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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April 22, 2020

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M.D. v. Aviva General Insurance (18-006666)

The claimant sought entitlement to two treatment plans, the costs of two examinations, and a special award, as well as a determination as to the quantum of an approved income replacement benefit. Adjudicator Boyce accepted the claimant's submission that she was entitled to an IRB in the amount of $297.88 per week, finding the calculation...

April 20, 2020

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S.S.Z. v. Certas Direct Insurance Company (18-007365)

The claimant filed a request for reconsideration arising from a decision in which the Tribunal found that his injuries fell within the MIG. Adjudicator Kaur first addressed the insurer's motion to exclude certain documents and submissions that were included in the claimant's request for reconsideration. Adjudicator Kaur granted the insurer's motion. She found that the...

April 17, 2020

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K.P. v. Aviva General Insurance (19-004361)

The claimant was injured while walking down the driveway to get into a Lyft, which was waiting to take her to a medical appointment. She applied for accident benefits. The insurer denied the claim, stating that the incident was not an accident. Adjudicator Mather concluded that the incident was an accident under the SABS. She...

April 17, 2020

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N.K. v. Intact Insurance Company (19-003405)

The claimant sought entitlement to the costs of examinations in two treatment plans that were performed as part of catastrophic impairment assessments. Adjudicator Norris found that although a psychiatric assessment was performed instead of an approved psychological assessment, the psychiatric assessment was reasonable and necessary in light of the claimant's post-concussion mental condition. The claimant...

April 17, 2020

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H.H. v. Aviva General Insurance (17-005287)

The claimant sought entitlement to non-earner benefits and an award. Adjudicator Gosio found that the claimant had not met her onus of establishing that she suffered a complete inability to carry on a normal life and was therefore not entitled to non-earner benefits or an award. He found that although the claimant demonstrated there were...

April 17, 2020

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M.G. v. Aviva Insurance Canada (18-002508)

The insurer sought reconsideration of the Tribunal's award of the cost of various catastrophic impairment assessments. The insurer argued that because the treatment plans were proposed after the OCF-19 was submitted, the assessments were not being proposed in accordance with section 45, and therefore not payable. Adjudicator Johal rejected the reconsideration. She held that catastrophic...

April 16, 2020

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F.J. v Intact Insurance Company (19-004400)

The claimant sought entitlement to various medical benefits. Adjudicator Paluch found that the claimant's claim for further physiotherapy and massage therapy was reasonable and necessary because they provided pain relief, increased her strength, and helped her emotionally and mentally.

April 15, 2020

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M.A. v Aviva General Insurance Company (18-011678)

The claimant sought entitlement to IRBs, removal from the MIG, and entitlement to various medical benefits. Adjudicator Grant found that the claimant's injuries were predominately minor in nature and there was no evidence before the Tribunal to support the claimant's submission that his psychological impairments remove him from the MIG. Adjudicator Grant also noted that...

April 14, 2020

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E.M. v Coachman Insurance Company (18-012570)

The claimant sought entitlement to medical benefits for chiropractic services, psychological services, and two examinations. Adjudicator Maleki-Yazdi found that the insurer's denials were vague and did not provide the claimant with a meaningful explanation, so the claimant was not able to make an informed decision about whether to accept or dispute the insurer's decision. Further,...

April 14, 2020

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R.T. v Coseco Insurance Company (18-004783)

The claimant filed a motion to withdraw some of the issues listed for an upcoming LAT hearing on a without-prejudice basis. The insurer submitted that the issues not identified for withdrawal (namely attendant care benefits) were still in dispute, while the claimant submitted that the issue of attendant care benefits was previously determined in a...

April 13, 2020

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W.E. v Aviva Insurance Company (18-011102)

The claimant sought removal from the MIG and entitlement to various medical benefits. Adjudicator Conway concluded that pursuant to section 38(11)(1), the insurer failed to comply with section 38(8) in its denial, and was barred from applying the MIG to the disputed benefits. While the adjudicator ultimately concluded that the disputed medical benefit was not...

