Category: LAT Rules

R.T. v. Aviva Insurance Canada (17-004564)

The claimant sought a entitlement to income replacement benefits. At the outset of the hearing, the insurer sought an order dismissing the application as abandoned because the claimant had not submitted written submission prior to the oral hearing, as ordered at the case conference. In the alternative, the insurer sought to have any further evidence or written submissions struck from the record. Adjudicator Norris held that the parties could make written submissions after the oral testimony. With regards to the claim for IRBs, Adjudicator Norris found that claimant was not entitled to the benefit for the period in which he was in non-compliance with section 33 requests for an executed WSIB assignment. Adjudicator Norris also found the claimant was not entitled to IRBs as he had not declared his pre-accident income pursuant to the Income Tax Act.

A.S. v. Pafco Insurance (16-003683)

The claimant sought reconsideration of the Tribunal’s decision to deny the claim for ongoing IRBs. The claimant requested reconsideration on the basis that the Tribunal denied him natural justice and procedural fairness. Associate Chair Batty agreed with the claimant that the Tribunal had overlooked or mischaracterized parts of the claimant’s evidence at the LAT hearing. Associate Chair Batty ordered that the application would be reheard in writing and be limited to considering anew evidence and submissions already provided by the parties.

R.P. v Aviva Insurance Canada (17-003500)

The claimant appealed Aviva’s MIG determination and sought medical benefits for chiropractic services, the completion of numerous OCF-3s, a social work assessment, and an orthopaedic assessment. The claimant also sought IRBs. Aviva opposed the claimant’s request to have a treating chiropractor qualified as an expert. Adjudicator Hines held that the claimant’s injuries were within the MIG and none of the OCF-18s or OCF-3s were reasonable and necessary. The adjudicator further held that the claimant was not entitled to IRBs. The adjudicator also held that the treating chiropractor was not qualified as an expert witness, but could give evidence in his capacity as a treating chiropractor. The adjudicator held that the claimant sustained soft-tissue injuries, which fell within the MIG. The adjudicator held that the chiropractor’s diagnosis of post-concussion syndrome/concussion was outside the scope of his expertise, and the adjudicator also found inconsistencies in the claimant’s evidence with respect to “loss of consciousness”. The adjudicator preferred Aviva’s IE report from a psychologist over the claimant’s report from a social worker with respect to psychological injuries. The adjudicator also held that the rates charged on the OCF-18s exceeded the amounts payable under the FSCO Guideline. The OCF-3s were not payable as particulars were not provided with respect to the claimant’s change in condition and updated OCF-3s were not requested by Aviva. Lastly, the adjudicator preferred Aviva’s multi-disciplinary report over the claimant’s evidence (OCF-3s) with respect to IRBs, and held that the claimant did not suffer a substantial inability to perform the essential tasks of a material handler or casino dealer.

Applicant v. Aviva Insurance Company (17-005081)

The claimant sought entitlement to three treatment plans, and interest on overdue payments.  The insurer brought a preliminary issue concerning whether the applicant was precluded from submitting evidence regarding the benefits in dispute; more specifically, the claimant had failed to submit two of the treatment plans to the Tribunal. Adjudicator Go determined that, it was in the interests of fairness to admit the treatment plans despite their late filing. Adjudicator Go further held that the claimant was not entitled to any of the medical benefits sought, or to interest.

Applicant v. Aviva Insurance (17-005318)

The claimant sought an adjournment of the hearing because the insurer’s IE assessor was unavailable. The insurer opposed the adjournment. Adjudicator Makhamra granted the adjournment, reasoning that the claimant was entitled to cross examine the IE assessor as part of her case.

B.B. v. Intact Insurance (17-005966)

This was a motion to adjourn an in-person hearing, heard via teleconference. The parties resolved the issues in dispute after commencement of the motion.

K.B. v. Aviva Insurance Canada (17-006903)

The claimant made a motion to add a request for a special award, seek productions, change the format of the hearing, and to add witnesses to the hearing. Vice Chair Hunter ordered a Case Conference resumption to deal with the requests, and also ordered that an in-person hearing be set.

T.H. v. The Personal Insurance Company (17-000121)

The insurer sought to rely on section 38(2) of the Schedule as a defence, asserting that the claimant incurred the expense of an assessment in dispute prior to submitting the OCF-18 to the insurer for approval. The claimant brought a motion for a declaration precluding the insurer from relying on the defence for a number of reasons: the insurer accepted the OCF-18 and scheduled IEs to assess its reasonableness and necessity; section 38 requires “all other reasons” to be provided in the denial; the denial of the OCF-18 was only based on the MIG; the issue was not raised by the insurer at FSCO before the matter was transferred to the LAT, in its response, at the case conference, or at any other time prior to written submissions being filed. Adjudicator Daoud denied the claimant’s motion, finding that a defence may be raised at any time within the proceeding as long as there is no prejudice caused to the claimant and the claimant has the opportunity to respond to it.

Applicant v. Aviva Insurance (17-006160)

The claimant sought entitlement to various medical benefits, a special award, and interest. The claimant raised a procedural issue, and asked the Tribunal to disregard attachments appended to the insurer’s written submissions, as they had not been transmitted properly via facsimile to the claimant; the attachments had been provided via mail several days later. Adjudicator Mazerolle denied the claimant’s request, as the potential prejudice to the insurer in refusing to consider the documents outweighed the effect of any delay in the claimant receiving the documents. Upon reviewing the medical documentation available, Adjudicator Mazerolle concluded that the claimant was entitled to the benefits in dispute, as they were reasonable and necessary, and to interest. However, Adjudicator Mazerolle held that the claimant was not entitled to a special award.

F.A. v. Aviva General Insurance (17-006302)

Seven days prior to an in-person hearing, the claimant brought a motion requesting an Order to add a special award to the issues in dispute and an Order for leave to examine the insurer’s claims adjuster. Adjudicator Maedel granted both requests.