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 6, 2021

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N.P. v. Wawanesa Mutual Insurance Company (18-010628)

The claimant filed a request for reconsideration of Adjudicator Norris' decision that found the claimant was entitled to a physiotherapy treatment plan but not entitled to a chiropractic treatment plan, nor a second physiotherapy treatment plan. The claimant submitted that Adjudicator Norris made a significant error of law and that he misinterpreted section 38(11). Adjudicator...

December 31, 2020

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Mahoney v. Co-Operators General Insurance Company (19-007708)

The preliminary issue at this hearing was whether the claimant was involved in an "accident" as defined within s. 3(1) of the SABS. The claimant submitted that she was involved in an accident because she was stepping out of her automobile when she slipped on ice and suffered injuries. The claimant's body did not strike...

December 30, 2020

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C.W. v. Jevco Insurance Company ( 18-000790)

This is a reconsideration decision of Adjudicator Shapiro. The insurer requested reconsideration of Adjudicator Shapiro's initial decision wherein he found the claimant entitled to retroactive ACBs with interest. The facts of this case were unusual. The claimant was a pedestrian struck by a vehicle. She did not have her own insurance. The driver of the...

December 30, 2020

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T.H. v. Allstate Insurance Company of Canada (19-004567)

The insurer sought reconsideration of the Tribunal's decision to award two treatment plans. The main argument for reconsideration was that the Tribunal considered an affidavit from the claimant that the insurer did not have an opportunity to cross-examine the claimant on. Adjudicator Paluch granted the reconsideration, holding that the Tribunal violated the rules of procedural...

December 29, 2020

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Chen v. Chubb Insurance Company of Canada (19-008582)

The claimant disputed her entitlement to NEBs, three medical benefits for treatment, and an attendant care assessment. Adjudicator Grant dismissed all of the claims. He found that the claimant was not prevented from engaging in substantially all of the activities in which she ordinarily had prior to the accident. The claimant had not provided a...

December 23, 2020

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M.L. v. The Dominion of Canada General Insurance Company (19-011699)

The claimant requested reconsideration of a preliminary issues decision in which the LAT adjudicator found that the claimant was barred from proceeding with her application for certain benefits because she failed to commence her application within two years of the insurer's refusal to pay the benefits claimed. The claimant submitted that the LAT acted outside...

December 22, 2020

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Namasivayam v. Certas Direct Insurance Company (19-010862)

This was the claimant's second LAT dispute. The claimant sought entitlement to NEBs, removal from the MIG, and various medical benefits. The insurer argued that the claimant could not re-litigate the applicability of the MIG. Adjudicator Farlam agreed with the insurer that the applicability of the MIG was res judicata and that the claimant could...

December 22, 2020

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Gomes v. Aviva General Insurance (19-005653)

The claimant applied to the LAT disputing 10 medical benefits. The claimant and her legal representative failed to attend two case conferences, and the legal representative subsequently removed himself from the record. The LAT issued a Notice of Dismissal to the claimant, and the parties were advised to make written submissions on the Tribunal's intention...

December 21, 2020

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A.M. v. Aviva Insurance Company (19-004182)

The claimant requested reconsideration of the Tribunal's preliminary issue decision barring the claimant from disputing IRBs. Adjudicator Grant dismissed the reconsideration. The claimant submitted that the Tribunal erred in equating the OCF-10 as a request for IRBs for less than the mandated seven working days lost. The claimant submitted the OCF-10 and she did not...

December 21, 2020

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Khashi v. Travelers Insurance Company of Canada (19-005457)

The claimant disputed his MIG determination and entitlement to non-earner benefits. With respect to the MIG, Adjudicator Norris found that the claimant's psychological symptoms were sequelae of minor injuries and did not meet the threshold to warrant removal from the MIG. He noted that the psychological IE assessor's conclusions aligned with the family doctor records,...

