LAT Case Law Summaries

Thomas Gold Pettingill LLP is pleased to provide this online resource to our clients. Below is a searchable database of the publicly released decisions from the Licence Appeal Tribunal. Assembled by the accident benefits group, the decisions are reviewed, briefly summarized, and categorized for easy access.

As of March 2020, we will not include any further decisions focused solely on the Minor Injury Guideline or treatment plans, unless the case may have broader applicability.

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June 9, 2021

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L.H. v. Aviva General Insurance (19-004132)

The claimant sought entitlement to ongoing NEBs and interest. The IE assessors concluded that the claimant did not suffer a complete inability to carry on a normal life. Adjudicator Kaur determined that there was limited evidence to refute the findings in these reports. Further, the claimant had not submitted any medical evidence to substantiate her...

April 28, 2021

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Porter v. Aviva Insurance Company of Canada (2021 ONSC 3107)

The insurer appealed the Tribunal's decision that the claimant was involved in an accident. The claimant slipped and fell on ice while making her way to a Lyft vehicle in her driveway. The Court granted the appeal and concluded that the facts of loss did not qualify as an accident. The Tribunal erred by conflating...

April 21, 2021

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Yatar v. TD Insurance Meloche Monnex (2021 ONSC 2507)

The claimant appealed and sought judicial review of the Tribunal's decision that her claims were barred by the limitation period. The Court dismissed both the appeal and the judicial review. The Court explained that statutory appeals are limited to strict questions of law, and the claimant had failed to identify an error of law on...

March 26, 2021

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Cura v. Aviva Insurance Canada (2021 ONSC 2290)

The claimant sought judicial review of the Tribunal's decision that her withdrawal of consent for the IE facility to possess her personal information amounted to IE non-attendance. The claimant's reconsideration request had been dismissed as pre-mature. The Divisional Court dismissed the review, holding that it was premature. Parties are not to appeal or seek judicial...

February 26, 2021

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Beaudin v. Travelers Insurance Company of Canada (2021 ONSC 1389)

The insurer appealed the Tribunal's decision that the dirt bike involved in the accident was an automobile for the purposes of the SABS. The Tribunal had concluded that the dirt bike was required to be insured under the Off-Road Vehicles Act and was not exempt from insurance through the regulation that allowed off-road vehicles to...

December 10, 2020

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Higashi v. Western Assurance Company (2020 ONSC 7616)

The claimant appealed the Tribunal's decision that her claim for IRBs was barred by the limitation period. She argued that the insurer's denials were invalid because the insurer did not provide copies of the IE reports to the practitioners who completed the Disability Certificates. The Court agreed with the Tribunal that the insurer's failure to...

November 26, 2020

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Patchett v. Optimum Insurance Company (19-008902)

The claimant applied for a catastrophic impairment under Criterion 2(iii) of the new definitions, requiring a SCIM score of five or less on an indoor mobility test. The claimant's score was below five shortly following the accident when she was recovering from fractures in her extremities. However, the score was above five after a number...

November 3, 2020

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P.P. v. Wawanesa Mutual Insurance Company (18-000957)

The claimant sought a catastrophic impairment based on a 55 percent impairment, IRBs, housekeeping expenses, and medical benefits. The insurer argued that the claimant's impairment arose from an earlier workplace accident, and that he was not entitled to any of the claimed benefits or a catastrophic impairment designation. Adjudicator Flude agreed with the insurer and...

October 22, 2020

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The Personal Insurance Co. v. Jia (2020 ONSC 6361)

The insurer appealed the LAT's decision that counsel acting in a priority matter could not also act in the LAT dispute, and the decision excluding the transcript from the priority EUO from the LAT hearing. The Court dismissed the appeal and concluded that the LAT's decision was reasonable. It held that a conflict could arise...

October 8, 2020

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V.G. v. Western Assurance Company (18-005817)

The 20 year old claimant was involved in an accident in 2014, suffering various orthopaedic injuries and a head injury. He entered a full and final settlement in April 2016. In June 2016, he underwent a capacity assessment, and the assessor concluded that the claimant lacked capacity. Based on the assessment, the claimant through counsel...

