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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January 24, 2020

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M.M. v. Royal & Sun Alliance Insurance Company of Canada (18-007290)

This is a preliminary issue decision addressing whether the claimant was barred from proceeding with a claim for NEBs for failure to commence the LAT application within two years after the insurer's refusal to pay the amount claimed. Vice Chair Flude found that a letter stating the claimant was not entitled to a specified benefit...

January 24, 2020

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F. A.-W. v. Aviva General Insurance Company (18-008742)

The claimant sought entitlement to a further $2,000 for catastrophic impairment clinic file review ($10,400 had been approved for other catastrophic impairment assessments). The insurer had initially denied entitlement on the grounds to the entire amount on the grounds that the claimant's medical benefits limits had been exhausted, but reversed that position eight months later....

January 24, 2020

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P.V. v. Economical Insurance (19-000069)

The claimant sought reconsideration of the Tribunal's decision that the limitation period applied to his IRB claim. The claimant had continued to work for over three years after the accident, and the insurer had denied entitlement to IRBs during that period because he did not meet the "substantial inability" test. Adjudicator Boyce granted the reconsideration...

January 23, 2020

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G.T. v. The Guarantee Company of North America (18-003334)

The claimant sought a declaration that she was catastrophically impaired as result of the accident due to a 55 percent WPI. The claimant's assessors opined that the claimant had a 67 percent WPI. The insurer's assessors opined that she had a 39 percent WPI. Causation and interpretation of the AMA Guides were in dispute. Adjudicator...

January 22, 2020

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K.L. v. CAA Insurance (19-000029)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to medical benefits and costs of examinations proposed in five treatment plans. Adjudicator Sharma found that the claimant's injuries were predominantly minor and fell within the MIG. Contrary to the claimant's submissions arguing otherwise, Adjudicator Sharma found no compelling evidence...

January 22, 2020

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N.S v. Wawanesa Insurance Company (19-000300)

The claimant sought a determination that her impairments were outside of the MIG and entitlement to medical benefits proposed in two treatment plans. Adjudicator Boyce found that the claimant's psychological and/or neurological impairment took her outside of the MIG, based on the medical opinions of her assessors. The claimant was subsequently found entitled to payment...

January 22, 2020

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S.W. v. Aviva General Insurance (19-002127)

The claimant sought entitlement to IRBs. The insurer argued that the limitation period barred the claim. Adjudicator Boyce concluded that the IRB denial was clear and unequivocal and that the limitation period expired on February 13, 2019, and that the claimant applied to the LAT on February 22, 2019. However, he allowed the claim to...

January 21, 2020

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J.C. v. Intact Insurance Company (18-010894)

The claimant sought entitlement to IRBs. The insurer argued that the limitation period barred the claim. Adjudicator Parish held that the limitation period barred the claim. The insurer's denial was clear and unequivocal, and the limitation period expired May 20, 2016. The LAT application in November 2018 was out of time, and was not saved...

January 17, 2020

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I.L.G. v. Aviva General Insurance Company (18-009010)

The claimant sought removal from the MIG and entitlement to a chronic pain assessment, a neurological assessment, an orthopedic assessment, assistive devices, and interest on the payment of overdue benefits. Adjudicator Grant found that the claimant's injuries were predominantly "minor injuries" and that injuries she suffered later, as a result of a July 21, 2016...

January 17, 2020

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M.Z. v. Aviva Insurance Canada (18-001324)

The claimant sought entitlement to the balance of a chiropractic treatment plan, four other treatment plans, and an award. The claimant argued the balance of the chiropractic treatment plan should be approved because the insurer failed to provide a response within 10 business days pursuant to section 38(3) of the Schedule. The insurer argued that...

January 17, 2020

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R.S. v. Aviva Insurance Canada (18-001324)

The claimant sought a determination that her impairments were outside of the MIG and entitlement to medical benefits proposed in seven chiropractic, attendant care, and psychological treatment plans and assessments. The claimant also argued the MIG limit did not apply to the psychological-based treatment plans, citing the insurer's failure to state in its denial letters...

