Licence Appeal Tribunal
Licence Appeal Tribunal File Number: 23-013306/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:
Eric Lee
Applicant
and
Co-operators General Insurance Company
Respondent
DECISION
VICE-CHAIR: Tyler Moore
APPEARANCES:
For the Applicant: No Submissions
For the Respondent: Julianne Brimfield, Counsel
HEARD: By Way of Written Submissions
OVERVIEW
1Eric Lee, the applicant, was involved in an automobile accident on September 30, 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, 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 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 $2,637.52 for physiotherapy services, proposed by Newmarket Health & Wellness Centre in a treatment plan/OCF-18 (“plan”) submitted December 17, 2021?
iii. Is the applicant entitled to the assessments proposed by Medical Assessments Inc., as follows:
(i) $282.50 for a psychological pre-screening assessment, in a plan submitted March 21, 2022; and
(ii) $2,486.00 for a psychological assessment, in a plan submitted March 21, 2022?
iv. Is the applicant entitled to interest on any overdue payment of benefits?
ANALYSIS
3In the case conference report and order released on May 31, 2024, the Tribunal ordered the dispute to proceed to a written hearing. The Tribunal scheduled a written hearing for February 21, 2025. Notice of the written hearing was e-mailed to the parties on June 6, 2024, using the contact information provided.
4On August 28, 2024, the applicant filed an adjournment request form with the Tribunal but listed the event to be adjourned as a case conference. The applicant also indicated that the date and time of the event was May 28th, 2024 at 3:00pm, which coincided with the date and time of the case conference.
5On August 30, 2024, the Tribunal e-mailed the applicant to advise him that if he wanted to adjourn the hearing, he would need to resubmit the adjournment request with the correct date and time before it could be processed. The Tribunal has not received any correspondence from the applicant since that time. I also find that no Notice of Motion has been filed seeking to extend the applicant’s submission deadlines.
6The applicant’s initial submissions were due on January 22, 2025.
7The respondent filed its written submissions on February 7, 2025.
8Since 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 June 6, 2024.
9The applicant has the onus of demonstrating that he should be removed from MIG, and that he is entitled to the medical benefits in dispute.
10As no submissions or evidence have been filed with the Tribunal by the applicant, I find that he has not demonstrated that he should be removed from the MIG, and that he is entitled to the medical benefits and interest in dispute.
ORDER
11The applicant remains in the MIG, and is not entitled to $2,637.52 for physiotherapy services, $282.50 for a psychological pre-screen, and $2,486.00 for a psychological assessment.
12As no benefits are payable, the applicant is not entitled to interest.
13The application is dismissed.
Released: August 19, 2025
Tyler Moore
Vice-Chair