Category: LAT Rules

P.J. v. Aviva Insurance Company (18-001418)

The insurer sought reconsideration of the order that it produce unredacted log notes and that the claimant was not required to provide the particular of the special award claim until after receipt of the log notes. Vice Chair Trojek held that the insurer was to provide the log notes up to the date the LAT application was filed, with redactions for reserves, litigation privilege, and solicitor-client privilege. She dismissed the request that the claimant be required to particularize the special award claim prior to receipt of the log notes and ordered that the claimant had 30 days to provide particulars.

P.Y.J. v. The Personal Insurance Company (17-004636)

The claimant sought an order removing the insurer’s counsel because the same counsel had acted for the insurer in the priority dispute. The claimant also sought to exclude the transcripts from the priority examination under oath. Vice Chair Trojek granted reconsideration and barred counsel from representing the insurer in the LAT dispute. She also barred the used of the examination under oath transcripts from the priority matter.

L.J. v. The Personal Insurance Company (17-004701)

The claimant sought an order removing the insurer’s counsel because the same counsel had acted for the insurer in the priority dispute. The claimant also sought to exclude the transcripts from the priority examination under oath. Vice Chair Trojek granted reconsideration and barred counsel from representing the insurer in the LAT dispute. She also barred the used of the examination under oath transcripts from the priority matter.

Intact Insurance Company v. Lanziner-Brackett (2018 ONSC 6546)

The insurer sought judicial review of the Tribunal’s decision that the claimant was involved in an accident, and also sought judicial review of the Case Conference adjudicator’s framing of the dispute. The claimant had been struck by the door of a vehicle twice, and then physically assaulted by the driver of the vehicle. The insurer had accepted that the door-related injuries qualified as an “accident,” but that the punches to the face did not. The adjudicator concluded that the whole incident was an “accident.” The Court concluded that the Tribunal’s decision was unreasonable and sent the matter back to the Tribunal for a new hearing. The Court explained that the Case Conference adjudicator’s reframing of the issue in dispute denied the insurer procedural fairness. The Court did not address whether the facts of loss qualified as an “accident.”

G.L. v. Security National Insurance Company (18-002099 and 18-004400)

The Case Conference adjudicator listed repayment of non-earner benefits as an issue in dispute. The claimant brought a motion seeking to remove repayment as an issue. Vice Chair Hunter concluded that he did not have jurisdiction to alter the Case Conference Order, and that the claimant should have sought reconsideration. However, he did order the insurer to provide the particulars of the dates for which repayment was sought and if fraud or wilful misrepresentation was being alleged.

Unifund Assurance Company v. R.O. (17-001773)

The claimant sought reconsideration of the Tribunal’s order for her to repay IRBs of $17,200. She argued that the insurer still owed her IRBs for a period prior to her return to work, which should be offset against the repayment. The hearing adjudicator did not address her argument. Associate Chair Jovanovic ordered a new hearing on the claimant’s entitlement to IRBs in order to quantify whether there was any offset that the claimant was entitled to in relation to the ordered overpayment.

X.L. v. Unifund Assurance Company (17-008769)

The insurer sought the production of records from all post-accident physicians identified on the OHIP summary. The claimant did not dispute the relevance, but argued that the production of all records would be disproportionate. The Case Conference adjudicator did not make an order for such records, and the insurer sought reconsideration. Associate Chair Jovanovic ordered that the claimant produce the records from all of the physicians. He noted that the insurer had agreed to pay for the records, so there was very little prejudice to the claimant, and that to not provide the records to the insurer would be prejudicial to it.

R.K. v. Aviva Insurance Company (16-003997)

The insurer sought reconsideration of the Tribunal’s award of medical benefits, arguing that the claimant had not provided invoices evidencing that services were incurred. Associate Chair Jovanovic denied the reconsideration. He held that the adjudicator had considered and weighed the evidence and accepted that the medical treatment in dispute was reasonable, and that it was incurred.

Applicant v. Certas Home and Auto Insurance Company (17-000513)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to benefits proposed in two treatment plans. Adjudicator Punyarthi found that the claimant’s injuries fell within the MIG and that the treatment plans in dispute were not payable as the MIG limits had been exhausted. Adjudicator Punyarthi decided not to consider the issue of the timing of the insurer’s denial letters as this issue was raised for the first time in the claimant’s reply submissions, and the respondent did not have an opportunity to reply to the submissions.

Applicant v. Allstate Insurance Company of Canada (17-005138)

The claimant sought removal from the MIG and five medical benefits. Adjudicator Parish concluded that the claimant suffered minor injuries and did not suffer psychological injuries or chronic pain as a result of the accident. She did not accept the opinions of the claimant’s experts. Adjudicator Parish did not permit the claimant to rely upon written submissions that were not served in accordance with the Case Conference Order timelines. She also did not allow the claimant to rely upon case law that had not been submitted in accordance with the Case Conference Order timelines.