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.

October 27, 2021

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Sonnet Insurance Company v. Mitchell (20-006073)

The insurer alleged that the claimant made material misrepresentations about her involvement in an accident. On receipt of the medical records and after an EUO, the insurer determined the claimant was not involved in a motor vehicle accident, but had sustained injuries as a result of a fall down a flight of concrete stairs while...

October 26, 2021

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Belanger v. Intact Insurance Company (19-013755)

The insurer argued that the claimant was precluded from proceeding to a hearing on the basis that the claimant's dispute was statute barred pursuant to s. 55 of the Schedule. Adjudicator Manigat concluded that the claimant's application for IRBs could proceed and that it was not statute barred. A denial of a benefit by an...

October 25, 2021

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Parker v. Aviva Gen. Ins. Co (19-010703)

The claim arose out of a dispute as to the appropriate quantum for IRBs. Prior to the accident, the claimant held both a full-time and a part-time employment position. She submitted two OCF-2s. The parties disagreed as to the appropriate calculation for the part-time income. The insurer calculated IRBs using the claimant's income for the...

October 22, 2021

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Ganea v. Travelers Insurance (19-012901)

The claimant and the insurer each sought a preliminary issue to answer the following question: was the insurer's request for an OCF-10 and an IE prior to starting IRB payment in accordance with s. 36 of the SABS? Adjudicator Gosio agreed with the insurer that its request for an OCF-10 and an IE prior to...

October 22, 2021

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Mirzaie v. Wawanesa Mutual Insurance Company (19-009605)

The claimant suffered a catastrophic impairment. He sought the purchase of a home for $1.277 million as a rehabilitation benefit. The insurer argued that the claimant failed to prove that a new home was reasonable and necessary, and that the claimant failed to consider the value of modifications to his existing home. Adjudicator Gosio agreed...

October 22, 2021

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Fariad v. Intact Insurance Company (2021 ONSC 6965)

The claimant appealed the Tribunal's decision that he was not involved in an accident. He had been driving an Uber and asked his passengers to leave due to unruly behaviour. After getting out the vehicle, a passenger struck the vehicle. The claimant sped away. He alleged suffering emotional and psychological injuries due to the incident....

October 21, 2021

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Gilani v. Travelers Insurance Company of Canada (19-009248)

A motion was brought by the claimant seeking an order for a contempt hearing because the insurer's occupational therapist failed to attend the hearing to give evidence. The hearing was commenced March 9, 2021 and the IE occupational therapist witness was called by the claimant. Two Summons to Witness were obtained on February 19 and...

October 20, 2021

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Vaillancourt v. Intact Insurance Company (19-009063)

The claimant was injured in an accident and sought benefits including IRBs. The insurer denied the claimant's IRBs based on the claimant not having proper insurance in place to access those benefits relying on the s. 31(1)(a)(i) exclusion for operation of an uninsured vehicle. Adjudicator Chakravarti concluded that the s. 31(1)(a)(i) exclusion did not apply....

October 19, 2021

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Micu v. The Personal Insurance Company (20-006746)

The claimant sought entitlement to attendant care benefits in the amount of $3,079.00 per month. At issue in the hearing was whether the claimant: (a) had proven that she incurred expenses for attendant care, and (b) the service provider sustained an economic loss due to providing attendant care services. The claimant submitted that her partner...

October 19, 2021

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tgp-admin

Micu v. The Personal Insurance Company (20-006746)

The claimant sought entitlement to attendant care benefits in the amount of $3,079.00 per month. At issue in the hearing was whether the claimant: (a) had proven that she incurred expenses for attendant care, and (b) the service provider sustained an economic loss due to providing attendant care services. The claimant submitted that her partner...

October 19, 2021

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Nadarajah v. Aviva General Insurance Company (20-009520)

The insurer filed a motion requesting that the Tribunal strike the claimant's reply submissions, contending that the claimant had split his case and provided new submissions in his reply, which prevented the insurer from responding. The insurer argued that is was not only improper but contrary to procedural fairness, and the insurer sought permission to...

