Category: LAT Rules

P.Y. v. Aviva General Insurance Company (17-003692)

Post author By tgp-admin
Post date July 29, 2019
No Comments on P.Y. v. Aviva General Insurance Company (17-003692)

The claimant sought reconsideration of the Tribunal’s decision that the claimant’s injuries fell within the MIG and the denial of three treatment plans. Following the Tribunal’s decision, the insurer removed the claimant from the MIG. The claimant argued that this was new evidence that could not have reasonably been obtained earlier. Adjudicator Grieves granted the reconsideration and ordered that the claims for three treatment plans be determined by the adjudicator originally hearing the matter.

J.Y. v. Aviva Insurance Canada (17-009034)

Post author By tgp-admin
Post date July 25, 2019
No Comments on J.Y. v. Aviva Insurance Canada (17-009034)

The claimant sought reconsideration of the Tribunal’s decision to dismiss all of his claims. Adjudicator Watt dismissed the reconsideration request. He held that the claimant had failed to provide written submissions to the Tribunal as ordered by the hearing adjudicator; that the surveillance considered by the Tribunal was not improper; that the Tribunal considered the proper test for IRBs; and that the Tribunal was not required to accept the evidence of an assessor whose report was inconsistent and contrary to other evidence.

N.A. v. Aviva General Insurance (18-006048)

Post author By tgp-admin
Post date July 18, 2019
No Comments on N.A. v. Aviva General Insurance (18-006048)

The claimant sought entitlement to a TMJ assessment. The insurer argued that the Tribunal had already determined whether the claimant suffered TMJ injuries in the accident during an earlier proceeding. Adjudicator Grant agreed with the insurer that the causation of the claimant’s TMJ symptoms had already been addressed by the Tribunal, and that res judicata barred the claimant from re-litigating the issue. He also held it would be an abuse of process for the Tribunal to make a determination contrary to the Tribunal’s earlier decision.

T.H. v. Aviva Insurance Company of Canada (17-001125)

Post author By tgp-admin
Post date July 8, 2019
No Comments on T.H. v. Aviva Insurance Company of Canada (17-001125)

The Tribunal dismissed the claim for NEBs and the claimant sought reconsideration arguing that he had been denied natural justice because he was not permitted to call additional witnesses at the hearing, despite agreeing to the procedure in the Case Conference. He also argued that the insurer failed to send an appropriate NEB denial. Member Jovanovic dismissed the reconsideration. He held that the claimant’s legitimate expectations were met because the hearing procedure had been agreed upon during the Case Conference. He also accepted that the insurer had sent an appropriate denial of NEBs. Finally, he held that the Tribunal had applied the correct NEB test.

M.J. v. Economical Mutual Insurance Company (18-005523)

Post author By tgp-admin
Post date July 5, 2019
No Comments on M.J. v. Economical Mutual Insurance Company (18-005523)

The claimant requested productions from SOMA Medical Assessment. SOMA was a third party who had concluded in its s. 44 assessments that the claimant’s injuries were not catastrophic. In the Case Conference for the matter, the adjudicator released an Order dated November 6, 2018 requiring the insurer to produce SOMA’s complete file as it pertained to the claimant. The insurer then requested these records from SOMA, who refused to produce the documents. In their letter to the insurer dated February 1, 2019, SOMA stated that the Case Conference Order required the insurer, and not SOMA, to produce these documents, and moreover, that the LAT could not order a third party to produce the documents. The claimant then brought a Motion for an Order to compel SOMA to produce their file as a third party. In her Order dated May 7, 2019, Adjudicator Helt acknowledged that the LAT did not have the power to order productions from a third party under the Tribunal’s Rules. However, Adjudicator Helt noted that the present matter involved a CAT application which required complex examinations of medical documents. Relying on obiter comments from the ONCA’s decision Ontario (Human Rights Commission) v. Dofasco Inc., and the decisions reached in two LAT cases, 17-00777 v. Aviva General Insurance and 17-007223 v. Wawanesa Mutual Insurance Company, Adjudicator Helt reasoned that the production of documents in advance of a hearing would prevent adjournments and was aligned with the SPPA’s scheme to ensure just, expeditious, and cost-effective determination of each matter on its merits. She relied on section 2 of the SPPA to order SOMA to produce its file to the Claimant by May 24, 2019.

Shuttleworth v. Ontario (Safety, Licensing Appeals and Standards Tribunal) (2019 ONCA 518)

Post author By tgp-admin
Post date June 21, 2019
No Comments on Shuttleworth v. Ontario (Safety, Licensing Appeals and Standards Tribunal) (2019 ONCA 518)

The Tribunal and the insurer appealed the Divisional Court’s decision that there was a reasonable apprehension of lack of adjudicative independence. The Court of Appeal dismissed the appeal and held that the Divisional Court had correctly applied the case law regarding adjudicative independence. The dispute was remitted to the Tribunal for a new hearing on the catastrophic impairment.

L.K.C. v. Unifund Assurance Company (18-004346)

Post author By tgp-admin
Post date May 23, 2019
No Comments on L.K.C. v. Unifund Assurance Company (18-004346)

The insurer sought reconsideration of the Tribunal’s order to produce adjusting log notes. Adjudicator Marzinotto dismissed the reconsideration request. She held that the Tribunal did not make a significant error of law, and that the log notes were relevant to the issues in dispute. She also noted that there was no legal requirement that a special award be sought in order for log notes to be relevant to the dispute.

J.L. v. Wawanesa Mutual Insurance Company (18-000766)

Post author By tgp-admin
Post date May 16, 2019
No Comments on J.L. v. Wawanesa Mutual Insurance Company (18-000766)

The claimant sought reconsideration of the Tribunal’s decision that he did not suffer a catastrophic impairment under the Glasgow Coma Scale. He argued that the Tribunal should have admitted video evidence of the paramedic administering the GCS. Adjudicator Boyce agreed with the Tribunal that the video had limited probative value and was unlikely to change the result of the hearing. The paramedic attended the hearing and was examined on his GCS measurements. The adjudicator also rejected the claimant’s arguments that the insurer’s expert gave evidence outside of his report (such as addressing inconsistencies within his expertise).

T.K. v. Allstate Insurance (18-007113)

Post author By tgp-admin
Post date May 16, 2019
No Comments on T.K. v. Allstate Insurance (18-007113)

The claimant sought an order for interim benefits pending the LAT hearing. The insurer argued that the LAT did not have jurisdiction to award interim benefits. Adjudicator Letourneau agreed with the insurer and held that he did not have jurisdiction to award interim benefits. When read together, none of the Insurance Act, the Statutory Powers Procedure Act, nor the LAT Act gave the Tribunal the power to make an interim award. Instead, the adjudicator suggested that an expedited hearing be scheduled.

F.C. v. Intact Insurance Company (18-005079)

Post author By tgp-admin
Post date May 15, 2019
No Comments on F.C. v. Intact Insurance Company (18-005079)

The claimant had applied to the Tribunal for accident benefits, and commenced an action for property damage in the Superior Court. The insurer alleged that the claimant had committed material misrepresentations, and sought a stay of the LAT proceedings until the Superior Court decision was rendered or a preliminary hearing addressing the material misrepresentations. The Tribunal rejected both requests; the insurer sought reconsideration. Adjudicator Lester held that the Tribunal did not act outside its jurisdiction or violate the rules of natural justice or procedural fairness, and noted that the claimant would be prejudiced by a stay of the LAT application.

Contact Us

Contact Us

Contact Us