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.

June 8, 2021

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Hardy-MacDonald v. Wawanesa Mutual Insurance Company (20-005392)

The preliminary issue in this matter was whether the claimant was barred from commencing a proceeding because she failed to comply with Section 44 of the Schedule by not attending insurer's examinations. Adjudicator McGee dismissed the application due to the claimant's failure to attend the IEs. The claimant submitted that she was not required to...

June 7, 2021

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Amani v. Certas Home and Auto Ins. (19-013741)

A preliminary issue hearing was held to address whether the claimant was barred from proceeding with her claim for ACBs and NEBs due to failure to commence an application within the two year limitation period. Vice-Chair Boyce determined that the application for ACBs was not properly before the Tribunal but that an exercise of discretion...

June 3, 2021

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Asher v. Wawanesa Mutual Insurance Company (19-013046)

A preliminary issue hearing was held to address whether the claimant was barred from proceeding with her claim for IRBs due to failure to commence an application within the two year limitation period. The claimant submitted that the insurer was estopped from arguing that the limitation period and the legislation ought to be construed in...

June 2, 2021

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Shpati v. Travelers Canada (19-008988)

The claimant disputed the insurer's determination that her injuries fell within the MIG, as well as her entitlement to various medical/rehabilitation benefits. The claimant made no submissions and made no reference to any evidence of a non-MIG injury, but rather made a broad claim that all of the insurer's denials failed to comply with section...

June 1, 2021

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Z.R. v. Certas Direct Insurance Company (18-001468)

The claimant sought reconsideration of the Tribunal's decision that he did not suffer a catastrophic impairment under section 3.1(1)(5)(i), which requires positive findings of a traumatic brain injury on a CAT scan, MRI, or other medically recognized brain diagnostic technology. Adjudicator Gosio rejected the reconsideration. The claimant did not make any arguments regarding the French...

May 28, 2021

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A.H. v. Unica Insurance Inc. (18-012320)

The claimant applied for reconsideration of the Tribunal's decision that he was not entitled to IRBs because he was not employed at the time of the accident. The claimant was scheduled to start a job two weeks after the accident. Because of the accident, he was unable to start the job. Adjudicator Grieves dismissed the...

May 28, 2021

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Munro v. Belair Direct (19-013690)

The claimant suffered a catastrophic impairment in an accident that resulted in the death of his son. He sought entitlement to various medical benefits, including nursing services, a meditation system, a portable modulation stimulator device, naturopathic treatment, an ozone generator device, and an infrared sauna. Some of the claimed services were submitted on an OCF-6....

May 28, 2021

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Amiri and Mireskandari v. The Co-operators (20-003296 & 20-003319)

The claimants made a claim for accident benefits following an incident in which they witnessed a vehicle strike a close family member (spouse and father-in-law, respectively). The incident was only a few feet in front of the claimant. The claimants heard the collision and witnessed the aftermath. The claimant alleged that they suffered psychological injuries....

May 26, 2021

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Solanes v. Aviva General Insurance (20-001140)

The claimant sought entitlement to ACBs, and the cost of two assessments. Adjudicator Chakravarti denied entitlement to all claimed benefits. ACBs were stopped at the 104 week mark, so the claimant could not claim ACBs unless she sustained a catastrophic impairment. The claimant failed to provide the Tribunal with the disputed treatment plans, so the...

May 26, 2021

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Hines v. TD Insurance Meloche Monnex (19-006324)

The claimant disputed entitlement to IRBs. The insurer sought repayment of IRBs paid to date due to the exclusion barring IRB entitlement when a person is operating an uninsured vehicle (section 31(1)(a)(i)). Adjudicator Farlam dismissed the IRB claim and ordered the claimant to repay all IRBs due to the exclusion. She held that the claimant...

May 26, 2021

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Strickland v. Economical Insurance (20-001811)

The claimant disputed entitlement to various medical benefits. The insurer argued that the dispute was barred due to the claimant's IE non-attendance. Adjudicator Chakravarti held that the dispute could proceed because the IE notice was not in accordance with section 44. The denial of benefits was generic and did not explain why benefits outside the...

