Category: LAT Rules

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

Post author By tgp-admin
Post date November 6, 2017
No Comments on 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)

Post author By tgp-admin
Post date November 2, 2017
No Comments on 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)

Post author By tgp-admin
Post date October 27, 2017
No Comments on 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)

Post author By tgp-admin
Post date October 25, 2017
No Comments on 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.

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

Post author By tgp-admin
Post date October 24, 2017
No Comments on 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)

Post author By tgp-admin
Post date October 19, 2017
No Comments on 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)

Post author By tgp-admin
Post date October 18, 2017
No Comments on 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)

Post author By tgp-admin
Post date October 16, 2017
No Comments on 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)

Post author By tgp-admin
Post date October 10, 2017
No Comments on 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)

Post author By tgp-admin
Post date October 6, 2017
No Comments on 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.

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