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.

June 8, 2022

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Bernard v. Unica Insurance Inc. (20-007082)

The claimant sought catastrophic impairment designation, as well as entitlement to non earner benefits, attendant care benefits, and housekeeping benefits. The claimant, who had a pre-existing history of ADHD and Asperger's syndrome, suffered a comminuted fracture of his left tibia/fibula when he was struck by a car while riding his bicycle. The claimant underwent two...

June 7, 2022

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Singh v. Wawanesa Mutual Insurance Company (2022 ONSC 3361)

The claimant appealed the LAT's decision that she was not entitled to IRBs. She argued that she was denied procedural fairness by the Tribunal due to late production of raw testing data from an IE psychologist. She also argued that the insurer did not make best efforts to obtain the IE assessor's records. The Court...

June 7, 2022

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Yatar v. TD Meloche Monnex

The claimant appealed the Divisional Court's dismissal of her judicial review application, in which the Divisional Court held that judicial review of a LAT decision should only be granted in exceptional circumstances. The Court of Appeal upheld the decision dismissing the judicial review, but modified the grounds on which judicial review could be sought. The...

June 6, 2022

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Padua v. Co-operators General Insurance Company (20-005450)

The claimant brought a LAT application after various treatment plans were denied because her injuries were deemed to fall under the MIG. She also sought a special award for unreasonably withheld or delayed payments. Several months after the accident in April 2018, the claimant had voluntarily withdrawn from receiving treatment without exhausting her MIG benefits....

June 5, 2022

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R. S. v. Optimum Insurance Company (20-006166)

The claimant alleged that he was involved in an accident and injured while using and operating his vehicle to drive to an outdoor space to meditate. The claimant has a long history of mental health issues and addiction, and had previously expressed suicidal ideations. The insurer denied the claimant’s accident benefits claim, and argued that...

June 5, 2022

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C.T. v Aviva Insurance Company of Canada (20-004000)

The claimant alleged that an accident occurred as he was walking towards a transit bus. As the bus began to pull away from the bus stop, the claimant reported that he knocked on the side of the bus as it drove away. He claimed to have made momentary eye contact with the driver before losing...

June 2, 2022

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Kalk v. Intact Insurance Company (20-002839)

The claimant sought catastrophic impairment designation, as well as entitlement to attendant care benefits and housekeeping benefits. The 24 year old claimant suffered numerous fractures as a result of a head-on collision, and required multiple surgeries and nearly two months in hospitals and in-patient rehabilitation. Vice Chair Shapiro found that the claimant was catastrophically impaired...

May 31, 2022

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G.P. v. Wawanesa Mutual Insurance Company (18-010583)

The claimant applied to the LAT for a catastrophic impairment designation, post-104 week IRBs, the cost of CAT assessments, and various medical benefits. Vice Chair Lester found that the claimant suffered a catastrophic impairment due to Class 4 Marked Impairments in both adaptation, and concentration, persistence, and pace. The claimant suffered from chronic pain as...

May 30, 2022

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Islam v. Toronto Transit Commission Insurance Company (20-014052)

The claimant applied to the LAT for a catastrophic impairment designation. Vice Chair Flude concluded that the claimant did not meet the definition, as she did not have a combined physical and mental impairment exceeding 55 percent WPI , and did not suffer at least one Class 4 Marked Impairment. The claimant's assessor wrote that...

May 30, 2022

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Sambasivam v. Sonnet Insurance Company (20-014115)

The insurer brought a preliminary issue motion with the LAT to determine whether the accident alleged by the claimant had occurred. It sought a repayment of IRBs paid and costs for investigation and legal fees. The claimant alleged that he had been a passenger in a vehicle driven by the witness, his sister, when they...

May 27, 2022

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Afshan v. Security National Insurance Co. (18-007658)

The claimant had initially sought a special award related to denial of NEBs. At a teleconference hearing an adjuster for the insurer gave testimony regarding the denial of benefits. At the conclusion of the hearing, the claimant requested that costs be added as an issue in dispute. Adjudicator Hines granted the request and the parties...

