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 3, 2017

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J.Y. v. Aviva Insurance (16-001993)

The insurer sought an adjournment of an oral hearing because two of its witnesses would be out of the country; the claimant's counsel consented to the adjournment. Nevertheless, Adjudicator Trojek rejected the request for an adjournment, reasoning that the request was not timely. The insurer made the request only 23 days before the hearing and...

February 27, 2017

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O.O. v. Aviva Insurance Company of Canada (16-00946)

The claimant, an articling student, sought entitlement to income replacement benefits and one psychological assessment plan. The claimant led a letter as evidence which was by the firm wishing him success in his future endeavours; it did not state that he was terminated. Adjudicator Truong found that the claimant was not terminated due to injury...

February 24, 2017

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T.K. v. Unica Insurance Inc. (16-000372)

The claimant was involved in two accident and sought two years of attendant care benefits. She submitted a Form 1 fifteen months after the second accident. She had also submitted a Form 1 for her first accident in which she claimed similar needs. Adjudicator Shapiro rejected the entire claim for attendant care benefits. First, he...

February 23, 2017

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E.K. v. Unifund Assurance Company (17-000897)

The parties were able to resolve the dispute during the Case Conference. The claimant sought costs and a special award. Adjudicator Makos denied both claims. He wrote that the insurer's delay in payment of the disputed benefits was not unreasonable in light of the lack of medical information provided by the claimant prior to the...

February 23, 2017

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D.O. v. TD Insurance Meloch Monnex (16-000142)

The claimant was a fetus at the time of the accident. The mother was 6 months pregnant at the time. After the MVA, the mother gave birth 2 months premature. 3 weeks after birth the claimant was discharged from the hospital; however, following the discharge she experienced difficulty swallowing and encountered choking episodes. As a...

February 21, 2017

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S.L. v. Pembridge Insurance Company (16-000393)

The claimant sought entitlement to medical treatment plans. The claimant asserted a chronic pain diagnosis to justify the treatment plans. The insurer asserted that the chronic pain diagnosis was as a result of a pre-existing injury and not the MVA. Adjudicator Derek Grant ruled that although "but for" is the default test for causation, "material...

February 14, 2017

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M.M. v. Northbridge Personal Insurance Corporation (16-000682)

The claimant sought entitlement to ongoing IRBs. Adjudicator Sewrattan applied a three-part test: (1) Was the claimant employed at the time of the accident, (2) Causation; did the claimant sustain an impairment preventing him/her from returning to work, and (3) Does the claimant suffer a substantial inability to perform the essential tasks of his/her employment,...

February 14, 2017

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M.M. v. Northbridge Personal Insurance Corporation (16-000682)

The claimant sought entitlement to ongoing IRBs. Adjudicator Sewrattan applied a three-part test: (1) Was the claimant employed at the time of the accident, (2) Causation; did the claimant sustain an impairment preventing him/her from returning to work, and (3) Does the claimant suffer a substantial inability to perform the essential tasks of his/her employment,...

February 13, 2017

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T.D. v. The Dominion of Canada General Insurance Company (16-002640)

The claimant sought to combine the hearing of his case with the hearing of another applicant's claim, as both claims arose from the same accident. The insurer opposed combining the files. Adjudicator Trojek denied the request to combine the hearings, reasoning that the claims dealt with two different claims by two difference people. Each claim...

February 13, 2017

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M.Y.Y. v. Dominion of Canada General Insurance Company (16-002636)

The accident involved two people, each with claims. The insurer requested that the matter be combined. The claimants did not consent. The two hearings shared only one common witness. Vice Chair Trojek denied the request for the combination of hearings. Under Rule 20.5 Vice Chair Trojek did not find any value in terms of "fairness,...

February 13, 2017

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L.Y.C. v. The Co-operators General Insurance Company (16-000881)

The claimant did not attend the hearing. Accordingly, the claims were dismissed.

February 13, 2017

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L.C. v. Aviva Insurance Company of Canada (16-001387)

The claimant sought removal from the MIG and entitlement to a series of treatment plans. Adjudicator Flude concluded that the applicant had suffered a predominantly minor injury. A post-accident MRI identified degenerative changes and nerve root compression. The applicant argued that the condition was pre-existing and entitled him to removal from the MIG. Adjudicator Flude...

February 13, 2017

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G.P. v. Northbridge Personal Insurance Company (16-001066)

The LAT was asked to consider the effect of a WSIAT decision finding that the applicant could pursue a claim under the WSIA. The applicant filed at LAT and argued that the insurer had to pay benefits notwithstanding the WSIAT decision, arguing that he had made an election to receive accident benefits. Adjudicator Grant held...

February 9, 2017

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Applicant v. Aviva Insurance Canada (16-000098)

This was a reconsideration request by the insurer following a decision that the claimant sustained psychological injuries that fell outside of the MIG. Executive Chair Lamoureux held that the adjudicator had weighed all of the evidence and made clear findings. There was therefore no basis to overturn the initial decision.

February 7, 2017

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A.W. v. Cooperators General Insurance Company (16-000283)

The claimant sought entitlement to non-earner benefits as well as a number of treatment plans. The insurer took a MIG position and also noted that the initial OCF-3 did not support an NEB claim. Although a subsequent disability certificate was submitted supporting NEBs, no further medical evidence was provided. On review, Adjudicator Pay concluded that...

February 6, 2017

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H.C. v. Certas Direct Insurance Company (16-001285)

The claimant sought entitlement to income replacement benefits along with two treatment plans, costs, and a special award. Adjudicator Bass reviewed the medical evidence, along with surveillance submitted by the insurer. It was found that the claimant's reports were "overly pessimistic in light of the surveillance evidence from only a few months later." As a...

February 3, 2017

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K.T. v. Allstate Insurance Company of Canada (16-000151)

The claimant was a pedestrian knockdown in Ontario. She applied for and received accident benefits, including IRBs, under Quebec's Quebec Societe de l'assurance automobile. Her IRBs were terminated 11 months post-accident and she did not appeal the decision. She then applied for IRBs in Ontario. The insurer paid IRBs and terminated benefits up to and...

February 2, 2017

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J.S. v. RBC Insurance Company (16-000576)

The claimant sought entitlement to eight treatment plans. The insurer maintained a MIG position. Adjudicator Makhamra found the claimant failed to meet the burden of proof to warrant removal from the MIG. The claimant holds the onus to prove removal from the MIG is justified. In doing so, Adjudicator Makhamra distilled the analysis to three...

February 1, 2017

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Applicant v. Aviva (16-001144)

The claimant sought entitlement to income replacement benefits and an orthopaedic assessment. The insurer paid IRBs for four months and terminated them after a number of IE reports. The orthopaedic assessment was denied based on a MIG position. As a preliminary issue, the insurer sought to add the claimant's LinkedIn page to show the claimant...

January 31, 2017

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J.V. v. Wawanesa Mutual Insurance Company (16-000722)

The claimant sought an order for IRBs in the amount of $280 per week. Adjudicator An concluded that the claimant suffered a substantial inability to engage in the essential tasks of her employment up to the date of her return to work.

January 30, 2017

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S.C.W.H. v. The Dominion of Canada General Insurance Company (16-000677)

The claimant sought entitlement to two chiropractic treatment plans and removal from the MIG. Adjudicator Makhamra concluded the claimant's injuries fell within the MIG and therefore the treatment plans were not payable. The claimant did not submit medical evidence in support of the non-MIG injuries. It was noted that the pre-existing medical condition to warrant...

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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