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.

September 19, 2022

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Williams v. Unifund Assurance Company (20-015158)

The claimant applied to the LAT seeking entitlement to various benefits, including payment for catastrophic assessments. The claimant submitted that the proposed CAT assessments met both the reasonableness and guideline requirements for entitlement to funding. Adjudicator Kaur disagreed with the claimant's position, noting that she had failed to submit appropriate evidence before the Tribunal in...

September 16, 2022

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Handy v. Aviva Insurance Company of Canada (20-006124)

The claimant sought catastrophic impairment designation under Criterion 7, arguing that he developed chronic pain from the soft tissue injuries sustained in the accident along with exacerbation of pre-existing asymptomatic degenerative disc disease and knee osteoarthritis. The insurer submitted that the claimant's present health condition was caused by an unrelated subsequent fall. The claimant's assessors...

September 15, 2022

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Alkhazov v. Aviva Insurance Company of Canada (21-004825)

The insurer brought a preliminary motion to address whether the claimant was barred from proceeding with his claim for NEBs as he failed to submit an OCF-10 form electing benefits. The claimant was injured in an automobile accident on April 18, 2019, and applied for accident benefits (OCF-1) on April 23, 2019. In his OCF-1,...

September 13, 2022

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Belanger v. Intact Insurance Company (19-013755)

The insurer requested reconsideration of the Tribunal’s earlier decision which held that the claimant was not statute barred pursuant to s. 56 of the Schedule. In the initial decision, the Tribunal found that the delivery of the initial IRB denial letter dated March 26, 2015, despite being an adequate stoppage letter, was not done in...

September 12, 2022

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Day v. BelairDirect Insurance Company (20-005603)

The claimant sought catastrophic impairment designation under Criterion 8 as a result of her involvement in an April 2016 accident. Both parties agreed that the claimant had a class 4 marked impairment due to a mental or behavioural disorder, but the insurer denied that her mental or behavioural disorder was caused by the accident and...

September 12, 2022

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Ladouceur v. Intact Insurance Company (2022 ONSC 5206)

The claimant sought judicial review of the Tribunal's decision that the limitation period barred the claim for NEBs, and the Tribunal's decision not to extend the limitation period under section 7 of the LAT Act. The Court dismissed the matter, holding that judicial review was only warranted in rare circumstances. The claimant chose not to...

September 6, 2022

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Ferlisi v. Allstate Insurance Company of Canada (21-000013)

The claimant sought catastrophic impairment under Criterion 7. The claimant sustained soft tissue injuries to her left side and developed chronic regional pain syndrome (CRPS) in her left foot as a result of the accident. She had a spinal cord stimulator (SCS) surgically inserted into her spine to address the pain she experienced from the...

September 1, 2022

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Aviva Insurance Company of Canada v. Spence (2022 ONSC 4988)

The insurer appealed the Tribunal's decision that EI sickness benefits are not deductible from IRBs as "gross employment income". The Court reversed the Tribunal's decision, holding that there was no ambiguity in the SABS, and that EI sickness benefits were deductible as "gross employment income". The Court wrote that the Tribunal erred in not treating...

August 30, 2022

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Jevco Insurance Company v. Hang (2022 ONSC 4961)

The insurer brought an urgent motion for a stay of the scheduled hearing due to counsel's unavailability to attend the hearing. Justice London-Weinstein applied the three-prong test from RJR MacDonald v. Canada (Attorney General) and concluded that a stay was not warranted. The insurer demonstrated that there was a serious issue to be tried, and...

August 30, 2022

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Lynch v. Intact Insurance Company (20-014497)

The claimant applied to the LAT seeking CAT determination under Criteria 8 and entitlement to post-104 IRBs . Vice-Chair Shapiro applied the "but for" test to the issue of causation. Vice-Chair Shapiro found that the claimant's current stand-up comedy activities were a "hobby" and not a career that disqualified the claimant from post-104 IRBs. The...

August 29, 2022

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Mears (Griffiths) v TD General Insurance Company (20-012014)

The parties agreed that the claimant met the legal test for entitlement to IRBs for the time period claimed, but could not agree on the appropriate quantum owed. The claimant relied on an accounting report from ADS, which calculated his past entitlement to be $166,821.32. The insurer relied on an accounting report from PWC, which...

August 26, 2022

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Vaillancourt v. Intact Insurance Company (19-009063)

This is a reconsideration decision. In the initial preliminary hearing decision, the LAT found that that the exclusion in s. 31(1)(a)(i) of the SABS did not apply in this matter. Pursuant to 31(1)(a)(i), an insurer is not required to pay IRBs, NEBs, or a benefit under ss. 21, 22, or 23 in respect of a...

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...

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com