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.

January 5, 2017

/

tgp-admin

P.L.F.R. v. Intact Insurance Company (16-000145)

As a result of the accident, the claimant suffered GCS scores in the range of 12 to below 9 and sought an order that her impairment was catastrophic. The insurer argued that the GCS scores below 9 were not caused by a brain impairment. Adjudicator Flude concluded that the SABS did not require ongoing neurologic...

December 28, 2016

/

tgp-admin

T.S. v. Allstate Insurance Company of Canada (16-001916)

The claimant sought entitlement to a number of medical benefits. Additionally, the claimant sought entitlement to medical benefits generally, in the sum of $10,000,000.00. The insurer resisted the claims and asserted the matter was dealt with at FSCO. The insurer raised a preliminary issue to that effect, to which the claimant was not prepared for...

December 23, 2016

/

tgp-admin

A.B. v. Aviva Insurance Company of Canada (16-000342)

The claimant sought entitlement to NEBs and transportation costs. The insurer relied upon surveillance as part of its defence. Adjudicator Richards concluded that the claimant did not meet the complete inability test, and was not entitled to transportation costs. The adjudicator allowed the surveillance to be admitted despite non-compliance with the timelines in the LAT...

December 22, 2016

/

tgp-admin

Applicant v. The Personal Insurance Company (16-000338)

The claimant sought reconsideration regarding the exclusion of audio evidence obtained by the claimant during an IE. The Executive Chair held that the adjudicator had not acted outside his jurisdiction or violated the rules of natural justice or procedural fairness. The request was denied.

December 21, 2016

/

tgp-admin

Applicant v. Aviva Insurance Company (16-000272)

The insurer sought reconsideration of the Tribunal's decision on MIG because the claimant had been removed from the MIG two years prior. The Executive Chair rescinded the adjudicator's decision regarding MIG because it was not an issue before the Tribunal in dispute.

December 19, 2016

/

tgp-admin

Aviva Canada v. S.A. (16-000409)

The insurer alleged that the claimant had made material misrepresentations, and sought repayment of IRBs. After reviewing the chronology of events, Adjudicator Bass found the claimant provided a "shifting version of the facts as a whole" that evidenced "a persistent attempt to receive benefits to which he was not entitled." Repayment of IRBs was ordered.

December 16, 2016

/

tgp-admin

V.L. v. TD Meloche Monnex (16-000308)

The claimant applied for caregiver benefits. The claimant did not reside with his parents (the alleged dependants), but rather resided approximately 900 metres away on foot and 3 kms away by car. Adjudicator Treksler awarded caregiver benefits stating the legislation was silent on the term "reside" and therefore must be interpreted on a case-by-case basis...

December 16, 2016

/

tgp-admin

N.P.M.T. v. State Farm Insurance Company (16-002709)

The claimant withdrew the LAT application at the Case Conference. The insurer objected and sought costs. Adjudicator Treksler stated that the mere withdrawal of an application will "rarely, if ever, be a sufficient basis on which the Tribunal will make a costs order." The claimant's application and subsequent withdrawal did not rise to the level...

December 14, 2016

/

tgp-admin

P.C. v. State Farm Insurance Company (16-000588)

The claimant sought entitlement to non-earner benefits. The insurer raised a preliminary issues motion asserting the claimant was outside of the two year limitation period. Vice Chair Gregory Flude reviewed the chronology of the claim and noted a disability certificate was submitted, albeit not endorsing entitlement to non-earner benefits. A FSCO mediation was applied for...

December 14, 2016

/

tgp-admin

J.C. v. Certas Direct Insurance Company (16-000940)

The claimant sought entitlement to two medical benefits. Adjudicator Sewrattan dismissed the claim. He wrote that reports in favour of a treatment plan failed to provide sufficient detail explaining why the specific treatment request was reasonable and necessary. Simply showing a treatment is "necessary" was not enough. More was required to discharge the claimant's onus.

December 14, 2016

/

tgp-admin

J.B. v. Meloche Monnex Financial Services Inc. (16-000766)

The claimant sought entitlement to three medical benefits. As a preliminary issue, the insurer sought exclusion of the claimant's submissions due to late filing. Adjudicator Treksler held that a large and liberal interpretation of Rule 3.1 allowed the late filing of submissions in this case. The adjudicator found the disputed treatment plans reasonable and necessary.

