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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February 22, 2021

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Duncan v. The Co-operators General Insurance Company (19-014310)

A written preliminary issue hearing was held to determine whether the claimant was involved in an accident as defined in s. 3(1) of the SABS. The parties agreed that the claimant sustained injuries when he slipped and fell after exiting his vehicle. The claimant was completely out of the vehicle and had walked approximately 10...

February 22, 2021

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Khamis v. Unifund Assurance Company (19-013760)

A written hearing was held to determine whether the claimant was involved in an accident as defined in s. 3(1) of the SABS. The parties agreed that the claimant sustained injuries when he slipped on ice as he was exiting his vehicle and fell to the ground on his left side. The insurer disputed the...

February 19, 2021

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Lindo v. Echelon General Insurance Company (19-014520)

A written preliminary issue hearing was held to determine whether the claimant was involved in an accident as defined in s. 3(1) of the SABS. The claimant claimed she was involved in an accident when her vehicle was side swiped by another vehicle, causing her injuries and damaging her vehicle. The insurer submitted that the...

February 18, 2021

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D.L. v. Aviva General Insurance Company (19-000651)

The claimant sought entitlement to medical benefits, a social work assessment, an OCF-3 expense, and interest. Adjudicator Boyce concluded that the claimant was entitled to the three medical benefits, but not the assessment or expense. The insurer agreed to fund these treatment plans subject to a ruling with respect to the amounts proposed in excess...

February 17, 2021

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Aviva General Insurance v. E.R. (19-001839)

The insurer requested repayment as a result of IRB payments made in error, as it was unaware that the claimant had returned to work until it received the information in a section 44 IE report. The claimant argued that it was prejudicial for his own insurer to penalize him as a result of their error....

February 16, 2021

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Spence v. Aviva Insurance Company of Canada (19-013457)

The claimant and insurer disagreed over the deduction of EI sickness benefits from IRBs. Vice Chair Boyce held that EI sickness benefits were not deductible from IRBs because they were not considered "gross employment income". He distinguished cases which permitted the deduction of EI maternity benefits - which were received because a person is employed...

February 12, 2021

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Baldinelli v. Aviva Insurance Company (19-013752)

The claimant was injured in an incident that involved a series of assaults, resulting in physical injuries. The facts of the case are unusual: The claimant heard a commotion on his street. He got in his vehicle and drove down his driveway where he was met by two assailants. The claimant opened the driver's side...

February 11, 2021

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Jamon v. The Co-operators (19-006256)

The claimant sought entitlement to IRBs and various medical/rehabilitation benefits, including an attendant care assessment and functional abilities assessment. With respect to IRBs, Adjudicator Parish found that the claimant had proven on a balance of probabilities that she was substantially unable to perform the essential tasks of her pre-accident employment as a supervisor at Dairy...

February 11, 2021

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Aviva General Insurance Company v. Ghandahari (19-009382)

The insurer requested repayment as a result of benefit payments made based on the claimant's wilful misrepresentation when she failed to disclose that the accident occurred during the course of her employment and she made a claim for benefits from the WSIB. The claimant did not participate in the hearing. Adjudicator Chakravarti agreed with the...

February 10, 2021

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Alakoozi v. ACE INA Insurance (20-000516)

The claimant sought entitlement to benefits following an accident that occurred on December 15, 2016. At the case conference, the insurer raised the preliminary issue that the claimant was statute-barred from proceeding with his claim under s. 56 of the Schedule because he failed to appeal its valid denial within the two-year limitation period. Adjudicator...

February 10, 2021

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Mohammad v. The Dominion of Canada General Insurance Company (20-000007)

The claimant sought entitlement to benefits following an accident that occurred on August 28, 2015. At the case conference, the insurer raised the preliminary issue that the claimant was statute-barred from proceeding with his claim under s. 56 of the Schedule because he failed to appeal its valid denial within the two-year limitation period. A...

February 9, 2021

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Seepersaud v. Allstate Insurance (20-000400)

The claimant sought a special award due to the insurer's unreasonable delay in paying his IRB. Vice Chair Boyce found that the evidence demonstrated that the insurer withheld and delayed the payment of the claimant's IRB claim for over one year of his eligibility, despite having all of the documentation reasonably required to initiate and...

February 8, 2021

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Sheriffe v. Aviva Insurance Company of Canada (19-009684)

This was a preliminary motion decision on the claimant's request for production of adjuster's log notes beyond the date of the LAT application, and the insurer's request for production of a 2010 AB file for a previous accident. Adjudicator Maedel ordered that the insurer produce the log notes beyond the date of the LAT application,...

February 8, 2021

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S.P. v. Aviva General Insurance Company (18-008876)

The claimant sought reconsideration of a LAT dispute denying her entitlement to IRBs and medical benefits. The claimant was represented by counsel at the hearing and with respect to the reconsideration application. Adjudicator Boyce noted that the claimant's reconsideration submissions were 24 pages single spaced and made sweeping accusations that the adjudicator denied her procedural...

February 8, 2021

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Khosla v. TD General Insurance Company (19-010508)

The claimant applied to the LAT disputing her entitlement to a chiropractic treatment plan. The issue in this dispute was the application of sections 38(5) and (6), and the MIG. The insurer denied the treatment plan in accordance with section 38(5) on the basis that the claimant was being treated within the MIG. Later, the...

February 5, 2021

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Cox v. Wawanesa Mutual Insurance Company (19-012281)

The claimant was involved in a serious motor vehicle accident in 2014. She received IRBs for four years, until they were terminated based on multidisciplinary s. 44 opinions. The claimant applied to the LAT seeking entitlement to post-104 week income replacement benefits and a special award. As a preliminary issue, the claimant requested that the...

February 5, 2021

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Duah v. Wawanesa Mutual Insurance Company (19-006610)

The claimant was injured when he slipped and fell on ice while attempting to retrieve his car key from his bag. He suffered a displaced spiral fracture of his fibula. The claimant applied to the insurer for accident benefits. The insurer denied that an accident occurred. The claimant applied to the LAT and the matter...

February 4, 2021

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Z.R. v. Gore Mutual Insurance (18-000017)

The insurer sought reconsideration of the Tribunal's decision that the claimant suffered a catastrophic impairment, and that he was entitled to NEBs. Adjudicator Hines dismissed the reconsideration. She accepted that the Tribunal ought not to have counted 3 percent WPI for medication use because the medication did not have the effect of cancelling out the...

February 3, 2021

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J.J. v. Economical Insurance Company (19-003835)

A preliminary issue hearing was held to determine whether the claimant was involved in an accident as defined in s. 3(1) of the SABS. The claimant submitted that he was riding on the back of an ATV down a laneway on the way to his home when he fell off the back and suffered a...

February 3, 2021

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Escobar v. The Guarantee Company of North America (20-000259)

The claimant sought entitlement to two treatment plans, including a medical benefit for dental treatment and a rehabilitation benefit for a hot tub. The claimant also sought a special award. Adjudicator Grant found that the claimant was entitled to the OCF-18 for dental treatment, but was not entitled to the OCF-18 for a hot tub,...

February 3, 2021

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Shih v. Economical Insurance (20-005669)

The claimant sought entitlement to Income Replacement benefits and three treatment plans. The insurer raised a limitation defence in accordance with s. 56 of the Schedule. The insurer argued that the claimant failed to challenge the denial of the IRB and two of the three treatment plans within the two-year limitation period. Adjudicator Mazerolle found...

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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