Category: LAT Rules

S.M. v. Motor Vehicle Accident Fund (17-001681)

The claimant brought a motion to add costs and a special award as issues in dispute. The motion also sought to compel the claims handler to submit to cross-examination as well as production of the entire accident benefits file and IE assessors records, inclusive of correspondence between the vendor and assessor. The insurer eventually consented to the production of the AB file and much of the records sought from the IE assessors. The insurer also indicated that it would request the correspondence between the IE vendor and its assessor. However, Adjudicator Rebecca Hines held that should the IE vendor fail to produce the records, a summons of the vendor would follow. Of note, since the insurer was the Fund, it initially sought exemption from being compelled to provide documentary and oral evidence under section 71 of the Legislation Act and section 8 of the Proceedings Against the Crown Act; this was rejected.

M.J. v. Aviva General Insurance (17-002229)

After the commencement of the hearing, the claimant withdrew the application. The Tribunal closed its file and no costs were awarded.

M.C. v. Aviva General Insurance (17-002614)

The insurer sought reconsideration of an order made by the Tribunal allowing the claimant to summons the adjuster who had handled his matter. The insurer argued that it should have been given a copy of the claimant’s summons request, and should have had the opportunity to respond to that request. Executive Chair Lamoureux rejected the reconsideration. She held that Rules 8 and 4.3, when read together, allowed the claimant to request a summons without notifying the insurer.

C.T. v. Aviva Insurance Canada (16-000958)

The claimant sought entitlement to income replacement benefits and was successful at the LAT. The insurer sought reconsideration as it asserted that the claimant was working during a period in which IRBs were awarded. The claimant countered by asserting improper notice was provided under Rule 18.1. Executive Chair Linda Lamoureux determined that the proviso noting a party indicate if it is seeking judicial review was only if the party is indeed seeking an appeal and that a party need not declare it is not appealing. Moreover, Rule 3.1 allowed for a liberal interpretation of the Rules so as to not cause unfairness or prejudice. The reconsideration was allowed and on review, Executive Chair Lamoureux noted that the LAT decision did not properly consider evidence that the claimant worked during a period in which IRBs were claimed. As a result, the reconsideration was granted and the matter remitted for a rehearing.

C.T. v. Aviva Insurance Canada (16-000958)

The claimant sought entitlement to income replacement benefits and was successful at the LAT. The insurer sought reconsideration as it asserted that the claimant was working during a period in which IRBs were awarded. The claimant countered by asserting improper notice was provided under Rule 18.1. Executive Chair Linda Lamoureux determined that the proviso noting a party indicate if it is seeking judicial review was only if the party is indeed seeking an appeal and that a party need not declare it is not appealing. Moreover, Rule 3.1 allowed for a liberal interpretation of the Rules so as to not cause unfairness or prejudice. The reconsideration was allowed and on review, Executive Chair Lamoureux noted that the LAT decision did not properly consider evidence that the claimant worked during a period in which IRBs were claimed. As a result, the reconsideration was granted and the matter remitted for a rehearing.

Applicant v. Waterloo Insurance (17-001265)

The claimant sought removal from the MIG and entitlement to four treatment plans. A number of procedural issues were first addressed. Adjudicator Ferguson rejected the claimant’s objection to the insurer’s expert report being considered by the Tribunal because the issue was not raised until the claimant’s reply submissions. The adjudicator rejected the insurer’s objection about the claimant’s written materials being too long, the insurer’s objection about late medical documents, and the insurer’s objection about the lack of Acknowledgement of Duty form by the claimant’s experts. He reasoned that excluding the impugned records or opinions would prevent him from making a fair and proportional determination on the merits of the case. In terms of the claims, Adjudicator Ferguson held that the claimant suffered a “minor injury” in the accident, and that he did not have any pre-existing conditions warranting removal from the MIG. He noted that none of the claimant’s experts were professionally qualified to make psychological diagnoses, there were no medical reports formally making a diagnosis, and the practitioners supporting a chronic pain diagnosis had no expertise in the area.

J.S. v. Aviva General Insurance Company (16-002529)

The claimant sought entitlement to a treatment plan. The insurer asserted the treatment plan was not reasonable a necessary. The insurer also objected to evidence supplied by the claimant’s OT, as it was not disclosed at the case conference. Adjudicator Sandeep Johal ruled that the inclusion of more documentation on the part of the claimant did not prejudice the insurer and allowed the testimony. However, on review of the evidence, the treatment plan was physical-based and the claimant’s aliments, psychological; the plan was deemed not reasonable and necessary and not payable.

Applicant v. Aviva Insurance (17-004068)

The claimant sought production of the entire file from the insurer’s IE assessors based on notations in the reports referring to drafts. The insurer did not object to production of the file from the IE assessors. Adjudicator Makhamra ordered the IE assessors to produce their entire files including all draft reports.

P.L. v. Aviva Insurance Canada (17-002907)

The insurer sought to admit two late IE reports at a hearing. Adjudicator Bickley granted the request without opposition from the claimant, and noted that if the IEs had proceeded when originally scheduled, the insurer would have had the IEs in advance of the deadline set by the Tribunal for exchange of documents.

D.N. v. Aviva Insurance (17-004104)

The claimant failed to provide records as ordered by the Case Conference adjudicator, and submitted his written materials 15 days late. The insurer sought to have the claim dismissed and requested costs. Adjudicator Paluch held that the dismissal of a claim should only occur with utmost caution in unusual circumstances. However, he was prepared to allow the insurer additional time to complete written submissions, and ordered that the claimant be barred from relying upon the late records. The adjudicator declined to make an order on costs and reasoned that it would be best for the hearing adjudicator to decide costs upon disposition of the matter.