December 9, 2016

/

tgp-admin

N.E. v. Waterloo Regional Municipalities Insurance Pool (16-000066)

The claimant sought IRBs at a rate above the weekly rate paid by the insurer. The claimant also sought removal from the MIG. Adjudicator Gottfried dismissed the claim for increased IRBs as the claimant had not provided any documentation to support increasing the weekly quantum. The adjudicator also noted that entitlement to ongoing IRBs does...

December 7, 2016

/

tgp-admin

TD General Insurance Company v. A.B. (16-000060)

The insurer sought repayment of IRBs based on the claimant's return to work prior to IRB discontinuance. Adjudicator Go found that the claimant had returned to work as of at least May 1, 2014, and ordered repayment of IRBs from that date onward. The adjudicator was unwilling to find that the claimant had returned to...

December 7, 2016

/

tgp-admin

N.C. v. RBC General Insurance Company (16-000282)

Following an accident, the self-employed claimant stopped operating his business in January 2016. Adjudicator Sewrattan concluded that the IRB calculation could not take into account business losses, as the claimant did not have business losses (as calculated by the Income Tax Act) after he ceased operations of his business. In terms of medical benefits, the...

December 6, 2016

/

tgp-admin

M.M. v. Wawanesa Mutual Insurance Company (16-000642)

The claimant sought removal from the MIG, and entitlement to two treatment plans. Arbitrator Truong concluded that the MIG applied despite various pre-existing conditions, previous motor vehicle accidents, and earlier psychological injuries.

December 2, 2016

/

tgp-admin

Applicant v. Old Republic Insurance Company (16-000179)

The insurer appealed a decision by an adjudicator that the claimant was entitled to IRBs up until a particular date in the future. The Executive Chair held that the adjudicator made an error of law by setting an end date for the reinstated IRBs. An insurer has an ongoing obligation to adjust a file, and...

December 2, 2016

/

tgp-admin

Applicant v. Old Republic Insurance Company (16-000179)

The insurer appealed a decision by an adjudicator that the claimant was entitled to IRBs up until a particular date in the future. The Executive Chair held that the adjudicator made an error of law by setting an end date for the reinstated IRBs. An insurer has an ongoing obligation to adjust a file, and...

December 1, 2016

/

tgp-admin

L.W. v. The Co-operators General Insurance Company (16-000536)

The claimant sought entitlement to six treatment plans. Adjudicator Sewrattan adopted FSCO case law on the legitimacy of pain relief being a reasonable and necessary goal of treatment, and awarded all six treatment plans. The adjudicator also rejected the insurer's position that surveillance could accurately capture the sensation of pain.

November 29, 2016

/

tgp-admin

D.J. v. Aviva Insurance Canada (16-000098)

The claimant sought removal from the MIG and entitlement to various treatment plans. Adjudicator Theoharis concluded that the claimant suffered from depression and anxiety, which entitled her to benefits above the MIG limits. However, Adjudicator Theoharis concluded that all treatment plans for physical treatment were not reasonable and necessary, as the claimant had met maximum...

November 21, 2016

/

tgp-admin

J.W. v. Echelon General Insurance Company (16-000082)

The claimant sought IRBs for both the first 104 weeks after the accident, and beyond the first 104 weeks after the accident. Adjudicator Flude accepted the that the claimant met the "complete inability" test as neither the claimant nor the insurer submitted evidence of employment for which the claimant might reasonably be suited by education,...

November 15, 2016

/

tgp-admin

J.W. v. The Co-operators General Insurance Company (16-000248)

The claimant sought IRBs during a period in which he was in non-compliance with the requirement to attend an IE. He argued that there were no "medical and any other reasons" in the IE notice. Adjudicator Richards upheld the non-payment of IRBs, stating there is no requirement to "invent" a medical reason; medical and other...

Contact Us

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

416.507.1850

eodonnell@tgplawyers.com

Contact Us

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

416.507.1850

eodonnell@tgplawyers.com

© 2020 Thomas Gold Pettingill LLP Disclaimer | Privacy Policy | Statement of Principles

Powered by Crow & Pitcher

Contact Us

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

416.507.1850

eodonnell@tgplawyers.com