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.

March 24, 2017

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T.E. v. Unifund Assurance Company (16-001326)

A preliminary hearing was held to decide whether the claim for IRBs was barred by the limitation period. Adjudicator Sewrattan concluded that the denials by the insurer were clear and unequivocal, and that the claim for IRBs was therefore barred. No costs were awarded.

March 24, 2017

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P.C. v. Wawanesa Mutual Insurance Inc. (16-000989)

The claimant sought entitlement to three treatment plans. The insurer denied the plans and maintained a MIG position. Adjudicator Truong reviewed the medical reports and found each to have competing views; as a result, a review of the clinical notes was undertaken. On review, the claimant was said to suffer from soft tissue injuries and...

March 23, 2017

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Y.Y. v. Unica Insurance Inc. (16-000552)

The claimant sought entitlement to attendant care benefits. Adjudicator Theoharis did not find the account of the service provider credible as the testimony was vague and did not sound convincing when cross-examined. Additionally, the claimant provided contrary evidence to a statutory declaration. The evidentiary record also contained conflicting accounts as to who provided services, if...

March 23, 2017

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W.P. v. Aviva Insurance (16-000693)

In this preliminary issue decision, the insurer argued that the claimant had failed to attend an IE and EUO and therefore could not proceed to arbitration at the LAT. Adjudicator Neilsen held that the insurer's request for an IE was reasonable, and the insurer had provided a notice that satisfied section 38 of the SABS....

March 23, 2017

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N.M. v. Certas Direct Insurance Company (16-001438)

The claimant sought entitlement to medical benefits. The insurer denied the benefits and held the claimant within the MIG. The claimant argued that a pre-existing condition of spina bifida warranted removal from the MIG. The claimant also advanced a chronic pain and psychological impairment argument. Adjudicator Rebecca Hines noted that the asserted pre-existing condition was...

March 23, 2017

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Applicant v. Wawanesa Mutual Insurance Company (16-001181)

This is a reconsideration decision under LAT Rule 18.2(b) wherein the original decision found the claimant not entitled to claim expenses related to a trip to Disney World. Executive Chair Lamoureux noted that there were no further submissions on the part of the claimant, and it appeared the Tribunal was merely "urged to discover the...

March 21, 2017

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Applicant v. Aviva Insurance Company (16-001144)

The original adjudicator had awarded IRBs up to the 104 week mark, which was a future date; the weekly quantum of IRBs awarded was not analysed in the decision. The insurer appealed the adjudicator's order related to the period and quantum of IRBs. Executive Chair Lamoureux accepted the insurer's arguments and held that the order...

March 21, 2017

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Applicant (Minor) v. Wawanesa Mutual Insurance Company (16-000323)

The minor claimant sought removal from the MIG based on incomplete medical records and selective school records showing absenteeism. Adjudicator Mather rejected the claimant's position and held that there was insufficient evidence to show that the relatively minor accident was related to the claimant's school performance or causing any psychological difficulties.

March 17, 2017

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Applicant v. Wawanesa Mutual Insurance Company (16-000433)

The insurer requested reconsideration of a costs award against it arising out of the failure to provide records. Executive Chair Lamoureux overturned the costs award, writing that the adjudicator's decision was premised on incorrect facts (the dispute had been resolved at the time).

March 17, 2017

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Applicant v. TD General Insurance Company (16-000134 and 16-000646)

Executive Chair Lamoureux was asked to reconsider two decisions in which the claimant was found MIG and found not entitled to NEBs. The applicant argued that "the entirety" of his evidence was "not considered at all." Similarly, in his request for reconsideration of NEBs the applicant argued that his "evidence was not considered at all...

March 16, 2017

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K.J. v. Wawanesa Mutual Insurance Company (16-001732)

Adjudicator Pay was asked to exclude a report by Dr. Ogilvie-Harris that was served two days before the hearing date. Adjudicator Pay allowed the submission of this late report as it was relevant and likely necessary to the determination of the issues in dispute. However, she extended the timelines for the submission of the insurer's...

March 16, 2017

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H.A.J. v. Aviva Insurance Canada (16-001418)

The claimant sought entitlement to a treatment plan for occupational therapy. Adjudicator Sewrattan awarded the claimed treatment plan based on the theory that the treatment would provide potential pain management or reduction, which was a reasonable goal for the claimant's physical impairment.

March 15, 2017

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Applicant v. The Guarantee Company of North America (16-001348)

The claimant sought entitlement to attendant care benefits as well as expenses for an office desk, chair, and for a mattress. Having re-calculated the claimant's needs when comparing competing Form 1s, Adjudicator Treksler found attendant care payable at a reduced rate, but not payable for a period claimed when the claimant had not received any...

March 15, 2017

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A.T. v. Aviva Insurance Canada (16-001934)

The claimant sought entitlement to a treatment plan for physiotherapy and another treatment plan for a chronic pain assessment, as well as costs. On review of the medical evidence, Adjudicator Sewrattan found the chronic pain assessment reasonable.

March 14, 2017

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S.S. v. Northbridge Personal Insurance Corporation (16-000960)

The claimant sought entitlement to various medical benefits. Adjudicator Theoharis accepted that the proposed treatment plans provided pain relief to the claimant, which allowed him to engage in his daily activities. She concluded that the medical benefits were reasonable and necessary.

March 10, 2017

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M.Y. v. Allstate Insurance Company of Canada (16-002740)

The claimant sought entitlement to non-earner benefits. The insurer resisted the claim on two grounds: (i) the claim was limitations barred, and (ii) a claim for income replacement benefits precluded a non-earner benefits claim. Adjudicator Hines noted that the claimant received income replacement benefits which were ultimately stopped in August of 2014 due to her...

March 10, 2017

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M.K. v. Dumfries Mutual Insurance Company (16-000501)

The claimant sought IRBs and removal from the MIG. Adjudicator Theoharis rejected the claimant's case. She held that the claimant did not suffer impairments that would entitle her to IRBs or removal from the MIG. In particular, Adjudicator Theoharis relied upon surveillance showing the claimant engaging in multiple activities she said she could not do....

March 9, 2017

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R.U. v. Aviva General Insurance Company (16-001649)

The claimant left the country prior to a scheduled hearing and had failed to communicate with her counsel. The hearing was adjourned to a later date. The insurer was awarded costs of $700 by Adjudicator Bickley, who concluded that the claimant's actions had caused unnecessary expense and delay.

March 9, 2017

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J.J. v. Aviva Insurance Canada (16-001031)

The claimant was involved in two accidents and sustained a heart attack months after the second accident. A treatment plan for assistive devices was denied by the insurer with the assistance of a GP IE report. The insurer objected to the inclusion of documents not disclosed 10 days before the service and filing of written...

March 9, 2017

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A.A. v. State Farm Mutual Automobile Insurance Company (16-000448)

The claimant sought entitlement to social rehabilitation counseling services. The insurer denied the claim asserting (i) the limitations period barred the claim and (ii) the claim was already adjudicated at FSCO under a different date of loss. Adjudicator Sewrattan cited section 23 of the Statutory Powers and Procedures Act in precluding a party from proceeding...

March 9, 2017

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R.U. v. Aviva General Insurance Company (16-001649)

The claimant left the country prior to a scheduled hearing and had failed to communicate with her counsel. The hearing was adjourned to a later date. The insurer was awarded costs of $700 by Adjudicator Bickley, who concluded that the claimant's actions had caused unnecessary expense and delay.

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

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Contact Us

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

416.507.1850

eodonnell@tgplawyers.com