January 16, 2020

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G.N. v. The Guarantee Company of North America (18-007546)

The claimant sought entitlement to the cost of a capacity assessment and the cost of a court application for guardianship. Adjudicator Ferguson dismissed both claims. He held that the capacity assessment was not payable because it was not incurred within five days of the accident, so the exception at 38(2) did not apply. He also...

January 14, 2020

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S.R. v. Certas Home and Auto Insurance Company (18-006442)

The claimant was deemed catastrophically impaired. He sought entitlement to ongoing HK expenses, and entitlement to the rent differential for a larger rental home. Adjudicator Paluch rejected both claims. While he held that the claimant suffered a substantial inability to perform housekeeping tasks, he also found that the claimant had not incurred expenses related to...

January 14, 2020

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A.K. v. Allstate Insurance (17-008646)

The claimant sought a determination that she suffered a catastrophic impairment. Adjudicator Gosio concluded that the claimant suffered a catastrophic impairment as a result of a Class 4 marked impairment in adaptation. The claimant suffered psychological injuries as a result of the accident, including pain disorder, major depressive disorder, and anxiety disorder with features of...

January 14, 2020

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J.H. v. CUMIS General Insurance Company (18-012367)

The claimant sought a determination that she suffered a catastrophic impairment, entitlement to IRBs, and entitlement to various medical benefits. Adjudicator Gosio held that the claimant did not meet the criteria to suffer a catastrophic impairment. He agreed that the claimant suffered a psychological impairment, but that the maximum impairment was a Class 3 moderate...

January 14, 2020

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K.A. v. Unica Insurance (18-011192)

The claimant sought entitlement to IRBs. The insurer argued that the claimant did not meet any of the criteria for initial entitlement to IRBs. Adjudicator Punyarthi agreed with the insurer, holding that the documentary evidence showed that the claimant was not employed at the time of the accident, was not receiving employment insurance at the...

January 13, 2020

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J.S. v. Aviva Insurance Canada (18-008643)

The claimant sought entitlement to an orthopedic assessment, a chiropractic treatment plan, interest on the payment of overdue benefits, and a special award. Adjudicator Norris found that the disputed orthopaedic assessment plan was not reasonable and necessary; it was a duplication of services as the claimant was previously assessed by an orthopaedic fewer than two...

January 13, 2020

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A.S. v. Aviva Insurance Canada (18-010483)

The claimant sought entitlement to medical benefits proposed in two treatment plants. The insurer raised a preliminary issue on the claimant's late production of evidence. Adjudicator Johal admitted the late disclosure, finding the respondent did not suffer any resulting prejudice. Nevertheless, the claimant was found not entitled to any medical benefits as the treatment plans...

January 13, 2020

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T.A.K. v. Aviva General Insurance Company (18-008232)

The claimant sought entitlement to IRBs, ACBs, and a special award. The claim for IRBs only concerned the weekly quantum. Adjudicator Neilson held that the insurer was entitled to deduct CPP Disability Benefits, and entitled to deduct income reported on the claimant's tax returns which the claimant could not provide documentation for. She was critical...

January 10, 2020

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L.D. v. Aviva Insurance Canada (19-000674)

The claimant sought entitlement to an orthopedic assessment and interest on the payment of overdue benefits. Adjudicator Boyce found that the disputed orthopedic assessment was reasonable and necessary at the time it was requested because the claimant continued to experience pain post-accident and treatment had plateaued. On this basis, Adjudicator Boyce found it reasonable that...

January 10, 2020

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S.M. v. Aviva General Insurance Company (18-010116)

The claimant sought entitlement to the cost of an accounting report related to IRBs. Adjudicator Boyce dismissed the dispute. He held that it was not reasonable and necessary for the claimant to procure an accounting report. The claimant had a single source of income, and was not self-employed. The existence of short-term disability payments did...

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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