Ali v. Definity Insurance Company, 2025 CanLII 94788

Citation: Ali v. Definity Insurance Company, 2025 ONLAT 24-002726/AABS

Licence Appeal Tribunal File Number: 24-002726/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:

Mohamed Ali

Applicant

and

Definity Insurance Company

Respondent

DECISION

VICE-CHAIR: Tyler Moore

APPEARANCES:

For the Applicant: No Submissions

For the Respondent: Karly Lyons, Counsel

HEARD: By Way of Written Submissions

OVERVIEW

1Mohamed Ali, the applicant, was involved in an automobile accident on February 24, 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, Definity 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 an income replacement benefit in the amount of $400.00 per week from December 13, 2022 to date and ongoing?

iii. Is the applicant entitled to $99.91 ($1,299.91 less $1,200.00 approved) for chiropractic services, proposed by Activa Brampton in a treatment plan/OCF-18 ("plan") submitted May 24, 2022 and denied June 7, 2022?

iv. Is the applicant entitled to $2,008.10 for chiropractic services, proposed by Activa Brampton in a plan submitted June 15, 2022 and denied June 21, 2022?

v. Is the applicant entitled to $3,275.87 for a chronic pain assessment, proposed by Medex Assessments Inc. in a plan submitted January 18, 2023 and denied January 30, 2023?

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

ANALYSIS

3In the case conference report and order released on July 11, 2024, the Tribunal ordered the dispute to proceed to a written hearing. The Tribunal scheduled a written hearing for April 11, 2025. Notice of the written hearing was e-mailed to the parties on July 18, 2024, using the contact information provided.

4The applicant's initial submissions were due on March 12, 2025.

5The respondent filed its written submissions on March 28, 2025.

6On April 10, 2025, the applicant e-mailed the Tribunal to reiterate that he was self-represented and requested clarification about what he needed to do with the respondent's submissions.

7On April 11, 2025, the Tribunal responded to the applicant's e-mail, advising him that the written submissions due date had passed. The Tribunal referred the applicant to the case conference report and order and the notice of written hearing, which were included in the e-mail as attachments.

8The Tribunal has not received any further correspondence from the applicant. There has been no indication that the applicant has taken steps or intends to obtain new representation, and I find that there has been no Notice of Motion filed seeking to extend the applicant's submission deadlines.

9Since 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 July 11, 2024, and again on April 11, 2025.

10The applicant has the onus of demonstrating 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 in dispute.

11As no submissions or evidence have been filed with the Tribunal by the applicant, I find that the applicant has not demonstrated 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 in dispute.

ORDER

12The applicant remains in the MIG and is not entitled to an income replacement benefit from December 13, 2022 to date and ongoing.

13The applicant is not entitled to the medical benefits in dispute.

14As no benefits are owing, the applicant is not entitled to interest.

15The application is dismissed.

Released: September 15, 2025

__________________________

Tyler Moore

Vice-Chair