December 18, 2020

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Berisha v. Certas Home and Auto Insurance Company (19-012869)

The claimant sought entitlement to medical benefits and interest. The claimant had earlier been accepted as catastrophically impaired. The insurer disputed the overall costs of assessments, which it had partially approved. Vice Chair Boyce concluded the claimant was not entitled to any of the partially denied assessments. The claimant claimed entitlement to the assessor's denied...

December 17, 2020

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A.C. v. Aviva Insurance Canada (19-002793)

The claimant disputed her entitlement to NEBs and brought a claim for a special award. Adjudicator Shapiro found the claimant’s evidence was not consistent with a complete inability to carry on her pre-accident activities, which had been limited by a recent, prior unrelated fall, and did not establish that the motor vehicle accident was the...

December 17, 2020

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Boyle v. Travelers Canada (19-014423)

The claimant was a witness to a fatal motor vehicle accident. He applied for accident benefits based on claims of psychological impairments as a result of rushing to the scene to assist following the collision. The insurer determined that the claimant was not an "insured" who was "involved" in an "accident" under s. 3(1) of...

December 17, 2020

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Jones v. Aviva Insurance Canada (19-013768)

The insurer requested reconsideration of a preliminary issue hearing in which the Tribunal found that the claimant's application for a non-earner benefit was not barred pursuant to section 56 of the SABS. Vice Chair McGee dismissed the insurer's request for reconsideration, on the basis that Rule 18 of the LAT Rules provides that the Tribunal...

December 16, 2020

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T.P. v. Wawanesa Insurance Company (18-003718)

The claimant sought entitlement to IRBs. Adjudicator Boyce found that the claimant was not entitled to payment of IRBs as he did not demonstrate that he met the substantial inability test. While the adjudicator accepted that the claimant was not working during the period in dispute, the claimant failed to provide any objective medical evidence...

December 15, 2020

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Sniderman v. Aviva Insurance Company (19-006657)

Prior to the accident the claimant worked in two jobs. The parties agreed that she was self-employed with respect to a bridal boutique company. The parties disagreed on whether the claimant was employed or self-employed with respect to a television and stereo repair shop owned and run by her husband. Adjudicator Johal concluded that the...

December 15, 2020

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Mohamud v. Certas Home and Auto Insurance Company (19-005153)

The claimant disputed entitlement to four treatment plans for various assessments and assistive devices, and a special award. The insurer raised a preliminary issue, claiming that the disputed dental assessment was barred by the limitation period. The insurer denied the plan on April 6, 2017, provided a clear and unequivocal denial and warned of the...

December 14, 2020

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Salim v. Aviva General Insurance (19-006944)

The claimant was involved in a serious accident. He was skateboarding and was hit by a vehicle and suffered nasal, left elbow, pelvic, and sacral fractures, and psychological injuries. The claimant applied to the LAT disputing entitlement to NEBs, ACBs, and the full cost of partially approved medical benefits. Adjudicator Farlam dismissed the claimant's dispute...

December 14, 2020

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Nash v. Aviva General Insurance Company (19-010799)

The claimant sought entitlement to IRBs. The insurer brought a preliminary motion to strike evidence found in the claimant's document brief, arguing that the evidence was hearsay of unproven allegations and irrelevant to the matters to be determined at the hearing. Adjudicator Farlam dismissed the insurer's motion, stating that evidence is rarely excluded prior to...

December 14, 2020

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Halstead v. Aviva Insurance Company (19-01394)

The claimant sought a medical benefits in the amount of $12,341.56 proposing that the insurer pay the cash difference between her old vehicle, a 2016 Volkswagen Jetta, and a new vehicle, a 2017 Hyundai Tucson, which was a larger and more spacious SUV. The claimant and her treating OT argued that the new vehicle was...

December 11, 2020

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Rattan v. Aviva Insurance Company (19-006304)

The claimant applied to the LAT disputing his entitlement to three medical benefits and interest. The insurer argued that the doctrine of res judicata prevented the claimant from re-litigating his entitlement to two of the disputed benefits, which the LAT had dismissed in a previous decision. Adjudicator Grant agreed with the insurer that res judicata...

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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