amount of statutory accident benefits to which an insured is entitled.”

7The respondent submits that there are no benefits in dispute. The respondent further submits that to date, the applicant has not submitted any statutory accident benefits for the respondent’s consideration. The respondent points out that the only disputes on the LAT application are the applicability of the Minor Injury Guideline (“MIG”) and a claim for an award for unreasonably withheld or delayed payments.

8The respondent relies on the Tribunal decision of R.T. v. Certas Direct Insurance Company, 2020 CanLII 12782 (ON LAT) (“R.T.”), where the Tribunal held that the MIG is a guideline and not a benefit entitled to a determination on its own under the Schedule. The Tribunal went on to say that the MIG establishes a framework for treatment to speed access to rehabilitation for persons who sustain predominantly minor injuries in automobile accidents. Without any treatment being sought by the applicant, the issue of the MIG is moot.

9The applicant submits that on April 19, 2025, an adjuster on the file indicated that she had submitted all relevant information to process the claim and no other information was needed. The applicant also argues that to submit further information would be an additional frustration and financial burden on her.

10Although I am not bound by other decisions of the Tribunal, I agree with the reasoning in R.T. The MIG is not a statutory accident benefit; it is a guide that defines what is a minor injury and the treatment framework for medical providers.

11I find that since a determination of whether a person is in the MIG does not entitle that person to benefits, it is not a dispute pursuant to s. 280(1) of the Insurance Act. As such, I find that the Tribunal does not have jurisdiction to decide this matter unless a benefit is tied to it that requires its determination.

12Further, I find that an application for an award without a benefit tied to it is not a dispute in respect of an insured person’s entitlement of a statutory accident benefit or in respect of the amount of statutory accident benefits to which an insured is entitled.

13Since I find there is no dispute for benefits before the Tribunal, I find that the Tribunal does not have jurisdiction under s. 280 of the Insurance Act.

14Since I find that the Tribunal does not have jurisdiction to deal with this application, I do not need to consider the other preliminary issues in dispute.

ORDER

15For the above reasons, I find:

i. The Tribunal does not have jurisdiction under s. 280 of the Insurance Act.

ii. The application is dismissed.