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.

July 14, 2021

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Duval v. Aviva General Insurance (20-001990)

The claimant disputed entitlement to $1,030.84 in monthly attendant care benefits, treatments plans for cannabis and an orthopaedic mattress, interest, and a special award. Aviva initially accepted the Form 1 and paid attendant care invoices as they were submitted. Aviva then denied attendant care based on an orthopaedic assessment and Form 1. The claimant argued...

July 14, 2021

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Northbridge Personal Insurance Corporation v. Robinson (19-009743)

The claimant suffered injuries which rendered him paraplegic while attempting to load a GMC Sierra truck onto a trailer in order to move it to another location to be repaired. The trailer was attached to a Dodge truck driven by one of the claimant's friends. The insurer sought a determination of whether the incident met...

July 14, 2021

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Kyrylenko v. Aviva Insurance Canada (2021 ONSC 4929)

The claimant appealed the Tribunal's decision that he was not entitled to payment for benefits related to two treatment plans that the insurer had failed to respond to within 10 business days. Despite the language of section 38(11), the Tribunal considered whether the medical benefits were reasonable and necessary, and whether the MIG applied and...

July 14, 2021

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Ali v. Aviva Insurance Company of Canada (19-013677S)

The claimant submitted that the insurer failed to comply with its obligations under section 38(8) regarding its notices that denied the disputed treatment plans. Adjudicator Lake found that the insurer's response letter failed to provide any specific details about the claimant's condition that formed the basis of its decision, and failed to provide an explanation...

July 12, 2021

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

A motion was brought by the claimant for an order to add additional witnesses (the current claims adjuster and the case manager) and to allow the filing and use of certain documents from the OT's updated records requested by the insurer to be admitted into evidence. The motion to add the two additional witnesses was...

July 12, 2021

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P.P. v. Wawanesa Mutual Insurance Company (18-000957)

The claimant sought reconsideration of the Tribunal's decision that he did not suffer a catastrophic impairment and that he was not entitled to IRBs. With regard to the catastrophic impairment, he argued that the Tribunal erred in not counting 3 percent WPI for medication and 18 percent WPI for a potential future operation. Adjudicator Flude...

July 9, 2021

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Manoharan v. Allstate Canada (19-010782)

Allstate filed for reconsideration of the Tribunal's decision which Vice-Chair Boyce ruled in the claimant's favour and awarded her interest on the incurred amounts of three treatment plans and various other benefits. Allstate argued that Vice-Chair Boyce erred in fact and law in relation to section 38 and section 51, and that no interest was...

July 9, 2021

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Lo v. Allstate Insurance Company of Canada (20-003717)

The claimant sought entitlement to a special award in relation to a physiotherapy treatment plan, arguing that the insurer had "ample evidence as to the existence of the impairments she suffered." The claimant further submitted that the refusal was unreasonable and caused a substantial delay in the claimant's ability to access treatment that was recommended...

July 7, 2021

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Snagg v. Certas Home and Auto Insurance Company (20-003642)

A preliminary issue hearing was held to address whether the claimant was barred from proceeding with his claim for NEBs due to failure to submit a completed OCF-3. The claimant submitted an OCF3 which endorsed that he did not meet the test for NEBs. The insurer subsequently denied NEBs which led to the claimant commencing...

July 5, 2021

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Richards v TD General Insurance Company (20-001799)

The claimant was injured in an accident on December 2, 2016 and applied for benefits. The insurer denied the claim for NEBs. The preliminary issue for the Tribunal was whether the policy of insurance was entered into or renewed before June 1, 2016 such that the claimant would have access to the pre-June 1, 2016...

July 2, 2021

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Carpizo v. Co-operators General Insurance Company (20-007999)

A preliminary issue hearing was held to address whether the claimant was entitled to payment of NEBs until the substantive hearing based on the insurer's failure to comply with section 36 of the SABS. Adjudicator Farlam found that the claimant was not entitled to the payment of NEBs until the substantive hearing and that the...

June 30, 2021

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Sadni v. Allstate Canada (20-000670)

The claimant applied for accident benefits following a motorcycle accident. The insurer argued that the motorcycle was not insured at the time of the accident, and that section 31 applied to bar entitlement to IRBs. Adjudicator Boyce agreed with the insurer that the motorcycle was not insured, and that the claimant was not entitled to...

June 29, 2021

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S.B.S. v. Wawanesa Mutual Insurance Company (17-006935)

The claimant filed a request for reconsideration arising out of Adjudicator Neilson's decision that he was not entitled to IRBs or the cost of a psychological treatment plan. Adjudicator Neilson dismissed the request. At the initial hearing, the claimant brought a motion to exclude the insurer's experts' reports on the basis that the insurer failed...

June 29, 2021

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Malitskiy v. Unica Insurance Inc. (2021 ONSC 4603)

The claimant appealed the LAT reconsideration in which the Tribunal held that he was only entitled to ACBs calculated by using the Form 1 hourly rate multiplied by the time received for each service (rather than the full Form 1 amount of $6,000), and the Tribunal's decision that the claimant was not entitled to a...

June 29, 2021

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Liao v. Aviva General Insurance (19-004856)

The claimant applied to the LAT seeking entitlement to IRBs and a treatment plan proposing chiropractic treatment. The claimant submitted that she attempted to return to work after the April 2016 accident but ceased working in August 2016 due to accident-related impairments. The insurer argued that the claimant was not entitled to IRBs because she...

June 25, 2021

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Kane v. Aviva Insurance Company (20-006995)

The insurer partially approved a treatment plan for psychological treatment because the recommendation was made by a psychotherapist, who was an unregulated provider under the Professional Services Guideline, and therefore was subject to the hourly rate of $99.75 as opposed to the $149.61 per hour rate claimed. Adjudicator Boyce found that the claimant was not...

June 25, 2021

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Aslivo v. Aviva Insurance Canada (19-004717)

The claimant applied to the LAT seeking a special award and entitlement to interest on two lump sum payments of IRBs made by the insurer. The insurer sought repayment of an overpayment of IRBs. Vice Chair Flude began the analysis by stating: "While the Schedule has been characterized as consumer protection legislation and should be...

June 24, 2021

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Rodionova v. Aviva Insurance Company (19-012116)

The insurer initially denied four treatment plans because it believed that the MIG applied and the treatment plans proposed treatment outside of the MIG. Section 38(5) provides that the insurer may refuse to accept a non-MIG treatment plan during the period that the claimant is entitled to receive treatment under the MIG. The claimant submitted...

June 24, 2021

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Montesano v. Western Assurance Company (19-006780)

The claimant was smoking a cigarette on her driveway as she was walking towards her house and tripped and fell forward striking her face against the rear bumper of her SUV before falling on the ground. The insurer argued that the claimant was not involved in an "accident". Adjudicator Boyce dismissed the insurer's motion found...

June 24, 2021

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Illangeswaran v. Sonnet Insurance Company (19-013643)

The insurer raised a preliminary issue, arguing that the claimant's claim was barred pursuant to section 55 of the SABS because she failed to submit a completed OCF-1 until more than a year and a half after the accident. Both parties agreed that the claimant failed to comply with the time limit set out in...

June 24, 2021

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Green v. Intact Insurance Company (19-013031)

The claimant sought reconsideration of the Tribunal's decision that the SABS did not provide for funding of multidisciplinary IRB reports. Vice Chair McGee rejected the reconsideration, finding no error in law. She noted that nothing prevented the claimant from responding to the insurer's IE reports, but that he had to do so at his own...

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Contact Us

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

416.507.1850

eodonnell@tgplawyers.com

© 2020 Thomas Gold Pettingill LLP