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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June 15, 2020

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S.V. v. State Farm Mutual Automobile Insurance Company (18-000605)

The claimant sought reconsideration of the Tribunal's decision regarding certain denied ACBs for feeding, bathroom cleaning, and basic supervisory care. She also sought interest on ACBs from the retroactive date of the Form 1, rather than the date the Form 1 was submitted. Adjudicator Parish granted the reconsideration in relation to the quantum payable for...

June 11, 2020

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M.M. v. Aviva Insurance Canada (18-000467)

The claimant sought reconsideration of the Tribunal's decision that a special award was not payable on a psychological assessment that was initially denied but approved just before the hearing. Adjudicator Punyarthi granted the reconsideration and ordered a special award of 45 percent be paid on the denied assessment. She explained that the Tribunal had made...

June 11, 2020

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Z.M. v. State Farm Mutual Automobile Insurance Company (18-012546)

A preliminary issue hearing was held to determine whether the claimant was barred from proceeding with her application for non-earner benefits because the two-year limitation period had expired. The claimant argued that she did not discover that she was able to dispute the non-earner benefit until she retained a lawyer five years after the accident...

June 11, 2020

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B.N. v. The Co-Operators Insurance Company (19-006455)

The claimant sought removal from the MIG and entitlement to three treatment plans for psychology services and chiropractic treatment. This case also raised the issue of whether an insurer can properly deny medical benefits for a psychological assessment and psychological treatment without requiring the claimant to attend an in-person IE for a psychological assessment. With...

June 10, 2020

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Z.P. v. Certas Direct Insurance Company (19-003226)

The claimant suffered a catastrophic impairment and sought entitlement to three treatment plans for home modifications and assistive devices. With respect to a $9,025.30 home modification assessment, the insurer had already paid $2,000 and argued that it was the maximum payable under the SABS. Vice Chair McQuaid agreed that the maximum payable was limited to...

June 9, 2020

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L.H. v. Aviva General Insurance (19-004132)

The claimant sought entitlement to ongoing NEBs and interest. The IE assessors concluded that the claimant did not suffer a complete inability to carry on a normal life. Adjudicator Kaur determined that there was limited evidence to refute the findings in these reports. Further, the claimant had not submitted any medical evidence to substantiate her...

June 9, 2020

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F.A. v. Aviva General Insurance (18-0011952)

The claimant sought entitlement to various medical benefits and payment for the cost of examinations. Adjudicator Johal ruled that all disputed plans were not reasonable or necessary based upon the evidence provided. Further, the claimant had not satisfied her onus to prove on a balance of probabilities that the treatment and assistive devices were effective...

June 8, 2020

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L.D. v. Certas Home and Auto Insurance Company (19-001472)

The claimant disputed entitlement to four treatment plans for physical treatments and a chronic pain assessment, an invoice for completion of an OCF-3, a MIG determination, interest and a special award. The claimant alleged that he suffered from chronic pain as a result of the accident. In support of his claims, the claimant submitted medical...

June 8, 2020

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A.T. v. Aviva Insurance Canada (18-010303)

The claimant sought entitlement a treatment plan for $14,804.51 for medical services, which he claimed was not properly denied in accordance with section 38 of the SABS. The claimant further argued that the insurer's denial was deficient as it referenced a different health provider than the one listed on the disputed plan, and it did...

June 8, 2020

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B.E. v. The Personal Insurance Company (18-012331)

The insurer had initially treated the claimant with the MIG, but removed her from the MIG following receipt of medical records. Despite being removed from the MIG, the claimant sought an order that the MIG was unconstitutional. Adjudicator Boyce held that the Tribunal did not have jurisdiction to address the Charter challenge because the dispute...

