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.

December 2, 2021

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Gupta v. TD Insurance Meloche Monnex (19-010353)

The claimant applied to the LAT seeking entitlement to the cost of examinations, post-104 IRBs, ACBs, and a special award. The claimant was involved in a motor vehicle accident in 2016. Her injuries were found to include post-concussion syndrome and chronic pain. She received long-term disability benefits until 2020 (when she received an advance buyout...

December 1, 2021

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Scheltgen v. TD Insurance Meloche Monnex (20-010604)

The preliminary issue in this matter is whether the claimant was barred from commencing a proceeding for IRBs because he failed to comply with s. 44 of the Schedule by not attending an insurer's examination. The insurer submitted that the claimant should be statute-barred from proceeding with his application for failing to provide a reasonable...

December 1, 2021

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Francia v. Licence Appeal Tribunal (2021 ONSC 7847)

The claimant appealed the Tribunal's decision that he was not involved in an accident. He suffered injuries when responding to a fatal collision between a transport truck and tractor-trailer. The claimant was called to the scene to clean up the industrial spill. The fumes from the chemicals caused him to suffer a collapsed lung requiring...

November 29, 2021

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Amoaka v. Aviva Insurance Company of Canada (20-000377)

The claimant sought entitlement to an OCF-18 seeking funding for CAT assessments, submitted by an occupational therapist. The insurer denied the OCF-18 on the basis that since an occupational therapist could not complete an OCF-19, an occupational therapist could not propose CAT assessments. The claimant argued that section 45(2)(1) referred only to the submission of...

November 26, 2021

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Unica Insurance Inc. v. Jeyabalasingam (19-013236)

The insurer sought repayment of three months of IRBs after determining overpayment had been made due to the claimant's return to work. A request for overpayment dated April 10, 2019 was made by the insurer to the claimant and her legal representative by regular mail. The claimant took the position that the request for repayment...

November 26, 2021

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Howe v. The Commonwell Mutual Insurance Company (19-010824)

The claimant sought a determination that she suffered a catastrophic impairment as a result of a 2012 accident, due to psychological impairment, and claimed a special award. She was 15 years old at the time of the accident and had been diagnosed with Autism Spectrum Disorder prior to the accident. The insurer argued that the...

November 25, 2021

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Shen v. Aviva General Insurance Company (20-000662)

The claimant applied to the LAT seeking entitlement to NEBs and chiropractic services proposed in one OCF-18. Pursuant to section 36(4) of the SABS, the claimant argued that the insurer was required to pay for NEBs as a result of a failure to reply to an OCF-3 within 10 days and a failure to provide...

November 25, 2021

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Perrigard v. Primmum Insurance Company (19-010651)

The claimant applied to the LAT disputing entitlement to IRBs and a medical benefit. The insurer brought a preliminary motion arguing that the claimant was barred from proceeding with the dispute as he applied to the LAT more than two years after the denials. Adjudicator Boyce agreed with the insurer and dismissed the claimant's medical...

November 25, 2021

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Travis v. Aviva Insurance Company (20-004822)

This claim arises out of a vehicle attack that occurred in Toronto on April 23, 2018. The claimant, a firefighter, developed psychological impairments after responding to the incident. The insurer denied the application for benefits, arguing that the claimant had not been involved in an accident pursuant to the SABS. The Tribunal agreed with the...

November 25, 2021

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M. A-Y. v. Coachman Insurance (19-001026)

The claimant sought entitlement to an OCF-18 in the amount of $26,919.25 for 12 CAT assessments. Vice Chair Boyce dismissed the claim, finding that the claimant had not demonstrated that the OCF-18 was necessary for the purpose of her CAT application or that the proposed amount of $26,919.25 was a reasonable fee. He noted that...

