Mohamud v. Unifund Assurance Company, 2025 CanLII 78097

Citation: Mohamud v. Unifund Assurance Company, 2025 ONLAT 24-010180/AABS

Licence Appeal Tribunal File Number: 24-010180/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:

Ahmed Mohamud

Applicant

and

Unifund Assurance Company

Respondent

DECISION

PANEL:

Caley Howard

Melissa Shea

APPEARANCES:

For the Applicant:

Ahmed Mohamud, Applicant (did not attend)

For the Respondent:

David Koots, Counsel

Court Reporter:

Prashanth Thambipillai

Heard by Videoconference:

July 14, 2025

OVERVIEW

1Ahmed Mohamud, the applicant, was involved in an incident on March 24, 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, Unifund Assurance Company, and applied to the License Appeal Tribunal – Automobile Accident Benefits Services (the “Tribunal”) for resolution of the dispute.

Non-attendance of the applicant

2This matter was scheduled for a 3-day videoconference hearing, set to be heard at 9:30 am on July 14, 2025. At the start of the hearing at 9:30 am, the respondent was the only party to join the proceeding. The Tribunal attempted to reach the applicant by phone at the contact information provided by the applicant but was told by the person who answered the phone that it was the wrong number. There was no email on file for the applicant. After 30 minutes, the applicant was still not in attendance, and no reason was provided for his continued absence.

3The respondent submitted that the applicant had received proper notice of the hearing, that notice was mailed and emailed to the applicant’s representative, and that after notice was received, the applicant’s representative was removed from the record in May 2025. The respondent advised us that it attempted to contact the applicant by telephone after the applicant’s representative was removed from the record, but the telephone number that the respondent had on file no longer belonged to the applicant. The respondent requested updated contact information from the applicant’s former representative but did not receive any. The respondent submitted that, as per s. 7(3) of the Statutory Powers and Procedures Act (“SPPA”), the Tribunal should proceed with the hearing. The respondent cites Samra v Zenith Insurance Company, 2025 CanLII 47363 (ON LAT), and Mitchell v Intact Insurance Company, 2025 CanLII 52379 (ON LAT) in support of its position.

4Rule 3.7.1 of the Licence Appeal Tribunal Rules, 2023 (“Rules”) provides the Tribunal with the authority to proceed with the hearing in the absence of a party if that party does not arrive at the hearing within 30 minutes of the scheduled start time and if that party received proper notice in accordance with the SPPA. Rule 4.4 requires an applicant to notify the Tribunal promptly of any change in their contact information.

5We found the applicant had proper notice of the hearing as required by s. 6(5) of the SPPA, for the following reasons:

i. On January 8, 2025, a Case Conference was held by the Tribunal, and was attended by both parties, including the applicant and the applicant’s paralegal.

ii. On January 24, 2025, the Tribunal sent a Notice of Hearing to the parties. It was sent by email and by mail to the applicant’s paralegal, setting the hearing date as July 14, 2025 and the start time as 9:30 am.

iii. The applicant continued to be represented until May 9, 2025, when the applicant’s paralegal provided notice to the Tribunal that they were removing themselves as representative. The Tribunal requested updated contact information for the applicant, and no response was received from the paralegal.

iv. On July 2, 2025, the Tribunal telephoned the applicant to ascertain if the applicant had retained new representation but was not able to reach the applicant. The Tribunal mailed the January 4, 2025 Notice of Hearing to the applicant at the address the Tribunal had on file.

6Having satisfied ourselves that the applicant received notice in accordance with the SPPA, we proceeded with the hearing as per Rule 3.7.1.

PRELIMINARY ISSUE IN DISPUTE

7The preliminary issue to be decided is:

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

SUBSTANTIVE ISSUES IN DISPUTE

8The substantive issues to be decided 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 limit (“MIG”)?

ii. Is the applicant entitled to an income replacement benefit in the amount of $400.00 per week from March 30, 2023 to date and ongoing?

iii. Is the applicant entitled to chiropractic services, proposed by Windermere Rehabilitation Services in treatment plans/OCF-18 (“plan”) as follows:

a. $2,115.00, in a plan submitted September 7, 2023;

b. $1,353.72, in a plan submitted October 26;

c. $2,707.44, in a plan submitted December 21, 2023; and

d. $3,045.87, in a plan dated April 18, 2024?

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

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

RESULT

9The applicant has not met his onus to prove that the incident that occurred on March 24, 2023 constitutes an “accident”, as defined in s. 3(1) of the Schedule. The application is dismissed.

ANALYSIS

Was the incident an “accident”?

10We find that the applicant has not established that the incident that occurred on March 24, 2023 was an “accident” as defined in s. 3(1) of the Schedule.

11To be eligible for benefits, the applicant must prove on a balance of probabilities that the incident that occurred on June 22, 2022 meets the definition of an accident under the Schedule.

12The respondent submits that the applicant has the burden of proof, and because the applicant did not attend the hearing, and presented no evidence, he is not eligible for benefits under the Schedule. In support of its position that the applicant bears the burden of proof the respondent relies on Shakur v. Pilot Insurance Co. (C.A.), 1990 CanLII 6671 (ON CA) (“Shakur”), and Owusu v. TD Home & Auto Insurance Company et al, 2010 ONSC 6627 (“Owusu”).

13It is well established that the burden of proof lies with the insured. The Court of Appeal in Shakur held that it is fundamental in insurance law that the burden of proof rests on the insured to establish a right to recover under the terms of the policy. The Divisional Court in Owusu found that the burden of proof rests on the insured to establish a right to recover under the terms of the policy. Therefore, we find that the burden of proof in this case lies with the applicant.

14The applicant did not attend the hearing and did not present evidence or make submissions. As it is the applicant’s burden to establish that the incident was an accident, and as the Tribunal was not presented with evidence from the applicant in support of his application, it follows that the applicant cannot be successful with his claim.

15We find that the applicant has not proven, on a balance of probabilities, that the incident that occurred on March 24, 2023 was an “accident” as defined in s. 3(1) of the Schedule.

16Accident benefits are only available to those who were involved in an “accident” as defined in s. 3(1), therefore we find that the applicant is not entitled to the substantive issues listed above.

ORDER

17For the reasons outlined above, we find:

i. The applicant has not established that the incident that occurred on March 24, 2023 was an “accident” as defined in s. 3(1) of the Schedule. Therefore, he is not entitled to benefits under the Schedule.

ii. The application is dismissed.