Licence Appeal Tribunal File Number: 23-001011/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:
Thi Khanh Duy Pham
Applicant
and
Wawanesa Insurance
Respondent
DECISION
VICE-CHAIR: Craig Mazerolle
APPEARANCES:
For the Applicant: No submissions
For the Respondent: Nawaz Tahir, Counsel
HEARD: By way of Written Submissions
OVERVIEW
1Thi Khanh Duy Pham, the applicant, was involved in an automobile accident on January 8, 2020, 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, Wawanesa Insurance, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.
2In a case conference report and order released on November 1, 2023, the Tribunal ordered the dispute to proceed to a written hearing. The Tribunal scheduled a written hearing for June 21, 2024, with the Notice of Written Hearing e-mailed to the parties on November 9, 2023.
3The applicant’s initial submissions were due on May 22, 2024. The applicant has not provided any written submissions to the Tribunal. There has also been no Notice of Motion filed seeking to extend the applicant’s initial submissions deadline, nor has there been an adjournment request made seeking to reschedule the written hearing.
4The respondent filed submissions with the Tribunal stating it has not received submissions from the applicant. It is seeking a dismissal of the application.
ISSUES
5As listed in the case conference report and order, the 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 $2,300.56 for physiotherapy services, proposed by Pain Rehabilitation Clinic Inc., in a treatment plan/OCF-18 (“plan”) dated August 16, 2021, denied September 8, 2021?
iii. Is the applicant entitled to $2,200.00 for a psychological assessment, proposed by Pain Rehabilitation Clinic Inc., in a plan dated June 2, 2021, denied June 10, 2021?
iv. Is the applicant entitled to $2,200.00 for a functional abilities assessment, proposed by Pain Rehabilitation Clinic Inc., in a plan dated October 21, 2022, denied November 2, 2022?
ANALYSIS
6Section 7(2) of the Statutory Powers Procedure Act, R.S.O. 1990, c. S.22 states that, if notice of a written hearing has been given to a party who does not then participate in the hearing in accordance with the notice, the Tribunal may proceed with the hearing in the absence of that party’s participation.
7I am satisfied that both parties received notice of the written hearing, so I shall proceed without submissions from the applicant.
8The applicant has the onus of demonstrating removal from the MIG, as well as entitlement to the medical benefits in dispute. By not filing any submissions or evidence with the Tribunal, I find that the applicant has not met this burden.
9I further find that the applicant did not file a Notice of Motion requesting an extension of the initial submission deadline, nor has there been an adjournment request made seeking to reschedule the written hearing.
ORDER
10As the applicant has made no submissions and tendered no evidence in support of the claims before the Tribunal, the applicant has not demonstrated removal from the MIG, nor has the applicant demonstrated entitlement to the medical benefits in dispute.
11The application is dismissed.
Released: February 3, 2025,
Craig Mazerolle
Vice-Chair