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.

August 26, 2022

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Spiegel v. Intact Insurance Company (21-002468)

The insurer brought a preliminary issue motion to bar the claimant's claim for non-attendance at IEs. Although he had attended the IE clinic at the appropriate time, he had become aggressive and refused to proceed until the clinic agreed to use the consent form he had personally prepared. At the motion hearing, the claimant argued...

August 25, 2022

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Monteiro v. Novex Insurance Company (21-00261)

The insurer brought a preliminary motion to address whether or not the claimant was involved in an accident as defined in the Schedule. The claimant had started her car and brushed off the snow, and planned on throwing out the garbage in a nearby communal garbage bin before starting her day that morning. As she...

August 24, 2022

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Harland-Bettany v Aviva Insurance Canada (19-005099)

A preliminary issue hearing was held to determined whether an incident that occurred on February 5, 2017 was an accident as defined by s. 3(1) of the SABS. Adjudicator Mazerolle found for the claimant, highlighting that the insurer failed to raise the preliminary issue in a timely fashion and that regardless, the incident met the...

August 22, 2022

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Smith v. Certas Direct Insurance Company (20-006605)

The claimant was involved in an accident in 2017. He applied to the LAT seeking CAT determination under Criteria 2,6, 7, and 8, as well as entitlement to NEBs, ACBs, and medical benefits. Causation was a key issue at the hearing. Adjudicator Hines held that the "but for" test was the appropriate test to determine...

August 22, 2022

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Cruz v. Belair Insurance Company (20-014208)

The claimant was involved in a serious motor vehicle accident in September 2017, in which she sustained multiple fractures. She applied to the LAT seeking CAT determination under Criteria 7 and entitlement to post-104 IRBs, medical benefits, and a special award. Vice-Chair Lester decided to exclude two insurer reports that were served after the deadline...

August 17, 2022

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Valentine v AIG Insurance (20-008673)

A preliminary issue hearing was held to determine whether the claimant's application for NEBs was statute-barred. The claimant was involved in a motor vehicle accident on December 5, 2017, and submitted an OCF-3 dated June 14, 2019, indicating that she did not suffer a complete inability to carry on a normal life. The insurer subsequently...

August 12, 2022

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Papadakis v. Wawanesa Mutual Insurance Co. (2022 ONSC 6928)

The claimant appealed the Tribunal's decision that he did not suffer a catastrophic impairment, and that he was not entitled to IRBs or further physiotherapy. The Divisional Court dismissed the appeal. The only point of law raised in the appeal was whether the Tribunal was correct to exclude a WPI rating for a contingency of...

August 3, 2022

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Al-Mosawi v TD Insurance Meloche Monnex (20-004916)

The claimant applied to the LAT seeking entitlement to various benefits after being involved in a motor vehicle accident, including catastrophic determination assessments. Vice-Chair Ciriello concluded that none of the disputed treatment plans or assessments were payable due to a lack of supporting evidence, articulating that treatment plans alone do not prove that the proposed...

August 3, 2022

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Hawes v. Aviva General Insurance Company (20-009483)

The insurer challenged the hourly rates claimed in one of the claimant’s treatment plans. The claimant submitted a psychological treatment plan, which sought entitlement to psychological treatment at an hourly rate of $149.61 per hour. The psychological treatment plan was to be provided by a registered psychotherapist. The insurer partially approved the treatment plan at...

August 3, 2022

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Tamayo v. Travelers Insurance (20-014625)

The claimant disputed entitlement to IRBs and 10 treatment plans via a LAT Application filed on December 9, 2020 and a hearing was arranged to commence in November of 2022. The insurer filed a motion and raised a limitation defence under s. 56, arguing that the claimant failed to challenge the denial of IRBs within...

August 2, 2022

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K.G. v. Motor Vehicle Accident Claims Fund (20-003724)

The claimant disputed his entitlement to ACBs in relation to a 1999 accident. The Fund stopped paying ACBs in 2000 without a proper notice, and agreed to reinstate ACBs with interest at the Form 1 rate of $120.40, and paid interest at 1 percent per month. The claimant requested that the LAT award ACBs at...

