Licence Appeal Tribunal
Licence Appeal Tribunal File Number: 23-013487/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:
Carlton Watson
Applicant
and
Definity Insurance Company
Respondent
DECISION
VICE-CHAIR: Tyler Moore
APPEARANCES:
For the Applicant: No Submissions
For the Respondent: Mirsa Duka, Counsel
HEARD: By Way of Written Submissions
OVERVIEW
1Carlton Watson, the applicant, was involved in an automobile accident on August 25, 2021, 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, Definity Insurance Company, and applied to the Licence Appeal Tribunal - Automobile Accident Benefits Service (the "Tribunal") for resolution of the dispute.
ISSUES
2The Preliminary issue in dispute is:
i. Is the applicant barred from proceeding to a hearing for substantive issue number iii. below, because the applicant failed to attend an insurer's examination under s. 44 of the Schedule?
3The Substantive 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 an income replacement benefit in the amount of $400.00 per week from September 24, 2021 to date and ongoing?
iii. Is the applicant entitled to $1,687.95 for physiotherapy services, proposed by Maxwell Physiotherapy and Rehab Inc. in a plan dated June 15, 2022?
iv. Is the applicant entitled to $2,598.81 for a chronic pain assessment, proposed by Prime Health Care Inc. in a plan dated September 13, 2023?
v. Is the applicant entitled to $2,200.00 for a psychological assessment, proposed by Prime Health Care Inc. in a plan dated September 11, 2023?
vi. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
vii. Is the applicant entitled to interest on any overdue payment of benefits?
ANALYSIS
4In the case conference report and order released on May 30, 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.
5On October 29, 2024, the applicant's representative filed a Removal of Representative request form with the Tribunal. On that same date, the Tribunal acknowledged the Removal of Representative form by e-mail and thanked the parties for confirming the applicant's contact information. The Tribunal e-mailed the notice of the written hearing and case conference report and order directly to the applicant.
6On December 9, 2024, the Tribunal e-mailed the applicant to request that he advise the Tribunal if he was obtaining new representation or representing himself. The Tribunal then also sent the case conference report and order and notice of the written hearing to the applicant by regular mail, using the contact information provided by the applicant's former representative in October 2024.
7There is no indication that the applicant intends to obtain new representation, or evidence that he has taken steps to do so, since the Removal of Representative form was received by the Tribunal on October 29, 2024.
8On January 15, 2025, the Tribunal e-mailed the parties as a reminder that their written submissions due date was approaching.
9The applicant's initial submissions were due on January 22, 2025.
10The respondent filed its written submissions on February 6, 2025.
11On March 5, 2025, the Tribunal received returned mail marked "moved/unknown" that was mailed to the applicant on December 9, 2024. On that same date, the Tribunal e-mailed the applicant a request to submit his correct mailing address.
12There is no indication that any of the Tribunal's e-mails to the applicant have "bounced back" or were "undeliverable". Pursuant to the Licence Appeal Tribunal Rules, 2023 ("Rules") Rule 4.4, an applicant is also required to notify the Tribunal promptly of any change in contact information.
13Since 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, December 9, 2024, and January 15, 2025.
14The applicant has the onus of demonstrating that that he should be removed from the MIG, that he is entitled to an income replacement benefit, and that he is entitled to the medical benefits and award in dispute.
15As no submissions or evidence have been filed with the Tribunal by the applicant, I find that the applicant has not met the evidentiary burden to demonstrate that he should be removed from the MIG, that he is entitled to an income replacement benefit, and that he is entitled to the medical benefits, 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
16As the applicant has made no submissions and tendered no evidence in support of his claim before the Tribunal, the applicant has not met his onus to prove entitlement to the benefits claimed.
17The application is dismissed.
Released: August 19, 2025
Tyler Moore
Vice-Chair