October 7, 2020

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J.J. v. Jevco Insurance (18-012155)

The insurer sought reconsideration of the Tribunal's decision that the claimant's newly purchased motorcycle was insured under the policy as a "newly acquired automobile". The insurer's arguments were primarily based on failure to follow two Superior Court decisions. Vice Chair Flude rejected the reconsideration, holding that he did not make an error that would change...

October 6, 2020

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Heartland Farm Mutual Inc. v. Desjardins (19-008574)

The insurer sought repayment of $9,197.65 in IRBs it had paid to the claimant. The claimant's initial application stated that he had been working at the time of the accident, and an OCF2 was submitted with income information supporting $303.65 per week in payments. The insurer was eventually provided with two Records of Employment that...

October 5, 2020

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K.A.J. v. Aviva General Insurance (19-007068)

The claimant sought entitlement to a chronic pain assessment. Adjudicator Goela held that the assessment was not reasonable and necessary, and not payable. Additionally, she held that the treatment plan did not comply with section 38(3) as it was not signed by the claimant or the proposed assessor, nor did assessor provide information or opinion...

October 1, 2020

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Jones v. Aviva Insurance Canada (19-013768)

The claimant sought entitlement to NEBs. The Disability Certificate was submitted 126 weeks after the accident. The insurer argued that the dispute was barred due to the limitation period. Vice Chair McGee found that the insurer could not deny the NEBs prior to submission of the Disability Certificate, so the limitation period did not apply....

October 1, 2020

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TD General Insurance Company v. Altaweel (19-010100)

The insurer sought repayment of $1,114.60 that had been paid to the claimant rather than to a court reporter for the cost of an EUO. The claimant never responded to the insurer's requests for repayment, nor did he participate in the LAT dispute. Adjudicator Boyce awarded the insurer repayment. He held that the funds had...

September 30, 2020

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K.L. v. Aviva Insurance Company (19-004368)

The sole issue in dispute was whether the claimant was entitled to a special award under Ontario Regulation 664. The insurer initially denied a treatment plan, and referred the claimant to an IE to determine whether the plan was reasonable and necessary. Upon receipt of the IE reports, the insurer wrote to the claimant confirming...

September 29, 2020

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Staszewski v. Intact Insurance Company (19-012409)

The claimant applied to the LAT seeking entitlement to pre- and post-104 IRBs. Three medicolegal reports noted the claimant had returned to work in some capacity since the accident. The insurer suspended the claimant's entitlement to IRBs pursuant to section 33 of the SABS for failure to provide documentation regarding post-accident employment and income. The...

September 28, 2020

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B.M. v. Unica Insurance Inc. (19-009381)

The claimant sought entitlement to two medical benefits for physiotherapy and occupational therapy services. The claimant had a significant pre-accident medical history that included a workplace accident, two separate motor vehicle accidents in 2013, chronic lumbar radiculopathy, and chronic lower back pain. He was also involved in a subsequent motor vehicle accident in 2016 after...

September 28, 2020

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P.S. v. Allstate Insurance (18-012633)

The claimant was seriously injured in a 2013 accident and sought a determination that he suffered a catastrophic impairment due to a combined WPI of 55 percent. He also sought entitlement to three treatment plans for further physiotherapy and psychotherapy. The claimant suffered from chronic pain and abused opioids as a result of his injuries....

September 24, 2020

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A.J. v. Aviva General Insurance (19-010794)

The claimant disputed entitled to two treatment plans for physiotherapy and chiropractic services. The insurer disputed the claimant's entitlement based upon IE reports, and argued that new evidence was submitted in the claimant's reply submissions were prejudicial. The insurer, by way of motion, requested that the new evidence was improperly submitted and requested it be...

September 24, 2020

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Marca v. Aviva Insurance Company (19-004839)

The claimant sought entitlement to NEBs, a medical benefit for physiotherapy services, interest on overdue payment of benefits, and an award. The claimant argued that she had partially resumed some activities post-accident but not at all. The claimant also argued that even though she had returned partially to her personal care, she experienced pain when...

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Contact Us

150 York Street, Suite 1800
Toronto, Ontario M5H 3S5

416.507.1850

smilne@tgplawyers.com

© 2020 Thomas Gold Pettingill LLP