July 29, 2022

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The Dominion of Canada General Insurance Company v. Ridi (2022 ONSC 564)

The claimant appealed the Divisional Court's decision that HST payments on attendant care benefits were included in the $6,000 monthly limits. The Court dismissed the appeal and held that the HST on attendant care services was included in the monthly limit, and was not payable on top of the limit. The Court found that sections...

July 29, 2022

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Morrisey v. Wawanesa Insurance Company (2022 4398)

The claimant was injured in an accident in 2000, while the 1996 SABS applied. In 2018, the claimant filed a LAT dispute for (among other things) retroactive attendant care benefits. The Tribunal found the claimant was not entitled to retroactive ACBs because he had no excuse for the late Form 1. The Tribunal also held...

July 29, 2022

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Schuknecht v Economical Insurance Company (19-013098)

The parties agreed that the claimant was eligible for IRBs, but disagreed on the quantum of the benefit. The applicant received STD and subsequently LTD, as well as CPP disability benefits. Vice Chair Maedel confirmed that these benefits were all taxable and offset the standard weekly IRB payment, as per sections 4(1)(a) and (b) of...

July 29, 2022

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Singer v The Co-operators General Insurance Company (19-014099)

The claimant was seriously injured in an accident and received benefits from his insurer as a result. The claimant applied to the LAT seeking an award under s. 10 of Regulation 664, submitting that the insurer acted in bad faith to prevent him from applying for additional benefits. Specifically, the claimant argued that the insurer...

July 28, 2022

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Crecoukias v. Toronto Transit Commission (19-014590)

The claimant witnessed an individual being struck and killed by a bus. He applied to the LAT for a catastrophic impairment designation, and disputing entitlement to ACBs and various medical benefits. The insurer argued that the claimant's severe psychological impairments were the result of pre-existing schizophrenia that was already worsening prior to the accident. Adjudicator...

July 27, 2022

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Gamble v Allstate Insurance Company of Canada (20-010512)

The claimant was found to be entitled to post-104 week IRBs for psychological reasons. The insurer terminated the claimant's entitlement to IRBs pursuant to section 57(2) of the SABS, on the basis that she had failed to seek psychological treatment. Section 57(2) requires a person to obtain treatment that is reasonable, available, and necessary to...

July 27, 2022

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Ramkelawan v Aviva Insurance Company (20-006937)

The claimant retained an expert accountant to calculate their quantum of IRBs as a result of the subject accident. The insurer denied payment of the report. The matter eventually proceeded to a Case Conference and several issues were settled between the parties, the only remaining issue was the cost of the accounting report. The claimant's...

July 25, 2022

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Galang v. Coseco Insurance Company (20-008382)

The claimant was injured in an accident on April 30, 2018. She sought entitlement to various treatment plans, including a chiropractic treatment plan submitted on May 15, 2018, and a physiotherapy treatment plan submitted on July 19, 2018. The insurer denied the claimant’s chiropractor treatment plan and partially approved the physiotherapy plan. The claimant was...

July 14, 2022

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McBeth v Allstate Canada (20-007407)

The parties agreed that the claimant met the disability test and was entitled to IRBs, but disagreed over whether he had available to him, and could have received LTD from his collateral benefits insurer through his employment. The claimant took the position that he applied for LTD, which were refused, and therefore the insurer was...

July 14, 2022

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Mahoney v. Jevco Insurance Company (21-004916)

This motion was brought by the claimant for a declaration that she was not barred from proceeding to a hearing due to non-attendance at a psychological IE. The claimant argued that the Notice of Examination for the IE did not satisfy the requirements in s. 44, and that s. 55(1) was not triggered because the...

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Contact Us

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

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

416.507.1850

eodonnell@tgplawyers.com