Ocampo v. Cooperators General Insurance Company, 2025 CanLII 81423

Citation: Ocampo v. Cooperators General Insurance Company, 2025 ONLAT 23-014544/AABS

Licence Appeal Tribunal File Number: 23-014544/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:

Salome Ocampo

Applicant

and

Co-operators General Insurance Company

Respondent

DECISION

VICE-CHAIR: Tyler Moore

APPEARANCES:

For the Applicant: No Submissions

For the Respondent: Emily Schatzker, Counsel

HEARD: By Way of Written Submissions

OVERVIEW

1Salome Ocampo, the applicant, was involved in an automobile accident on November 21, 2019, 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, Co-operators General 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 section 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 a chronic pain assessment in the amount of $2,460.00, proposed by HM Medical Network Ltd. in a treatment plan/OCF-18 submitted on April 27, 2023 and denied on May 2, 2023?

iii. Is the respondent liable to pay an award under section 10 of Regulation 664 because it unreasonably withheld or delayed payments to the applicant?

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

ANALYSIS

3In the case conference report and order released on May 10, 2024, the Tribunal ordered the dispute to proceed to a written hearing. The Tribunal scheduled a written hearing for January 31, 2025. Notice of the written hearing was e-mailed to the parties on May 16, 2024, using the contact information provided.

4On December 16, 2024, the Tribunal e-mailed the parties as a reminder that their submission due date was approaching, and to request a Notice of Withdrawal if the matter had settled.

5The applicant’s initial submissions were due on January 2, 2025.

6The respondent filed its written submissions on January 17, 2025.

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 of e-mail on May 16, 2024.

8The applicant has the onus of demonstrating that they should be removed from the MIG, and that they are entitled to the medical benefit 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 demonstrated that they should be removed from the MIG, and that they are entitled to the medical benefit, award, and interest in dispute. I further find that no Notice of Motion has been filed seeking to extend the applicant’s submission deadlines.

ORDER

10The applicant remains in the MIG and is not entitled to $2,460.00 for a chronic pain assessment.

11The applicant is not entitled to an award, and as no benefits are owing, the applicant is not entitled to interest.

12The application is dismissed.