Licence Appeal Tribunal
Licence Appeal Tribunal File Number: 24-000169/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:
Dominador Ancheta
Applicant
and
Unica Insurance Inc.
Respondent
DECISION
VICE-CHAIR: Tyler Moore
APPEARANCES:
For the Applicant: No Submissions
For the Respondent: Modupe Egunjobi, Counsel
HEARD: By Way of Written Decisions
OVERVIEW
1Dominador Ancheta, the applicant, was involved in an automobile accident on March 23, 2022, 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, Unica Insurance Inc., 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 ("Minor") limit?
ii. Is the applicant entitled to $222.50 ($1,322.50 less $1,100.00 approved) for chiropractic services, proposed by Downsview Healthcare Inc., in a treatment plan/OCF-18 ("plan") submitted August 22, 2022 and partially denied August 23, 2022?
iii. Is the applicant entitled to $2,486.00 for a neurological assessment, proposed by Imperial Medical Assessments in a plan submitted April 22, 2022 and denied May 3, 2022?
iv. Is the applicant entitled to $2,045.88 for an in-home assessment, proposed by Imperial Medical Assessments in a plan submitted April 22, 2022 and denied May 3, 2022?
v. Is the applicant entitled to $1,863.72 for physiotherapy services, proposed by Downsview Healthcare Inc., in a plan submitted June 7, 2022 and denied June 16, 2022?
vi. Is the applicant entitled to $3,130.20 for chiropractic services, proposed by Downsview Healthcare Inc., in a plan submitted April 5, 2022 and denied April 19, 2022?
vii. Is the applicant entitled to $1,432.50 for chiropractic services, proposed by Downsview Healthcare Inc., in a plan submitted June 28, 2023 and denied July 7, 2023?
viii. Is the applicant entitled to $1,799.00 for chiropractic services, proposed by Downsview Healthcare Inc., in a plan submitted February 10, 2023 and denied February 15, 2023?
ix. Is the applicant entitled to $2,486.00 for psychological services proposed by Imperial Medical Assessments in a plan submitted May 5, 2022 and denied May 12, 2022?
x. Is the applicant entitled to $282.50 for psychological services, proposed by Imperial Medical Assessments in a plan submitted May 5, 2022 and denied August 1, 2023?
xi. Is the respondent liable to pay an award under s. 10 of Reg. 664 because it unreasonably withheld or delayed payments to the applicant?
xii. Is the applicant entitled to interest on any overdue payment of benefits?
ANALYSIS
3In the case conference report and order released on May 29, 2024, the Tribunal ordered the dispute to proceed to a written hearing. The Tribunal scheduled a written hearing for February 14, 2025. Notice of the written hearing was e-mailed to the parties on June 6, 2024, using the contact information provided.
4The applicant's initial submissions were due on January 15, 2025.
5The respondent filed its written submissions February 7, 2025.
6Since 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.
7The applicant has the onus of demonstrating that they should be removed from the MIG, and that they are entitled to the medical benefits and award in dispute.
8As 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 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
9The applicant remains in the MIG and is not entitled to the medical benefits in dispute.
10As no benefits are owing, the applicant is not entitled to interest or an award.
11The application is dismissed.
Released: August 19, 2025
Tyler Moore
Vice-Chair