May 26, 2022

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Tanner v. Certas Direct (21-000564)

The claimant applied to the LAT for a catastrophic impairment designation, post-104 week IRBs, and payment of various medical benefits including partially approved CAT assessments. Adjudicator Reilly denied all claims and dismissed the application. With respect to the catastrophic impairment, Adjudicator Reilly found a maximum combined WPI of 32 percent. She found the claimant's assessors...

May 25, 2022

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Bagherian v. Aviva Insurance Company (2022 ONSC 3103)

The claimant appealed the Tribunal's decision dismissing his application due to repeated non-attendance at IEs. The Court dismissed the appeal, holding that the LAT had the legal authority to dismiss the application. The claimant's failure to cooperate in obtaining IEs interfered with the insurer's ability to participate in the process before the Tribunal, and caused...

May 24, 2022

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Barrie v. Intact Insurance Company (20-004866)

The claimant sought full approval of an OCF-18 for psychological treatment in the amount of $3,491.48. The insurer had only approved $2,543.77 of the requested amount. The disputed treatment plan included 12, 1.5 hour sessions with psychologist Dr. Aghamohseni. The insurer had advised the claimant that it required additional information to justify approval of 1.5...

May 18, 2022

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Davis v. Aviva General Insurance Company (20-005334)

The claimant slipped and fell on black ice in a parking lot as she was trying to open the driver’s side door. The claimant applied for accident benefits, which was denied as her insurer took the position that the claimant was not involved in an accident. Adjudicator Kaur held that the incident did not meet...

May 17, 2022

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Gore v. Rusk (2022 ONSC 2893)

The insurer appealed the Tribunal's decision that the claimant suffered a catastrophic impairment, and that he was entitled to NEBs. The Court dismissed the appeal, holding that both appeals were on matters of mixed fact and law and that there were no extricable legal error that had been demonstrated. The findings regarding each WPI allocation...

May 16, 2022

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Katsaros v TD Insurance Meloche Monnex (20-010657)

A preliminary issue hearing was held to determine whether the claimant's application for IRBs was statute-barred per the limitation period. The claimant was involved in a motor vehicle accident on October 21, 2016 and was able to return to work within a week. Almost a year later, the claimant stopped working and began receiving short-term...

May 12, 2022

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Rao v. Wawanesa Mutual Insurance Co. (20-001654)

The claimant applied to the LAT seeking CAT determination under Criteria 8 and entitlement to post-104 IRBs and various medical/rehabilitation benefits. Causation was an issue at the hearing. The subject motor vehicle accident occurred on April 4, 2016. At the time of the subject accident, the claimant was still recovering from an incident in August...

May 10, 2022

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Ifraimov v. Wawanesa Insurance (19-014493)

The claimant was involved in a serious motor vehicle accident in October 2016, in which he sustained fractures to both arms and his left leg. He applied to the LAT seeking CAT determination under Criteria 7. The claimant's CAT assessors opined that the claimant had a combined WPI of 60%, and the insurer's assessors opined...

May 9, 2022

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Adams v. Federated Insurance Company of Canada (20-009293)

The claimant applied to the LAT seeking CAT determination as a result of a traumatic brain injury (Category 4). The parties agreed that the claimant met the criterion under s. 3.1(1)4.i of the SABS. The parties disagreed as to whether she also met the necessary criterion under s. 3.1(1)4.ii. Vice-Chair Lester found that the claimant's...

April 29, 2022

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Pham v. Coseco Insurance Company (20-004749)

The claimant commenced two applications for treatment and assessment plans. The first application dealt with certain disputed treatment and assessment plans, and the Insurer’s determination that the claimant sustained a minor injury. The second application concerned the claimant’s chronic pain treatment plan. A motion decision ordered that the decision rendered in the first application regarding...