November 24, 2021

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Foucade v. Coachman Insurance Company (19-005660)

The claimant sought entitlement to IRBs, which the insurer denied based on the findings of IEs. By the time of the hearing, IRBs were no longer an issue in dispute, as the insurer later reinstated IRBs and made a lump sum payment representing the amount withheld. The issue of a special award remained. The claimant...

November 19, 2021

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Crecoukias v. Toronto Transit Commission (19-014590)

This is a LAT motion decision on two issues: (1) The insurer requested an adjournment of the hearing because it underwent a cyber attack and did not have access to internal files, computers, or email; and (2) the claimant requested that the insurer's surveillance evidence be excluded because it was disclosed outside of the timelines...

November 17, 2021

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Foster v. Aviva General Insurance Company (19-014657)

The claimant sought reconsideration of the Tribunal's decision that the CERB / CRB was deductible from IRBs. The insurer agreed with the claimant that the Tribunal's decision was an error. Vice Chair Boyce granted the reconsideration and held that CERB / CRB was not deductible from IRBs because it was not "gross employment income" or...

November 15, 2021

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Pena v. Allstate Insurance Company of Canada (20-007893)

The claimant applied to the LAT disputing entitlement to IRBs. The insurer brought a preliminary motion arguing that the claimant was barred from disputing entitlement due to the two-year limitation period, as the application was made six years after the accident. Adjudicator McGee disagreed and found that the claimant could proceed with his dispute. Adjudicator...

November 8, 2021

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Demers v. Intact Insurance Co. (20-008399)

The claimant was involved in an assault by a motorcyclist and applied for accident benefits as a result. The insurer argued that the claimant had not been involved in an accident as denied by s. 3(1) of the SABS. The Tribunal agreed. Vice Chair Boyce highlighted that unless the vehicle itself is associated with a...

November 5, 2021

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Amrok v. Economic Insurance Company (20-007816)

The claimant was the victim of a physical assault after he had cut off a truck on the highway. The Tribunal found that this incident did not fall within the definition of an accident under the SABS as the claimant had failed to satisfy both the purpose and causation test. The vehicle was not responsible...

November 5, 2021

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Morris v. Aviva General Insurance (19-002717)

The insurer filed a request for reconsideration after the Tribunal previously decided that, among other things, the claimant was entitled to two OCF-18s, plus interest as a result of the insurer's failure to comply with section 38 of the SABS. The insurer argued that the Tribunal had referred to case law not submitted by either...

November 4, 2021

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Boileau v. Aviva Gen. Ins. Co. (20-005804)

The preliminary issue in this matter is whether the claimant was barred from proceeding with his claims because he failed to comply with s. 44 of the Schedule by not attending properly scheduled IEs. The claimant argued that the insurer arranging IEs to address whether the claims were reasonable and necessary was inconsistent with the...

November 2, 2021

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Allen v. Certas Home and Auto Insurance Company (19-014152)

The claimant applied to the LAT disputing her entitlement to NEBs. The insurer raised a preliminary motion arguing that the claimant's dispute was barred by the limitation period, as it was commenced two years after a valid denial. Adjudicator Flude agreed with the insurer and dismissed the claim. The insurer denied the claimant's NEBs on...

October 29, 2021

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Smektala v. TD Insurance Meloche Monnex (20-006086)

The claimant applied for accident benefits following an accident while she was in the course of her employment as a personal support worker. The insurer argued that the claimant was not entitled to claim IRBs because she had elected to receive WSIB. Adjudicator Lake agreed with the insurer, holding that the claimant was not entitled...

October 29, 2021

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Mohamed v. Aviva Insurance Company (2021 ONSC 7175)

The claimant appealed the Tribunal's decision that the limitation period barred her claim for IRBs. The Court dismissed the appeal as the Tribunal did not commit an error of law. The Tribunal applied the correct legal test for determining whether the insurer's denial was sufficient. The Tribunal also exercised it discretion not to extend the...

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Contact Us

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

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Contact Us

150 York Street, Suite 1800
Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com