Category: LAT Rules

Applicant v. Allstate Insurance Company of Canada (17-003121)

The claimant sought an summons for the claims adjustor and the manager of the claims adjustor to attend a hearing. The claims adjustor was listed on the Case Conference Order as a witness; the manager was not. Adjudicator Paluch held that the claimant had not complied with Rule 8.2 regarding the request for a summons of the claims adjustor, but that once the claimant filed materials complying with the Rule, a summons would be issued. The adjudicator refused to issue a summons for the claims manager because the claimant had not submitted sufficient evidence to prove that the manager’s evidence was necessary or relevant for the issues in dispute.

S.V. v. Aviva Insurance Company (17-002973)

The claimant sought an adjournment after two case conferences. The insurer requested a dismissal. Adjudicator Cezary Paluch noted that the claimant was effectively seeking an extension in timelines for submissions and should have properly brought documentation under Rule 15, than seeking an adjournment. Moreover, although the submissions of the claimant were late, Adjudicator Paluch ruled that it was not enough to have the entire claimed dismissed. Accordingly, an extension was granted to afford the insurer an opportunity to respond to the late submissions and the hearing would continue, albeit at a later date.

D.A. v. The Personal Insurance Company (17-001941)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to various medical benefits and costs of examinations. As a preliminary issue, the claimant requested to know the number of reports that each of the IE assessors had provided to the respondent for the last three years and the cost of each report. Adjudicator Paluch denied the claimant’s request for production. He failed to see how information about how many times a particular assessor has been retained by an insurer or how much the report cost would be relevant in assisting the claimant in satisfying that his injuries are not minor or that the proposed treatments are reasonable and necessary. The more appropriate forum to impugn the objectivity of an expert is at a live hearing, not a written preliminary issue hearing.

C.N. v. Aviva Canada Insurance (16-002658)

The claimant failed to attend two case conferences. Accordingly, the insurer sought to have the matter dismissed. The claimant argued that the matter was merely withdrawn and therefore it was available to return to the LAT to raise the same issues. The case conference adjudicator agreed with the claimant and found the issues withdrawn. The insurer sought a reconsideration to have the matters dismissed. Executive Chair Linda Lamoureux held that the LAT may only invoke Rule 3.4 (dismissal without a hearing) in a limited number of situations, such as abandonment. However, the matter was not abandoned in this matter – it was withdrawn based on the facts. The reconsideration request was denied.

K.D. v. TD Insurance Meloche Monnex (17-004213)

The claimant brought a motion seeking to add additional issues in dispute. The insurer resisted the motion. Adjudicator Cezary Paluch relied on Rule 20.5 and noted that “the Tribunal has an obligation to ensure a fair, just, expeditious and cost efficient determination of every case on its merits.” The issues were added.

N.Y. v. TD Insurance Meloche Monnex (17-001054)

The claimant sought entitlement to accident benefits. The LAT case conference adjudicator ordered a hybrid hearing with evidence to be entered via writing. After the claimant filed submissions, the insurer responded with submissions containing addendum IE reports as evidence. The claimant made a motion objecting to the admissibility of the new addendum reports and was partially successful. However, the case conference adjudicator did not grant the claimant access to the adjuster log notes, nor did the addendum reports get excluded. Rather, the authors of the reports were to be made available for cross-examination and a 90 day resumption of case conference was afforded to allow the claimant to commission rebuttal reports if desired. The claimant sought reconsideration of the case conference order seeking the addendum reports to be entirely inadmissible. Executive Chair Linda Lamoureux held the case conference adjudicator did not error – the addendum reports were considered relevant and therefore admissible. The denied request for log notes was also reaffirmed. The reconsideration appeal was dismissed.

N.Y. v. TD Insurance Meloche Monnex (17-001054)

The claimant sought entitlement to accident benefits. The LAT case conference adjudicator ordered a hybrid hearing with evidence to be entered via writing. After the claimant filed submissions, the insurer responded with submissions containing addendum IE reports as evidence. The claimant made a motion objecting to the admissibility of the new addendum reports and was partially successful. However, the case conference adjudicator did not grant the claimant access to the adjuster log notes, nor did the addendum reports get excluded. Rather, the authors of the reports were to be made available for cross-examination and a 90 day resumption of case conference was afforded to allow the claimant to commission rebuttal reports if desired. The claimant sought reconsideration of the case conference order seeking the addendum reports to be entirely inadmissible. Executive Chair Linda Lamoureux held the case conference adjudicator did not error – the addendum reports were considered relevant and therefore admissible. The denied request for log notes was also reaffirmed. The reconsideration appeal was dismissed.

J.K. v. Royal & SunAlliance Insurance (17-002272)

The claimant did not participate during a case conference. The case conference was therefore adjourned and rescheduled to allow for all parties to participate. The adjourning case conference report noted that the claimant was put on notice that failing to attend the rescheduled case conference would result in the dismissal of the claims before the LAT. Neither the claimant nor his representative participated at the reconvened case conference. The insurer brought a motion to have the matter dismissed. Adjudicator Blaine Baker, under Rule 3.4, construed the non-attendance by the claimant as an abandonment of the claims. Accordingly, since the insurer had brought a motion to dismiss that was compliant with Rule 15.2, the claimant’s case was dismissed.

J.K.H. v. Northbridge Insurance Company (17-002468)

The claimant brought a motion seeking an adjournment of the scheduled hearing and cited the submitted of an OCF-19 as reason for the added time. Adjudicator Lori Marzinotto reviewed section 21 of the Statutory Powers Procedures Act and noted the central consideration when contemplating an adjournment is whether a full and fair hearing is possible. An adjournment was granted and three alternative days were requested in accordance with Rule 16.1.

S.S. v. Wawanesa Mutual Insurance Company (16-003931)

The claimant failed to participate in the Case Conference, and failed to make written submissions on why his claim should not be dismissed. Adjudicator Maedel dismissed the claim after being satisfied that the claimant had been notified of the insurer’s motion and had failed to adhere to the Case Conference order.