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.

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...

April 29, 2022

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Rattani v. Unifund Assurance Company (20-001512)

The claimant applied to the LAT seeking entitlement to various medical benefits, including further physical treatment and assessments. Section 38(8) of the SABs provide that an insurer shall respond to a treatment plan within 10 business of receipt and must provide the claimant correspondence outlining all medical and all other reasons for any denial. As...

April 29, 2022

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Co-Operators General Insurance Company v. Branden (2022 ONSC 2473)

The insurer appealed the LAT's decision which found that it was not permitted to deduct an LTD litigation settlement from the claimant's ongoing IRBs. The Divisional Court rejected the appeal. The Court noted that the Tribunal made a finding of fact that the LTD settlement did not provide appropriate details to allow the insurer to...

April 26, 2022

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Giannoylis v Travelers Insurance (20-000280)

The claimant sought reconsideration of the Tribunal's decision in which it found that he: (i) was not entitled to IRBS from August 10, 2018 to February 19, 2019; (ii) failed to provide sufficient particulars to calculate the IRBs payable from February 20, 2019 to January 11, 2021; and (iii) was not entitled to IRBs from...

April 26, 2022

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O’Brien v. Intact Insurance Company (20-003729)

The claimant's father was fatally injured in an automobile accident which led the claimant to develop psychological injuries and claim benefits pursuant to the SABs. A section 44 examination concluded that the proposed psychological treatment sought by the claimant was reasonable and necessary; however an incorrect fax number was used to send correspondence approving treatment....

April 22, 2022

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Singh v. Certas Direct Insurance Company (20-011141)

The claimant alleged that he was the back-seat passenger in a car involved in a rear-end accident. The insurer believed the incident was staged, based on an accident reconstruction report. Adjudicator Neilson held that the claimant failed to prove that he was involved in an accident. Relying on the accident reconstruction report and the "black...

April 22, 2022

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Bishop v. TD General Insurance Company (20-006964)

The claimant sought a catastrophic impairment as a result of chronic pain and psychological impairment following an accident. Because the accident was after June 1, 2016, the claimant was required to prove that she suffered three Class 4 Marked Impairments. The insurer argued that the claimant's chronic pain pre-existed the accident, and was not worsened...

April 22, 2022

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G.H.M. v. Wawanesa Mutual Insurance Company (20-009986)

The claimant was a six year old minor, who sustained a significant brain injury as well as other impairments as a result of an accident on May 28, 2015. She was deemed catastrophically impaired. The claimant disputed entitlement to rehab benefits for tuition and other expenses for the claimant's brother to attend school as recommended...

April 21, 2022

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Aviva General Insurance Company v. Sayegh (20-013245)

The claim arose after the insurer denied further benefits and sought repayment on the basis of wilful misrepresentation under section 52(1) of the SABS. The insurer based its decision on the investigation of an accident reconstruction expert, William Jennings. At the LAT, the claimant testified that he had been a front-seat passenger of his friend's...

April 21, 2022

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Carmel Jeffery v. Aviva Insurance Company (20-006381)

The claimant's husband passed away from accident-related injuries in 2017. The insurer paid a funeral benefit and a spousal death benefit. The claimant also applied for a death benefit as a dependent, pursuant to section 26(2)2. of the SABS. The insurer denied the death benefit based on a determination that the claimant was not principally...

April 20, 2022

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Bagla v. TD Ins. Meloche Monnex (20-004159)

A request for reconsideration of a preliminary issue decision was filed by the claimant. The preliminary issue decision found the claimant was statute barred for failure to appeal the denial of attendant care benefits in the two year limitation period. In this case, the claimant was involved in two accidents: one on March 3, 2014...

April 19, 2022

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Gichuki v TD Insurance Meloche Monnex (20-004631)

The claimant sought entitlement to attendant care benefits in the amount of $7,644.34, less $225.75 approved by the insurer, per month, from May 22, 2018 and ongoing. Vice Chair McGee found that attendant care benefits were not payable prior to October 31, 2019 when she submitted an Assessment of Attendant Care Needs (Form 1), pursuant...

April 12, 2022

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Perrigard v. Primmum Ins. Co. (19-010651)

This is a reconsideration decision. At the hearing, Vice-Chair Boyce found that the claimant was barred under section 56 of the SABS from proceeding with his application for failure to commence the application within two years of receipt of valid denials, and for his failure to attend a properly scheduled IE assessments. The claimant submitted...

April 12, 2022

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Sahadeo v. Pafco Insurance Company (19-006331)

A hearing regarding disputed medical benefits and catastrophic impairment was scheduled over eight days. The hearing was originally scheduled for July of 2021, but was rescheduled to begin on January 18, 2022. Due to a scheduling conflict, the hearing that was supposed to take place consecutively beginning January 18, 2022, was bifurcated, and the remainder...

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Contact Us

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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