May 25, 2021

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Li v. Allstate Insurance (19-004738)

The claimant sought entitlement to IRBs, two treatment plans for physical and psychological therapy, and a special award. Vice Chair Boyce dismissed the claims. The claimant failed to provide sufficient information proving that she was employed at the time of the accident. The Record of Employment suggested that she quit her job a few days...

May 25, 2021

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E.L. v. Wawanesa Mutual Insurance Company (19-003212)

The claimant sought reconsideration of the Tribunal's decision that his IE non-attendance barred the LAT dispute. Adjudicator Makhamra dismissed the reconsideration, holding that the Tribunal properly considered whether the claimant was barred by section 55 from disputing the MIG and the disputed treatment plan. However, Adjudicator Makhamra noted that the decision did not bar the...

May 25, 2021

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A. G.-B. v. Unica Insurance Inc. (19-003153)

The claimant sought payment for accounting invoices related to calculating IRBs. The insurer argued that the accounting report was not reasonable or necessary for calculating IRBs. Vice Chair McGee found the accounting report costs were not payable. The claimant had only one source of income, and the IRB calculation required a simple deduction for short-term...

May 25, 2021

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Abou Hussini v. Travelers Insurance (19-002005)

The claimant sought entitlement to IRBs, removal from the MIG, and various medical benefits. Adjudicator Reilly dismissed all the claims. She held the claimant failed to prove that his accident-related injuries were non-minor, or that she suffered a pre-existing condition that would prevent maximal recovery under the MIG. She found that the allegations of chronic...

May 25, 2021

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J.T. v. Primmum Insurance Company (18-009043)

The claimant sought reconsideration of the Tribunal's decision that he did not suffer a catastrophic impairment, and that his injuries fell within the Minor Injury Guideline. He argued that the Tribunal acted outside of its jurisdiction or violated rules of procedural fairness. Vice Chair Maedel found no error on the part of the Tribunal. The...

May 25, 2021

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Omere v. The Commonwell Mutual Insurance Group (20-007753)

The insurer sought reconsideration of the Tribunal's refusal to decide an IE non-attendance defence upon the claimant's Notice of Withdrawal. Vice Chair Maedel dismissed the reconsideration. Once the claimant withdrew her LAT application, there were no matters in dispute between the parties. The IE non-attendance defence was moot and could not be decided by the...

May 21, 2021

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Manikam v. Aviva Insurance Canada (19-006126)

The claimant sought entitlement to a special award following payment of NEBs after the Case Conference. The insurer admitted that there was a two month initial delay of payment of NEBs. There was also a failure to provide IE reports within 10 days of receipt. A seven month delay in providing the IEs was due...

May 20, 2021

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Dominion of Canada General Insurance Company v. Ridi (2021 ONSC 3707)

The insurer appealed the Tribunal's decision that HST on attendant care benefits is payable above the $6,000 monthly maximum and that HST payments do not come out of the attendant care benefit limits. The Divisional Court allowed the appeal and reversed the Tribunal's decision. The Court held that prior to the June 3, 2019 amendments,...

May 20, 2021

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Habte v. Aviva General Insurance Company (19-008941)

The claimant was injured in a 2017 accident. She applied to the LAT in 2019 disputing, among other things, NEBs. The insurer argued that the failure to submit an OCF-3 within the first 104 weeks barred the claim for NEBs. Adjudicator Lake dismissed the NEBs claim as it was not made in a timely fashion....

May 20, 2021

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Weathers v. Toronto Transit Commission Insurance Company Limited (20-006288)

In 2000, when the claimant was seven years old, he injured his knee while on a TTC bus. The claimant's mother applied for NEBs on his behalf. The OCF-3 submitted by the claimant's family physician did not support entitlement to NEBs. In 2001, the TTC sent correspondence to the claimant stating that NEBs were not...

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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