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.

August 24, 2021

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Brule v. Intact Insurance Company (20-001905)

The preliminary issue in this matter was whether the claimant was statute barred from proceeding with her claim pursuant to section 56 of the Schedule. Adjudicator Makhamra found that the claimant was not statute barred from proceeding with her claim for IRBs. The insurer initially terminated the claimant's entitlement to the benefit based on multidisciplinary...

August 18, 2021

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P.M. v. Aviva General Insurance (19-002717)

The insurer requested reconsideration of a decision that awarded the claimant two treatment plans as a result of the insurer's non-compliance with sections 38(8) and 38(9). The insurer submitted that the Adjudicator erred in law by vitiating its right to "cure" its deficient notices regarding the treatment plans submitted under section 38(11) even after the...

August 12, 2021

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Catic v. Aviva General Insurance (19-005572)

The claimant requested reconsideration of a decision in which the Tribunal found that the claimant was not entitled to the cost of a psychological assessment because it was not reasonable and necessary, despite the insurer's denial not complying with section 38. The claimant argued that the applicable consequences set out in section 38(11) required the...

August 11, 2021

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Robertson v. Coseco Insurance Company (20-004779)

The insurer argued that the claim for NEBs was barred by the limitation period. The claimant argued that a June 2017 denial was not valid because she had not submitted an OCF-3 before the denial. However, the denial did follow receive the OCF-1 and a telephone conversation in which the claimant and the insurer discussed...

August 10, 2021

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Sandola v. Travelers Insurance (20-000648)

The claimant sought entitlement to various medical and rehabilitation benefits. At the case conference, the parties resolved the claimant's claim for all past, present, and future medical and rehabilitation benefits for $848.51, which was the remaining amount of benefits available under the claimant's policy limits. The only issue that remained in dispute was the claim...

August 6, 2021

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H.L. (By Her Litigation Guardian) v. Economical Insurance Company (20-002966)

The claimant was involved in an accident in 2014. The insurer determined that she was catastrophically impaired in 2018. The claimant received attendant care services from a hired attendant care services provider for the period of July 2014 to March 2020. Due to the COVID pandemic, after March 2020 the claimant's family decided to have...

August 6, 2021

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Parameswaralingam v. Echelon General Insurance Company (19-005907)

The claimant applied to the LAT disputing entitlement to IRBs and a special award. The insurer argued that the claimant was barred from claiming accident benefits based on section 61. The claimant conceded that he was working at the time of the accident, but argued that he was not entitled to benefits from WSIB and...

August 3, 2021

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Tipping v. Coseco Insurance Company (2021 ONSC 5295)

The claimant sought judicial review of the Tribunal's decision that he failed to attend properly requested IEs and that he could not proceed with his dispute relating to a catastrophic impairment. The Court dismissed the judicial review, holding that the claimant ought to have pursued a statutory right of appeal under the Insurance Act, and...

July 29, 2021

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Kipfer v. Belair (19-012008)

The insurer raised a preliminary issue, arguing that the claimant's injuries did not arise out of the use or operation of an automobile and therefore did not meet the definition of an "accident" as defined by section 3(1) the SABS. The claimant drove to pick her brother up from a party, where she was verbally...

July 28, 2021

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Johnson v. Jevco (2021 ONSC 4870)

The insurer appealed the Tribunal's reconsideration decision which concluded that the motorcycle operated by the claimant was insured under its policy as a ""newly acquired automobile"". The claimant had purchased the motorcycle 11 days before the accident, but did not notify the insurer until one month after the purchase. The ""newly acquired automobile"" provision of...

July 27, 2021

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Ahmed v. Aviva Insurance Company (19-999565)

The insurer brought a motion to dismiss the LAT application as abandoned; the claimant opposed the motion, and sought costs in response. The claimant was 64 years old, visually impaired, and did not speak English. The Case Conference took place on April 1, 2020. The written hearing was scheduled for November 30, 2020. In a...

July 20, 2021

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Kosiner v. Economical Insurance Company (19-007787)

This is a reconsideration decision. The claimant was self-represented. He attended the case conference and settled his file with Economical, which was confirmed in writing. Over one year later, the claimant filed a Notice of Motion to set aside the settlement and raised issue with the fact that Economical would not renew his insurance policy....

July 19, 2021

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Spiegel v. Intact Insurance Company (20-000279 & 20-000408)

Intact requested a preliminary issue hearing as the claimant failed to attend insurer examinations. Intact requested that two issues for medical benefits be barred from dispute pursuant to section 55. The claimant was involved in two accidents which were joined into a single matter for the purpose of the preliminary issues hearing. The two disputed...

July 19, 2021

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Hamad v. Travelers Insurance (19-014581)

A preliminary issue hearing was held to determine whether the claimant was barred from proceeding with her claim for NEBs and medical benefits after failure to submit to an insurer's examination under section 44 of the SABs. The claimant submitted an OCF3 supporting an entitlement to NEBs but containing no medical evidence. The insurer requested...

July 14, 2021

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A.H. v. Aviva Insurance Canada (19-004639)

The claimant applied to the LAT seeking entitlement to IRBs and medical benefits. Vice-Chair McGee found that the claimant failed to meet the substantive test for IRBs. The claimant submitted that under s. 36 of the SABS the insurer was required to pay IRBs for a five-month period because the insurer failed to request insurer...

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...

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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