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.

September 16, 2021

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M.N. v. Aviva General Insurance (19-001788 and 19-007595)

The claimant sought entitlement to attendant care benefits in the amount of $272.46 per month. Adjudicator Ferguson noted that to be payable, attendant care benefits must be incurred by the claimant, as defined by section 3(7) of the SABS, but the claimant submitted no evidence of same. The claimant relied on section 3(8) of the...

September 16, 2021

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M.N. v. Aviva General Insurance (19-001788 and 19-007595)

The claimant sought entitlement to attendant care benefits in the amount of $272.46 per month. Adjudicator Ferguson noted that to be payable, attendant care benefits must be incurred by the claimant, as defined by section 3(7) of the SABS, but the claimant submitted no evidence of same. The claimant relied on section 3(8) of the...

September 16, 2021

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Samuels v. BelairDirect Insurance Company (20-000929)

The claimant applied to the LAT disputing entitlement to the MIG status and medical/rehabilitation benefits. Concurrently, the insurer sought a repayment of approximately $5,000 in medical benefits paid above the MIG limits. Adjudicator Lake found the insurer was not entitled to the repayment. The claimant applied to two insurers for benefits: BelairDirect and Zenith. After...

September 15, 2021

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Stewart v. Certas Home and Auto Insurance Company (20-004275)

The claimant applied to the LAT seeking entitlement to ACBs and housekeeping expenses. The insurer had determined that the claimant was catastrophically impaired as a result of the accident and that ACBs were reasonable and necessary. The dispute was over the extent of ACBs to be provided and whether housekeeping benefits were reasonable and necessary....

September 14, 2021

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Giannoylis v. Travelers Insurance (20-000280)

The parties agreed that the claimant met the test for IRB entitlement, but disagreed on the quantum of IRBs payable. The claimant worked as a self-employed labourer for a construction business that was owned and operated by his father. Adjudicator Lake found that the claimant's weekly base income under the SABS was $355.58. However, the...

September 14, 2021

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Giannoylis v. Travelers Insurance (20-000280)

The parties agreed that the claimant met the test for IRB entitlement, but disagreed on the quantum of IRBs payable. The claimant worked as a self-employed labourer for a construction business that was owned and operated by his father. Adjudicator Lake found that the claimant's weekly base income under the SABS was $355.58. However, the...

September 13, 2021

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N.M. v. Aviva General Insurance (18-008710 and 18-008717)

The claimant requested reconsideration of the Tribunal's decision which found she was entitled to NEBs in the amount of $185.00 per week up to the two-year mark. The claimant submitted that the Tribunal made a significant error of fact and law when it ordered NEBs payable only up to the two-year mark by using the...

September 13, 2021

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N.M. v. Aviva General Insurance (18-008710 and 18-008717)

The claimant requested reconsideration of the Tribunal's decision which found she was entitled to NEBs in the amount of $185.00 per week up to the two-year mark. The claimant submitted that the Tribunal made a significant error of fact and law when it ordered NEBs payable only up to the two-year mark by using the...

August 31, 2021

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F.C. v. Intact Insurance Company (18-012357)

The claimant was a long haul truck driver taking a load from Brampton to Edmonton. The claimant testified that while driving, a fire started due to overheating of electrical wiring, and he was forced to jump out of the moving truck to prevent personal injuries. The insurer took the position that claimant deliberately set the...

August 30, 2021

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Tsiofa v. Wawanesa Mutual Insurance Company (20-001419)

The issue before the LAT was whether the claimant was involved in an accident. Adjudicator Farlam dismissed the claimant's application finding that the claimant was not involved in an accident as defined by the SABS. The claimant submitted that he sustained physical and psychological injuries when he had to move out of the way of...

August 30, 2021

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Marsh v. Allstate Insurance Company of Canada (20-002936)

The claimant sought removal from the MIG and entitlement to various treatment plans. The insurer argued that the claimant was barred from claiming accident benefits due to section 61 of the SABS. The claimant was employed as a personal support worker at the time of the accident, and was driving from one client to another...

August 27, 2021

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Thring v. Economical Insurance Company (20-000309)

The claimant applied to the LAT seeking entitlement to ACBs and transportation expenses associated with a psychological assessment. The insurer accepted the claimant's entitlement to ACBs prior to denying entitlement base on its own Form 1. Vice-Chair McGee found that ACBs were not payable as the claimant failed to establish that the expenses he claimed...

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...

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Contact Us

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

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Contact Us

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

416.507.1850

eodonnell@tgplawyers.com