Category: LAT Rules

M.Y. v. Aviva Insurance Company (17-007683)

The Insurer filed a Request for Reconsideration of a hearing decision that allowed the claimant to proceed with her application despite non-attendance at insurer examinations requested under s. 44 of the SABS. The hearing adjudicator had ordered the respondent to attend the insurer examinations as a condition to allowing the claimant to proceed. The insurer had been ordered to provide the claimant with new examination dates within 35 business days of receiving the hearing decision. The insurer argued in the Request for Reconsideration that due to the prejudice it suffered as a result of the claimant’s failure to attend numerous examinations over a period of years, the claimant should be barred from proceeding with her application. Vice Chair Trojek dismissed the insurer’s request that the claimant be completely barred from proceeding with the LAT application. Vice Chair Trojek found that the hearing decision did not violate the rules of natural justice or make a significant error in law or fact.

Applicant v. The Guarantee Company of North America (18-002753)

The claimant sought the raw test data from the insurer’s psychologist. The request was denied during the Case Conference. On reconsideration, Vice Chair Marzinotto also dismissed the request. She wrote that the claimant failed to provide any basis for reconsideration, and there were no supporting facts for the reconsideration.

L.H. v. Aviva Insurance Company of Canada (17-008904)

The claimant failed to make written submissions. The insurer sought the dismissal of the application and costs. Adjudicator Norris concluded that the matter should be dismissed due to the claimant’s default. He also awarded costs of $125 because the claimant’s behaviour was unreasonable and frivolous (she had failed to comply with the Case Conference Order regarding disclosure of her treatment provider, in addition to failing to make submissions).

Aviva Insurance Canada v. R.R. (16-004445)

The insurer sought repayment of $9,673.38 in IRBs and accountant fees of $2,353.93. Adjudicator Ferguson concluded there was an overpayment of IRBs because the claimant had misrepresented his pre-accident income and that the insurer’s payment of IRBs was therefore made in error. He held that he had no jurisdiction to order the claimant to reimburse the insurer for the cost of the accounting costs.

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.

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