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 25, 2021

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Kane v. Aviva Insurance Company (20-006995)

The insurer partially approved a treatment plan for psychological treatment because the recommendation was made by a psychotherapist, who was an unregulated provider under the Professional Services Guideline, and therefore was subject to the hourly rate of $99.75 as opposed to the $149.61 per hour rate claimed. Adjudicator Boyce found that the claimant was not...

June 25, 2021

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Aslivo v. Aviva Insurance Canada (19-004717)

The claimant applied to the LAT seeking a special award and entitlement to interest on two lump sum payments of IRBs made by the insurer. The insurer sought repayment of an overpayment of IRBs. Vice Chair Flude began the analysis by stating: "While the Schedule has been characterized as consumer protection legislation and should be...

June 24, 2021

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Rodionova v. Aviva Insurance Company (19-012116)

The insurer initially denied four treatment plans because it believed that the MIG applied and the treatment plans proposed treatment outside of the MIG. Section 38(5) provides that the insurer may refuse to accept a non-MIG treatment plan during the period that the claimant is entitled to receive treatment under the MIG. The claimant submitted...

June 24, 2021

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Montesano v. Western Assurance Company (19-006780)

The claimant was smoking a cigarette on her driveway as she was walking towards her house and tripped and fell forward striking her face against the rear bumper of her SUV before falling on the ground. The insurer argued that the claimant was not involved in an "accident". Adjudicator Boyce dismissed the insurer's motion found...

June 24, 2021

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Illangeswaran v. Sonnet Insurance Company (19-013643)

The insurer raised a preliminary issue, arguing that the claimant's claim was barred pursuant to section 55 of the SABS because she failed to submit a completed OCF-1 until more than a year and a half after the accident. Both parties agreed that the claimant failed to comply with the time limit set out in...

June 24, 2021

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Green v. Intact Insurance Company (19-013031)

The claimant sought reconsideration of the Tribunal's decision that the SABS did not provide for funding of multidisciplinary IRB reports. Vice Chair McGee rejected the reconsideration, finding no error in law. She noted that nothing prevented the claimant from responding to the insurer's IE reports, but that he had to do so at his own...

June 22, 2021

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Edwards v. Wawanesa Mutual Insurance Company (19-009437)

The preliminary issue in this matter was whether the claimant was barred from proceeding with a claim for IRBs because he failed to commence his application within two years after the insurer's refusal to pay the amount claimed. Adjudicator Farlam concluded that the application was statute barred and dismissed the application. Section 7 of the...

June 22, 2021

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Abadicio v. Economical Insurance Company (20-000099)

The claimant sought removal from the MIG and entitlement to three assessments. The insurer sought repayment of $7,120 in IRBs. Adjudicator Farlam held that the claimant failed to prove that she did not suffer a minor injury. She also concluded that the insurer was entitled to repayment of IRBs. The claimant had returned to work...

June 21, 2021

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Cargnelli v. Aviva Insurance Company (20-001892)

The claimant applied disputed his entitlement to NEBs, two medical benefits, interest, and a special award. Adjudicator Boyce dismissed the NEBs claim, awarded the two medical benefits plus interest, and awarded a 10 percent special award with respect to the medical benefits. With respect to NEBs, Adjudicator Boyce noted that while according to Heath a...

June 17, 2021

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Haines v. Aviva Insurance Company of Canada (20-003388)

The claimant was involved in an accident in 2016 and found catastrophically impaired in 2020. The insurer denied entitlement to ACBs in 2016, and refused to reconsider entitlement to ACBs after the catastrophic impairment finding. The insurer argued that the claimant's 2020 LAT application for ACBs was barred by the limitation period. Vice Chair Boyce...

June 16, 2021

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Madore v. Intact Insurance Company (20-000703)

The claimant was on the roof of his trailer checking the roof in preparation for a road trip when he fell off the roof and suffered significant injuries. The insurer brought a motion arguing that the claimant was not involved in an accident. Adjudicator Grant agreed with the insurer. Adjudicator Grant accepted that the incident...

June 16, 2021

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Subaskaran v. RSA Insurance (20-000368)

The insurer sought repayment for IRBs in the amount of $9,028 on the basis that the claimant returned to work and materially misrepresented his return to work status. Adjudicator Farlam found in favour of the insurer. The claimant admitted on cross-examination during the hearing that he worked as a taxi driver during the time in...

June 15, 2021

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Fratarcangeli v. North Blenheim Mutual Insurance Company (2021 ONSC 3997)

The Divisional Court considered three LAT decisions addressing section 7 of the LAT Act, to determine whether the Tribunal had the power to extend the two-year limitation period. The Court held that the LAT Act did grant the Tribunal the power to extend the limitation period and upheld two of the decisions in which the...

June 11, 2021

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Dankha v. Aviva Insurance Company (19-009569)

The claimant applied to the LAT seeking removal from the MIG, entitlement to three treatment plans, and a special award. Prior to the LAT hearing, the insurer removed the claimant from the MIG and approved all the treatment plans, so the only issue at the hearing was whether the claimant was entitled to a special...

June 11, 2021

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Basuric v. Dominion of Canada General Insurance Company (20-007187)

The insurer raised a preliminary issue, arguing that the claimant's claim was barred pursuant to section 55 of the SABS because she failed to notify the insurer of her intention to apply for accident benefits until over three years after the accident. Both parties agreed that the claimant failed to comply with the time limit...

June 10, 2021

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Travelers Insurance Company of Canada v. Matich (19-008573)

The insurer applied to the LAT seeking repayment of IRBs. The claimant did not participate in the hearing. Adjudicator Grant found the evidence established the insurer paid the claimant an IRB during a period when the claimant had returned to work and had failed to notify the insurer of same. The insurer relied upon statements...

June 9, 2021

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Polis v. Aviva General Insurance (20-000025)

The claimant sought entitlement to IRBs and ACBs. Adjudicator Kaur found that the claimant did not suffer a substantial inability to perform the tasks of her pre-accident employment as a result of the subject accident. The claimant was not working at the time of the accident due to a prior workplace injury, and her family...

June 9, 2021

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A.B. v. The Co-Operators Insurance Company (19-004401)

The claimant applied to the LAT seeking entitlement to benefits after being involved in an automobile accident in 2016. The insurer raised two preliminary issues: 1) Was the claimant statue-barred from proceeding with a claim for NEBs for failure to commence the application within the two year limitation period; and 2) Was the claimant entitled...

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...

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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