Category: LAT Rules

Applicant v. Aviva Insurance Company of Canada (16-004144)

This motion concerned the appointment of a litigation guardian. The claimant’s counsel wrote to the LAT stating that the claimant did not have capacity, and was impecunious and unable to afford the cost of proceeding with a guardianship application. The LAT Rules did not provide a process for appointing a guardian. Vice Chair Hunter held that Rule 14 allowed him to make any order that was proper for the hearing to proceed. He adopted the process used by the Social Justice Tribunal of Ontario to allow the claimant to appoint a litigation guardian.

Applicant v. Echelon (16-003223)

The claimant was involved in a serious accident in which his daughter was fatally injured. The claimant was deemed to have sustained a catastrophic impairment. The claimant sought entitlement to occupational therapy assistance. The insurer denied the treatment plan and stated there was no rehabilitative goal of consuming the treatment. On review of the medical evidence, Adjudicator Mather concluded the treatment plan was reasonable and necessary and awarded the benefit. The claimant sought costs and asked that a negative inference be drawn of the insurer’s behaviour due to its refusal to produce log notes. Costs were denied and no inference was made regarding the non-production of log notes, since the notes were considered not relevant to the issues in dispute.

V.H.T. v. Certas Home and Auto Insurance Company (16-000874)

The claimant sought entitlement to IRBs and further medical benefits. A preliminary motion was first heard to address the admissibility of late documents. Adjudicator Sapin held that the late documents were admissible, that the insurer had sufficient time to review the new documents, and that the insurer should have requested an adjournment if it believed prejudice would result. In terms of the benefits in dispute, Adjudicator Sapin held that the claimant was entitled to post-104 week IRBs due to ongoing psychological issues, chronic pain, and inability to use his right hand. The medical benefit sought were not awarded because the claimant did not provide evidence that they were reasonable and necessary, or were not on a treatment plan.

J.X. v. TD Insurance Meloche Monnex (16-003179)

The decision dismissed an LAT application, given a settlement was reached during the hearing

L.S. v. Royal & Sun Alliance Insurance Company of Canada (16-002381)

The claimant sought entitlement to a medical treatment plan. In addition to the issues outlined in the Case Conference Order, the claimant also sought a lump sum payment of $35,000.00 for 5 years of future medical treatment. Adjudicator Truong noted that issues not codified by the Case Conference Order were not properly before the Tribunal and therefore could not be determined. On review of the medical evidence, the treatment plan in dispute was found not reasonable and necessary. It was noted that a treatment plan alone is not sufficient evidence to establish entitlement – corroborating evidence is also required.

Applicant v. Aviva General Insurance Company (17-000370)

The claimant sought entitlement to a number of benefits. At the case conference, a number of timelines were set. The claimant missed a number of document exchange deadlines and subsequently sought an adjournment and the insurer did not consent. The Tribunal did not grant the adjournment. On reconsideration Executive Chair Lamoureux noted the reason for the adjournment request was to allow for receipt of IE reports completed by the insurer on unrelated benefits. The claimant at the time of reconsideration now had the reports and therefore a determination was no longer necessary and the hearing was able to continue.

A.V.de V. v. Intact Insurance Company (16-002061)

The claimant sought an adjournment of the LAT hearing after receipt of insurer addendums occurred two weeks before the hearing. Those addendums were completed late in the process because the claimant had himself served the insurer with s.25 reports just five weeks prior. Vice Chair Flude concluded that an adjournment was warranted to allow a full hearing on the merits. He also ordered both the claimant’s assessors and the insurer’s assessors to produce their entire files and records.

M.T. v. Optimum Insurance Company (16-002744)

In advance of the scheduled LAT hearing, the insurer sought the production of the complete clinical notes and records from a variety of medical practitioners. Adjudicator Markovits rejected the insurer’s motion, reasoning that the Case Conference adjudicator clearly set out the documents that the parties had agreed to exchange prior to the hearing. The newly requested records were not discussed during the LAT Case Conference. The insurer was obliged to list the documents it was seeking at that time.

S-A. A. v. TD General Insurance Company (16-004361)

The claimant had sought production of all of clinical notes and records of the insurer’s IE assessors prior to the LAT hearing. Those records had not been produced in accordance with the Case Conference order. The claimant sought an order extending the deadline for his opening statements. Adjudicator Lester granted the claimant’s motion and issued a further Order setting out the dates by which all documents must be produced, and stated that any records not produced by a particular date could not be considered by the hearing adjudicator.

M.R. v. Aviva Insurance (16-001739)

The insurer filed a motion in advance of the LAT hearing seeking an order for unredacted clinical notes and records and OHIP summary. Adjudicator Lester declined to make an order in advance of the hearing and directed the parties to argue the motion before the hearing adjudicator.