Citation: Dhanjal v. TD General Insurance Company, 2026 ONLAT 24-014262/AABS

Licence Appeal Tribunal File Number: 24-014262/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:

Prabhjot Dhanjal

Applicant

and

TD General Insurance Company

Respondent

DECISION

ADJUDICATOR:

Aric Bhargava

APPEARANCES:

For the Applicant:

Moninder Khattra, Counsel

For the Respondent:

Hilary Doyle, Counsel

HEARD:

By way of written submissions

OVERVIEW

1Prabhjot Dhanjal, the applicant, was involved in an automobile accident on December 20, 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, TD General Insurance Company, and applied to the Licence Appeal Tribunal — Automobile Accident Benefits Service (the “Tribunal”) for resolution of the dispute.

ISSUE

2The issue in dispute is:

i. Is the applicant entitled to $5,620.00 for hearing aids, proposed by Hearing Excellence in an invoice from the clinic submitted October 24, 2023?

RESULT

3I find the applicant is not entitled to the expense for hearing aids.

ANALYSIS

Is the applicant entitled to a hearing aid expense totalling $5,620.00?

4I find the applicant is not entitled to the hearing aid expense.

5The applicant submits that the hearing devices are reasonable and necessary for his recovery from accident-related symptoms. The applicant relies on the clinical notes and records (“CNRs”) of Dr. Vara Mahadevan, family physician, the neurology progress reports prepared by Dr. Charles Tator, neurosurgeon, the Hearing Excellence letter dated August 7, 2024, and the Hearing Excellence Audiological Assessment dated September 5, 2024.

6The respondent did not make any submissions on whether the expense is reasonable and necessary. The respondent submits the applicant did not submit a treatment plan prior to incurring the expense, the applicant is not in compliance with section 38(2) of the Schedule, the expense does not meet the eligible exceptions in section 38(2), and the respondent denies authorizing the expense without a plan.

[7]

7The CNRs of Dr. Mahadevan notes the applicant suffered a mild concussion as a result of the accident, and five days after the accident he suffered a syncopal event that is not attributed to the accident. On October 26, 2022, almost a year after the accident, Dr. Tator, neurologist, notes in the electroencephalogram (“EEG”) report that the applicant had five previous episodes of unconsciousness, and that as a result of the accident he has “major sensitivity to loud sound”, eyestrain, and sensitivity to light. However, Dr. Tator’s EEG study does not refer to any audiological testing.

8Sixteen months after the accident, on April 10, 2023, Dr. Mahadevan notes the applicant complained of hypersensitivity to sound and the applicant was referred to an otolaryngologist (“ENT”) for an audiology test and report. The ENT report prepared by Dr. Frank Bravo, otolaryngologist, dated June 6, 2023, notes that the “hearing loss and tinnitus is due to his guitar playing noise exposure as a significant contributor.”

9I find the hearing aid expense is not reasonable and necessary. The applicant has not persuaded me that his hearing loss is a result of his accident-related injuries, and I note that his family doctor CNRs first report the issue of hearing loss sixteen months after the accident and that is when he was referred to Dr. Bravo, ENT, and the ENT report did not note the accident or his accident-related injuries resulted in his hearing loss.

10In the event that I am wrong and the disputed expense is reasonable and necessary, the respondent submits pursuant to section 38(2), an insurer is not liable to pay an expense in respect of a medical or rehabilitation benefit that is incurred before the insured submits a treatment plan unless certain criteria are met.

11Pursuant to section 38(2) of the Schedule, an insurer is not liable to pay an expense in respect of a medical or rehabilitation benefit that is incurred before the insured person submits a treatment plan subject to certain exceptions; none of which are argued by the applicant.

12The applicant did not submit a reply submission and has not directed me to a treatment plan proposing hearing aids/devices. The evidence before me is that the hearing aids were purchased and paid for in full on October 10, 2023. The invoice was submitted on October 24, 2023.

[13]

13The evidence before me is that the exceptional criteria under section 38(2) are not applicable in this instance. The applicant did not direct me to evidence that the respondent provided notice under section 39(1) that the expense would be paid without a treatment plan; or that the expense is for goods and services provided on an emergency basis not more than five business days after the accident; or that the expense is reasonable and necessary as a result of the impairment sustained by the insured for goods with a cost of $250 or less per item; or that the insurer agreed that the expense is essential for the treatment of the insured for goods with a cost of $250 or less per item.

14For the reasons set out above, I find on a balance of probabilities that the applicant is not entitled to the expense for hearing aids.

ORDER

15The applicant is not entitled to the hearing aids expense.