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.

October 18, 2021

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Chen and Chen v. Travelers Insurance Company of Canada (20-007653 and 20-007658)

The claimants' daughter was involved in an accident in Ontario. The claimants resided in China at the time. They moved to Canada to assist their daughter with her recovery. They applied for accident benefits under the daughter's policy. The insurer argued that the claimants were not insured persons at the time of the accident. Adjudicator...

October 15, 2021

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Frymus v. Aviva Insurance Canada (19-000055)

The claimant applied to the LAT for entitlement to ACBs. Vice-Chair McGee found that the claimant failed to prove entitlement to ACBs for the relevant time period. It was undisputed that the claimant was entitled to attendant care directly following the accident. At issue before the Tribunal was whether the claimant submitted appropriate proof of...

October 13, 2021

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Dooley v. Aviva General Insurance (20-006951)

The insurer filed a Notice of Motion seeking a ruling that the claimant was precluded from proceeding with his application with respect to IRBs from the date of the loss to 104 weeks post-accident because the claimant failed to submit a Disability Certificate (OCF-3) supporting entitlement. Adjudicator Mazerolle agreed with the insurer and concluded that...

October 12, 2021

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Amare v. Economical Insurance Company (19-004635)

The claimant applied to the LAT seeking entitlement to accident benefits. A preliminary issues hearing was held to determine whether the claimant was involved in an accident, as defined in the SABS. The claimant said that his Samsung mobile phone spontaneously exploded in his pocket while he was driving, and that he hit his head...

October 7, 2021

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

The claimant brought a motion for interim benefits, including attendant care benefits at $6,000 per month. The claimant argued that it had been 2.5 years since he was denied the benefits in dispute. The insurer had inadvertently delayed providing catastrophic impairment IE reports for 7 months and post-104 IRB IE reports for 9 months. The...

October 7, 2021

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Nguyen v. Economical Insurance Company (20-006171)

The self-represented claimant was involved in a motor vehicle accident in 2003. In 2018, FSCO denied the claimant's claims for caregiver benefits and NEBs and awarded costs against the claimant, which she did not pay. The claimant later submitted claims for a CAT determination, NEBs, ACBs, and housekeeping benefits, which the insurer denied. The claimant...

October 7, 2021

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Ababio v. TD Insurance Meloche Monnex (20-001415)

The insurer denied IRBs effective March 12, 2019, but paid the claimant in error. The insurer requested repayment from the claimant under section 52 of the SABS. The claimant did not repay the requested amount, stating he was unable to work since the subject accident, and only began to work again in January 2020. The...

October 5, 2021

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Fahritdinov v. Aviva General Insurance (19-009897)

The claimant sought entitlement to NEBs and ACBs. Adjudicator Norris concluded that the claimant was not entitled to the benefits claimed. The claimant sustained injuries to his neck, shoulder, back, and knee as a result of the accident and required surgical intervention. Adjudicator Norris found that while the claimant may have experienced some changes to...

October 5, 2021

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Phillip v. Intact Insurance Company (20-000674)

The claimant was injured in an accident and sought benefits including IRBs from the insurer. The insurer denied the claimant's IRBs relying on the s. 31(1) exclusion based on the claimant failing to notify the insurer of his change of address from Brantford to Toronto and therefore, intentionally failing to disclose a material change in...

October 5, 2021

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Millar v. The Cooperators General Insurance Company (2021 ONSC 6643)

The insurer appealed the Tribunal's decision that the claimant was an insured person under its policy as a "dependant". A LAT hearing on the benefits was scheduled for six months later. The Divisional Court dismissed the appeal as being premature because the claimant's status as an insured person was only a preliminary matter that the...

October 1, 2021

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Kfouri v. TD General Insurance Company (19-006916)

The claim arose out of a dispute for the appropriate quantum for IRBs. The claimant argued that she was employed, rather than self-employed, at the time of the accident and that her IRB payments should be calculated based on employment income. The insurer argued that according to the claimant's tax returns she was actually self-employed...

September 27, 2021

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Villegas v. Travelers Canada (20-007827)

The claimant disputed the MIG determination and entitlement to chiropractic treatment outside of the MIG. The claimant argued that he had pain in his neck, back, and shoulder, as well as psychological symptoms that justified removal from and treatment beyond the MIG. Vice Chair Boyce dismissed the application. The physical injuries identified in the OCF-3...

September 27, 2021

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Villegas v. Travelers Canada (20-007827)

The claimant disputed the MIG determination and entitlement to chiropractic treatment outside of the MIG. The claimant argued that he had pain in his neck, back, and shoulder, as well as psychological symptoms that justified removal from and treatment beyond the MIG. Vice Chair Boyce dismissed the application. The physical injuries identified in the OCF-3...

September 27, 2021

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Ratnam v. Primmum Insurance Company (19-006706)

The claimant sought a determination that he suffered a catastrophic impairment due to a 2014 accident. He had already been found to suffer a catastrophic impairment from a 2011 accident. The insurer argued that the 2014 accident did not cause an exacerbation of the claimant's impairments, and argued that the claimant was not credible. Vice...

September 23, 2021

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Rios v. Chieftain Insurance (20-009779)

The claimant applied to the LAT seeking entitlement to accident benefits. A preliminary issues hearing was held to determine: (1) whether the claimant was disentitled to accident benefits because he did not have a reasonable explanation for failing to comply with the time limit imposed by s. 32(1) of the SABS, and (2) whether the...

September 21, 2021

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Carter v. Aviva Insurance Company of Canada (19-013446)

The insurer filed a Notice of Motion seeking to stay the claimant's application, alleging that the claimant failed to participate in a neuropsychological insurer's examination meant to assess his entitlement to IRBs. The insurer's request for a neuropsychological assessment was made after the claimant submitted his own neuropsychological assessment. The insurer corresponded with the claimant's...

September 20, 2021

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Young v. Cumis General Insurance Company (20-002837)

The claimant had attended a vehicle dealership to pick a van that she and her spouse had purchased. Construction was underway in the dealership parking lot. The claimant exited the dealership and proceeded towards her van, which was located by a sidewalk. As the claimant walked to the van to open its door, she slipped...

September 20, 2021

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

The claimants were out for a walk with their spouses when a member of their group, a close relative, was struck by a motor vehicle in a pedestrian accident. The claimants, who were uninsured, applied for accident benefits under the driver's policy, claiming emotional shock and psychological distress. Adjudicator Norris had previously ruled that the...

September 20, 2021

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Aviva Insurance Company of Canada v. Suarez (2021 ONSC 6200)

The insurer appealed the Tribunal's decision awarding four treatment plans for chiropractic therapy, two as reasonable and necessary, and two others due to non-compliant section 38 notices. The insurer argued that because the claimant had not received the treatment, she was not permitted to apply to the LAT. The Court rejected the insurer's position, holding...

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...