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 28, 2021

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Jama v. Unifund (20-005328)

The insurer brought a preliminary issue hearing seeking an order that the claimant was not entitled to receive an IRB pursuant to section 57, which outlines an insured person's responsibility to pursue reasonable, necessary, and available forms of treatment if the insured person continues to receive a weekly benefit, such as an IRB. Adjudicator Mazerolle...

January 28, 2021

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Zhao v. Allstate Canada (20-000134)

The claimant filed a LAT application seeking entitlement to an attendant care assessment, various other treatment plans, and an award under Regulation 664. The claimant's hearing submissions noted that the dispute over medical benefits other than the attendant care assessment were resolved prior to the hearing. While the case conference order referenced a claim for...

January 26, 2021

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G.W.R. v. Commonwell Mutual Insurance (19-002647)

The claimant applied to the LAT disputing entitlement to four treatment plans. The insurer raised a preliminary issue that the disputed treatment plans were barred from litigation under section 55 of the SABS due to the claimant's failure to attend section 44 IE assessments to address the disputed issues without a reasonable explanation. In response,...

January 26, 2021

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Terrio v. Aviva General Insurance (20-000524)

The claimant disputed entitlement to NEBs. The claimant had a number of pre-existing health conditions. The claimant's affidavit indicated that she was independent prior to the accident, had managed her various medical conditions well, and was looking for employment. Adjudicator Farlam found that the documentary evidence did not prove the claimant's position. The medical records...

January 22, 2021

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Hastings v. Royal Sun Alliance insurance (20-001485)

The claimant sought entitlement to two treatment plans, including chiropractic services and physiotherapy. Adjudicator Mazerolle found that the claimant was not entitled to payment for either of the disputed treatment plans. The claimant alleged that the treatment plans were not denied within the ten-day timeline required by section 38(8) and that the insurer relied on...

January 22, 2021

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Delagrammatikas v. Aviva General Insurance (19-013365)

The claimant sought entitlement to a treatment plan for dietician services, a treatment plan for physiotherapy, a rehabilitation benefit for rehabilitation support worker services, and interest. The claimant submitted that he gained weight after the accident which has been a barrier to his recovery. The parties disagreed as to the amount of weight the claimant...

January 21, 2021

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Manoharan v. Allstate Canada (19-010782)

The claimant sought entitlement to various medical benefits, which the insurer had denied based on the MIG. At the LAT case conference, the insurer removed the claimant from the MIG and approved some of the treatment plans. At the LAT hearing, the claimant disputed entitlement to one treatment plan plus interest on the previously approved...

January 21, 2021

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Drew v. Travelers Insurance Company of Canada (20-007200)

This is a motion decision made prior to a written preliminary hearing that was scheduled to determine whether the claimant was barred from proceeding with her application to the LAT pursuant to section 55 of the SABS for failure to submit an OCF-1 in accordance with section 32. The insurer filed the motion after the...

January 20, 2021

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H.V. v. Certas Direct Insurance Company (18-008349)

The claimant sought a catastrophic impairment based on a Class 4 Marked Impairment in adaptation. Vice Chair Marzinotto rejected the claimant's position, and concluded that he did not suffer a catastrophic impairment. She began by noting that a comparison of the claimant pre-accident and post-accident over a long period should be considered, rather than the...

January 19, 2021

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Budhram v. Aviva General Insurance (19-014428)

The claimant sought entitlement to two treatment plans, including massage therapy and a chronic pain assessment. Adjudicator Lake found that the claimant was entitled to a portion of the remaining amount for the massage therapy, but was not entitled to the chronic pain assessment. The claimant submitted that the insurer failed to comply with its...

January 19, 2021

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N.M. v. Aviva Insurance Canada (18-008710)

The claimant was involved in two accidents. He sought entitlement to NEBs for the second accident, and sought various medical benefits for both accidents. Adjudicator Paluch held that the claimant was entitled to NEBs up to the two-year mark because the insurer failed to properly stop entitlement. The insurer had stopped payment of NEBs after...

January 19, 2021

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Jones v. The Co-operators (19-013271)

The claimant applied to the LAT seeking entitlement to IRBs and medical benefits outside of the MIG. At the outset of the hearing, the claimant sought to change his claim for IRBs to a claim for NEBs. Claimant's current counsel advised the LAT that he had not received the claimant's file from a former counsel,...

January 18, 2021

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A.G. v. Allstate Insurance Company of Canada (19-003687)

A preliminary issue hearing was held to determine whether the claimant was barred from proceeding with appealing a claim for neurological assessment that was denied because the claimant was past the two year limitation period. The claimant relied on section 7 of the LAT Act to allow for an extension of time to file an...

January 18, 2021

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Rohile v. Intact Insurance Company (19-009857)

The claimant disputed his entitlement to a partially approved OCF-18 for psychological treatment. The only issue between the parties was the hourly rate for the service provider for the psychological services. The insurer approved the treatment plan at the rate of $99.75 per hour. The claimant argued that the service provider, who was a social...

January 18, 2021

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Alassal v. Co-Operators General Insurance Company (20-004648)

A preliminary issue hearing was held to determine whether the claimant was barred from proceeding with her application for failure to comply with the time limits imposed section 32 of the SABS. The claimant submitted her application nearly 11 months post-accident, despite multiple requests from the insurer for an OCF-1. The claimant's explanation at the...

January 15, 2021

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Manuel v. Certas Direct Insurance Company (19-008341)

The claimant disputed her entitlement to IRBs. The insurer agreed that the claimant was entitled to pre-104 week IRBs and so the central issue in the dispute was whether the insurer could deduct Employment Insurance (EI) maternity benefits and the employer's ""top up"" benefits from the IRB payment. Adjudicator Grant found that the insurer was...

January 15, 2021

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Ramlal v. Aviva General Insurance (19-011325)

The claimant sought to be removed from the MIG and sought entitlement to three treatment plans and the cost of an orthopaedic assessment. Adjudicator Hines concluded that the claimant sustained a minor injury, but was entitled to payment for the disputed treatment plans if they had been incurred prior to receiving proper notice from the...

January 15, 2021

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Sookram v. Zenith Insurance Company (19-012732)

The claimant sought entitlement to NEBs, and seven medical benefits for various treatment and assessments. Adjudicator Watt dismissed all of the claims, holding that the claimant failed to prove entitlement. With regard to the NEB claim, Adjudicator Watt also noted that the claimant was employed at the time of the accident, and that he did...

January 15, 2021

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S.B v. Aviva General Insurance Company (19-004142)

The claimant disputed entitlement to NEBs. The claimant outlined the activities that were important to him before the accident, such as caregiving and spending time with his grandchildren, fishing, hunting with his father and camping. The claimant had a number of pre-existing health issues, but was still able to participate in these activities. As a...

January 15, 2021

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Walcott v. Aviva General Insurance (19-007910)

The claimant sought entitlement to three treatment plans for chiropractic services, one treatment plan for psychological services, and a catastrophic impairment assessment. Adjudicator Grieves noted that given the time elapsed before the claimant reported any accident-related complaints, and that there were only three entries relating to the accident despite seeing her family physician very frequently,...

January 14, 2021

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Verschuren v. the Personal Insurance Company (20-003677)

The claimant was involved in a serios motorcycle accident and was determined to be catastrophically impaired by the insurer. The claimant submitted a treatment plan for a home modification assessment by Adapt-Able Design in the amount of $9,217.40. The insurer partially approved the assessment in the amount of $2,200. The claimant applied to the LAT...

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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