June 5, 2020

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O.S. v. Certas Home and Auto Insurance Company (18-006633)

The claimant disputed entitlement to three treatment plans for chiropractic services, an orthopaedic assessment, and a neuropsychological assessment, as well as multi-disciplinary CAT assessments. Adjudicator Pinto ruled that all disputed plans were not reasonable or necessary based upon the evidence provided. In her decision, she noted that the disputed treatment plans did not provide medical...

June 3, 2020

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F.P. v. The Personal Insurance Company (19-001886)

The insurer denied payment of IRBs and NEBs on March 30, 2017. The claimant argued that he mistakenly claimed IRBs instead of NEBs and requested to correct the Application at a Case Conference on September 26, 2019. He further claimed that the denials by the insurer were not clear and unequivocal, but confusing, ambiguous and...

June 3, 2020

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J.V.D.A. v. Aviva General Insurance(19-002631)

The claimant sought payment of HST on attendant care services outside of the ACB limit. Aviva had paid a total of $1,829.62 in HST as charged by the AC service provider, but paid it from the ACB limits. The claimant argued that the payable HST was not subject to the ACB limit as set out...

June 3, 2020

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C.W. v. Aviva Insurance Company (19-002426)

The claimant sought removal from the MIG and entitlement to various medical benefits. Adjudicator Farlam found that the claimant sustained minor injuries in the accident. While the disability certificate noted COPD, mild stroke, right sciatica, low back pain, they appeared to be self-reported by the claimant, and there was no pre-accident medical records documenting the...

June 2, 2020

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N.I.F. v. Certas Home and Auto Insurance Company (19-004334)

The claimant's adult son was involved in a motorcycle accident and died as a result of the accident. A preliminary issue hearing was held to determine: (1) if the claimant was an "insured person" under the SABS at the time of the accident, and (2) whether the claimant was statute-barred from claiming benefits sought as...

June 1, 2020

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A.B. v. Aviva General Insurance (19-005231)

The claimant sought ongoing IRBs in the amount of $385. The adjudicator found that the claimant was not entitled to IRBs because the claimant failed to provide evidence from the employer or himself regarding his employment (other than differing self-reports to various assessors), and failed to provide sufficient medical evidence that he suffered a substantial...

June 1, 2020

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Q.N.N. v. Aviva Insurance Canada (19-003381)

The claimant sought IRBs in the amount of $400 per week and the cost of prescriptions. Adjudicator Farlam found that the claimant was not entitled to payment of IRBs because he had only submitted his 2016 T4 and failed to report his 2016 income to the CRA. The adjudicator held that it was unnecessary to...

June 1, 2020

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S.V. v. Aviva Insurance Canada (18-011347)

The claimant sought entitlement to ongoing NEBs, and medical benefits for physical therapy. With regard to NEBs, the claimant argued that the insurer failed to respond to the application within the timelines set out in section 36. Adjudicator Flude found that the insurer did not comply with its obligations under section 36(4)(b) of the SABS...

May 29, 2020

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L.C. v. Aviva Insurance Canada (18-008289)

The claimant attended IEs addressing her determination of a catastrophic impairment, but refused to allow the IE facility to release the assessment reports, arguing that the insurer's use of a third party to conduct the assessments violated her privacy rights and Charter rights. Adjudicator Norris held that the claimant's refusal to allow the IE facility...

May 28, 2020

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G.S. v. The Personal Insurance Company (19-001049)

The claimant sought various accident benefits. The insurer argued that the claimant was not involved in an accident, and alleged that he had made material misrepresentations. The insurer sought repayment of all accident benefits paid. Regarding the burden of proof, Adjudicator Hines held that the claimant had to prove that he was involved in an...

May 27, 2020

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K.P. v. CUMIS General Insurance (18-001556)

The claimant applied to the LAT seeking entitlement to pre- and post-104 IRBs, psychological treatment, and physical treatment. Adjudicator Letourneau found that, due chiefly to the pain management needs of the claimant and the diagnoses presented by treating practitioners, the claimant was entitled to the medical benefits in dispute. The claimant was not entitled to...

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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