Citation: Kumarasamy v. The Personal Insurance Company, 2026 ONLAT 25-002381/AABS

Licence Appeal Tribunal File Number: 25-002381/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:

Lejina Kumarasamy

Applicant

and

The Personal Insurance Company

Respondent

ADJUDICATOR:

Melanie Malach

APPEARANCES:

For the Applicant:

Lejina Kumarasamy, Self-Represented

For the Respondent:

Stacey Karellas, Counsel

HEARD:

By way of written submissions

1Lejina Kumarasamy, the applicant, was involved in an automobile accident on January 23, 2023, 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, The Personal 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 the services and assessments proposed by Pro Life Wellness Center, as follows:

a. $2,656.96 for physiotherapy services, in a treatment plan submitted June 15, 2023; and

b. $2,200.00 for a psychological assessment, in a treatment plan submitted July 27, 2023?

iii. Is the respondent entitled to repayment of $400.00 relating to its payment of an income replacement benefit for the period of April 3, 2023 to April 9, 2023?

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

RESULT

3I find that the applicant’s injuries are predominantly minor as defined in s. 3 of the Schedule and she is therefore subject to treatment within the $3,500.00 MIG limit.

4I find that the applicant is not entitled to the treatment plans in dispute.

5I find that the respondent is entitled to repayment of $400.00 relating to its payment of an IRB for the period of April 3, 2023 to April 9, 2023.

ANALYSIS

The Application has not provided submissions or evidence

6In the Case Conference Report and Order (“CCRO”), released on June 26, 2025, the Tribunal ordered the dispute to proceed to a written hearing. The Tribunal scheduled a written hearing for January 9, 2026. Notice of the written hearing was sent to the parties on July 3, 2025, using the contact information provided.

7On September 26, 2025, counsel for the applicant filed a Removal of Representative form. Counsel’s email was sent to the applicant, the respondent and the Tribunal advising that she would no longer be representing the applicant regarding her accident benefits claim. Counsel for the applicant further confirmed the applicant’s email address.

8By email dated September 26, 2025, the Tribunal wrote to the applicant and advised the applicant that it had received a Removal of Representative form indicating that her counsel is no longer representing her. The email requested that the applicant advise the Tribunal if she has retained another counsel or if she intends to retain one as soon as possible. No response to this email was received from the applicant.

9On November 17, 2025, counsel for the respondent sent an email to the applicant reminding her of the written hearing scheduled for January 9, 2025, and that her submissions are due on December 10, 2025. There was no response or further communication from the applicant in response.

10The applicant’s written submissions were due on December 10, 2025. The Tribunal has not received the applicant’s written submissions.

11The respondent filed its written submissions in compliance with the CCRO on December 11, 2025.

12I find that as the applicant did not file a Notice of Withdrawal with the Tribunal the file was not closed. I will therefore proceed with the hearing pursuant to s. 7(2) of the Statutory Powers Procedure Act. I find that the parties had notice of the written hearing by way of email on July 3, 2025, and the applicant chose not to participate. Accordingly, I shall proceed with the hearing.

Removal from the MIG and Entitlement to the Treatment Plans in Dispute

13I find that the applicant’s injuries are predominantly minor as defined in s. 3 of the Schedule and she is therefore subject to treatment within the $3,500.00 MIG limit. I find that the applicant is not entitled to the treatment plans in dispute or interest.

14The applicant in her Application has claimed that her injuries are not predominantly minor and that she is entitled to the treatment plans in dispute plus interest. She has not provided any submissions or evidence to support her position.

15The respondent submits that the applicant has failed to meet her evidentiary burden, as she has not adduced any submissions or evidence. The respondent submits that the applicant has not proved on a balance of probabilities that her injuries are not predominantly minor or that she suffers from a pre-existing medical condition which would prevent recovery within the $3,500.00 MIG limit. The respondent further submits that as the $3,500.00 MIG limit has been paid out, the treatment plans in dispute are not payable. The respondent argues that the issues of MIG and the treatment plans in dispute, plus interest, should be dismissed with prejudice due to the lack of submissions and evidence provided by the applicant.