April 9, 2020

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J.N. v Co-Operators General Insurance Company (18-012227)

The claimant submitted a LAT Application in August 2017 disputing attendant care benefits, among other benefits. The parties resolved the issues in dispute and entered into a partial settlement agreement. In 2018, the claimant filed a second LAT Application disputing entitlement to attendant care benefits. The insurer brought this preliminary issue hearing, arguing that the...

April 9, 2020

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Z.S. v Intact Insurance Company (19-000175)

The claimant was deemed catastrophically impaired, and sought entitlement to attendant care benefits which were denied by the insurer on the basis that the claimant's alleged service provider, his wife, did not meet the requirements for a provider under the SABS and did not incur an economic loss. The claimant's wife was laid off by...

April 9, 2020

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J.K. v Aviva Insurance Company of Canada (18-008054)

The insurer submitted a request for reconsideration following a decision in which the Tribunal found that the claimant was entitled to various medical benefits. In making its decision, the Tribunal addressed a procedural issue that arose as a result of the parties not filing the OCF-18s in dispute with their written submissions and evidence. As...

April 8, 2020

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A.K. v Aviva Insurance Canada (18-002488)

The claimant disputed his entitlement to non-earner benefits, which the insurer had discontinued six months post-accident based on the medical evidence on file and the results of multi-disciplinary insurer examinations. In determining whether the claimant was entitled to ongoing non-earner benefits, Adjudicator Kowal compared his pre and post-accident activities of daily living. Adjudicator Kowal concluded...

April 8, 2020

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D.M. v. Royal Sun Alliance Insurance (18-003146)

The claimant sought reconsideration of the Tribunal's decision that it could not adjudicate or enforce a purported full and final settlement. Vice Chair Hunter granted the reconsideration and held that the Tribunal did have a more robust jurisdiction under the Insurance Act than simply deciding entitlement to benefits. Whether an accident benefits settlement had been...

April 7, 2020

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R.S. v. Pafco Insurance Company (19-006331)

The claimant sought a determination that he sustained a catastrophic impairment, and entitlement to IRBs and various medical expenses. The insurer argued that the claimant was barred from proceeding with a catastrophic impairment determination until he attended a neurological IE, and also argued that the claimant was barred from proceeding with the claims for IRBs...

April 7, 2020

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Motor Vehicle Accident Claims Fund v. Z.M.H. (18-011392)

The Fund sought repayment of accident benefits on the basis that the claimant was not involved in an accident, and that she had misrepresented the facts of loss. The claimant alleged that she was part-way in her son's vehicle when he started driving, causing her to fall out of the vehicle onto her knees. The...

April 7, 2020

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M.Y. v Wawanesa Mutual Insurance Company (19-003973)

The insurer brought this preliminary issue hearing arguing that the claimant was barred from disputing her entitlement to medical/rehabilitation benefits beyond the MIG and attendant care benefits on the grounds that she failed to attend two section 44 IEs. The claimant took the position that she was not required to attend the IEs because the...

April 7, 2020

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G.K. v Coseco Insurance (18-007434)

The claimant disputed her MIG determination and sought entitlement to various medical/rehabilitation benefits and income replacement benefits. Adjudicator Hans concluded that the claimant's injuries did not fall within the MIG, as the medical evidence established that she suffered from chronic pain syndrome that was not merely a sequelae of the soft tissue injuries sustained in...

April 7, 2020

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Applicant v. Co-operators General Insurance Company (18-003622)

The claimant was involved in an accident in 2003. His entitlement to ACBs and HK expenses were denied in 2012. He applied to the LAT disputing further entitlement. The insurer argued that the claimed were barred by the limitation period. Adjudicator Helt concluded that the limitation period did not apply because the claimant was deemed...

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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