October 18, 2021

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Chen and Chen v. Travelers Insurance Company of Canada (20-007653 and 20-007658)

The claimants' daughter was involved in an accident in Ontario. The claimants resided in China at the time. They moved to Canada to assist their daughter with her recovery. They applied for accident benefits under the daughter's policy. The insurer argued that the claimants were not insured persons at the time of the accident. Adjudicator...

October 15, 2021

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Frymus v. Aviva Insurance Canada (19-000055)

The claimant applied to the LAT for entitlement to ACBs. Vice-Chair McGee found that the claimant failed to prove entitlement to ACBs for the relevant time period. It was undisputed that the claimant was entitled to attendant care directly following the accident. At issue before the Tribunal was whether the claimant submitted appropriate proof of...

October 13, 2021

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Dooley v. Aviva General Insurance (20-006951)

The insurer filed a Notice of Motion seeking a ruling that the claimant was precluded from proceeding with his application with respect to IRBs from the date of the loss to 104 weeks post-accident because the claimant failed to submit a Disability Certificate (OCF-3) supporting entitlement. Adjudicator Mazerolle agreed with the insurer and concluded that...

October 12, 2021

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Amare v. Economical Insurance Company (19-004635)

The claimant applied to the LAT seeking entitlement to accident benefits. A preliminary issues hearing was held to determine whether the claimant was involved in an accident, as defined in the SABS. The claimant said that his Samsung mobile phone spontaneously exploded in his pocket while he was driving, and that he hit his head...

October 7, 2021

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Gilani v. Travelers Insurance Company of Canada (19-009248)

The claimant brought a motion for interim benefits, including attendant care benefits at $6,000 per month. The claimant argued that it had been 2.5 years since he was denied the benefits in dispute. The insurer had inadvertently delayed providing catastrophic impairment IE reports for 7 months and post-104 IRB IE reports for 9 months. The...

October 7, 2021

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Nguyen v. Economical Insurance Company (20-006171)

The self-represented claimant was involved in a motor vehicle accident in 2003. In 2018, FSCO denied the claimant's claims for caregiver benefits and NEBs and awarded costs against the claimant, which she did not pay. The claimant later submitted claims for a CAT determination, NEBs, ACBs, and housekeeping benefits, which the insurer denied. The claimant...

October 7, 2021

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tgp-admin

Ababio v. TD Insurance Meloche Monnex (20-001415)

The insurer denied IRBs effective March 12, 2019, but paid the claimant in error. The insurer requested repayment from the claimant under section 52 of the SABS. The claimant did not repay the requested amount, stating he was unable to work since the subject accident, and only began to work again in January 2020. The...

October 5, 2021

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Fahritdinov v. Aviva General Insurance (19-009897)

The claimant sought entitlement to NEBs and ACBs. Adjudicator Norris concluded that the claimant was not entitled to the benefits claimed. The claimant sustained injuries to his neck, shoulder, back, and knee as a result of the accident and required surgical intervention. Adjudicator Norris found that while the claimant may have experienced some changes to...

October 5, 2021

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tgp-admin

Phillip v. Intact Insurance Company (20-000674)

The claimant was injured in an accident and sought benefits including IRBs from the insurer. The insurer denied the claimant's IRBs relying on the s. 31(1) exclusion based on the claimant failing to notify the insurer of his change of address from Brantford to Toronto and therefore, intentionally failing to disclose a material change in...

October 5, 2021

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Millar v. The Cooperators General Insurance Company (2021 ONSC 6643)

The insurer appealed the Tribunal's decision that the claimant was an insured person under its policy as a "dependant". A LAT hearing on the benefits was scheduled for six months later. The Divisional Court dismissed the appeal as being premature because the claimant's status as an insured person was only a preliminary matter that the...

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

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

416.507.1850

eodonnell@tgplawyers.com