16I find that the applicant has the onus of demonstrating removal from the MIG and entitlement to the treatment plans in dispute and interest. As no submissions or evidence have been filed with the Tribunal by the applicant, I find that the applicant has not met her burden of demonstrating that her injuries are not predominantly minor or that she suffers from a pre-existing medical condition that would prevent recovery within the $3,500.00 MIG limit. I further find that the applicant has not met her burden of demonstrating entitlement to the treatment plans in dispute, or interest.

IRB Repayment

17I find that the respondent is entitled to a repayment of $400.00 relating to its payment of an IRB for the period of April 3, 2023 to April 9, 2023.

18An insurer is permitted to claim the repayment of an IRB in certain situations and subject to certain conditions as established by the Schedule. Section 52(1)(a) of the Schedule establishes that an insured person is liable to repay the insurer any benefit “paid as a result of an error on the part of the insurer, the insured person or any other person, or as a result of wilful misrepresentation or fraud.” Section 52(2) of the Schedule provides that an insurer must give an insured person notice of the amount that is required to be repaid. Section 52(3) of the Schedule mandates that such notice be provided within 12 months of the payment of the amount that is to be repaid, unless the amount was originally paid because of wilful misrepresentation or fraud.

19The applicant has not made any submissions.

20The respondent claims repayment of IRBs in the amount of $400.00 for IRBs paid during the period of April 3, 2023 to April 92, 2023, pursuant to s. 52 of the Schedule.

21The respondent submits that it paid the applicant an IRB at $400.00 per week from January 30, 2023 to April 9, 2023. On April 13, 2023, the respondent was advised by way of email from the applicant’s representative, that the applicant had returned to work on April 3, 2023. On April 14, 2023, the respondent provided a Request for Income Information acknowledging the applicant’s return to work and requesting income documentation to determine her IRB entitlement.

22On May 5, 2023, the respondent received a copy of the applicant’s paystub showing that she worked 70.8 hours and earned $2,415.43 in the period of April 2, 2023 to April 15, 2023. As such, the quantum of her IRB entitlement was calculated and determined to be $Nil for April 3, 2023 to April 9, 2023, leading to an overpayment of $400.00. On May 9, 2023, the respondent provided an Overpayment Notice advising the applicant of the $400.00 overpayment of IRBs as she had returned to work on April 3, 2023, and the benefit was paid at $400.00 per week up to April 9, 2023.

23The respondent submits that the Notice complied with s. 52 of the Schedule, as it indicated the amount to be repaid; which benefit was to be repaid; and the period for which the benefit to be repaid covers.

24I find upon review of the respondent’s correspondence sent to the applicant on May 9, 2023, that this Notice meets the notice requirements of s. 52 of the Schedule, as it was provided within the 12-month period. The Notice identified the amount of IRBs being sought in repayment and the reason that repayment was being sought. I further find that the paystubs provided by the applicant support that the applicant returned to work on April 3, 2023 and that the calculation of her income during this period supports that her IRB was $NIL. I therefore find that the respondent is entitled to a repayment of $400.00 relating to its payment of IRBs to the applicant for the period from April 3, 2023 to April 9, 2023.

25Pursuant to s. 52(5) of the Schedule, an insurer “may” charge interest on the outstanding balance of the amount to be repaid. As the respondent has not provided any submissions that it claims interest on the outstanding balance, no interest is payable pursuant to s. 52(5) of the Schedule.

26For the reasons outlined above, I find that the pursuant to s. 52(1) of the Schedule, the applicant is liable to repay $400.00 to the respondent in relation to its payment of IRBs to the applicant for the period of April 3, 2023 to April 9, 2023.

ORDER

27For the reasons outlined above, I find:

i. The applicant’s injuries are predominantly minor as defined in s. 3 of the Schedule and she is therefore subject to treatment within the $3,500.00 MIG limit;

ii. The applicant is not entitled to the treatment plans in dispute or interest; and

iii. The respondent is entitled to repayment of $400.00 relating to its payment of an IRB for the period of April 3, 2023 to April 9, 2023.

Released: June 3, 2026