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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October 8, 2019

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Motor Vehicle Accident Claims Fund v. I.G. (18-000798)

The Fund sought repayment of IRBs and medical benefits, arguing that the claimant was not employed at the time of the accident and was not involved in a motor vehicle accident as claimed. Adjudicator Makhamra accepted that the claimant had committed a wilful misrepresentation. A few years after initially making the accident benefits claim, the...

October 7, 2019

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D.M. v. Aviva General Insurance Company (18-003850)

The claimant sought entitlement to three medical benefits. The insurer approved the treatment plans shortly after written submissions were due. Adjudicator Norris held that interest was also payable on the treatment plans from the date of the LAT application onwards.

October 7, 2019

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B.H. v. Certas Home and Auto Insurance Company (17-006967)

The insurer sought reconsideration of the Tribunal's decision that the denial letter for a psychological assessment was deficient and that the insurer was barred from applying the MIG; the assessment was also found reasonable and necessary. Vice Chair Lester dismissed the reconsideration. She held that the Tribunal had not violated the rules of procedural fairness...

October 4, 2019

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E.G. v. Wawanesa Insurance (18-010183)

The claimant sought removal from the MIG and entitlement to two medical benefits. Adjudicator Grant concluded that the claimant suffered minor injuries. There was no evidence of pre-existing conditions, psychological impairments, or chronic pain syndrome.

October 4, 2019

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W.P. v. Travelers Insurance (18-010458)

The claimant sought removal from the MIG and entitlement to two medical benefits. Adjudicator Grant concluded that the claimant suffered minor injuries. There was no evidence of impairments falling outside of the MIG definition.

October 3, 2019

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P.V. v. Aviva Insurance Company (18-009130)

The claimant sought entitlement to nine assessments in relation to a catastrophic impairment determination. The insurer approved four (an orthopaedic assessment, an occupational therapy assessment, a psychiatry assessment, and a WPI rating); it denied five other assessments. Adjudicator Boyce accepted that each assessment had to be reasonable and necessary for the completion of the OCF-19...

October 3, 2019

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T.A. v. Aviva General Insurance Company (18-006820)

The claimant sought entitlement to NEBs, ACBs, three medical benefits, and a special award. Adjudicator Lake awarded NEBs for just under two years, denied ACBs, awarded the cost of psychological treatment plan, and granted a special award of 25 percent on NEBs and the psychological assessment. NEBs were awarded because the insurer failed to properly...

October 2, 2019

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D.T. v. Wawanesa Mutual Insurance Company (18-005613)

The claimant sought entitlement to IRBs, the MIG, and various medical benefits. The insurer argued that the claimant's entitlement to IRBs had already been decided and was res judicata. The Tribunal had already adjudicated an application for IRBs (among other things), which was upheld on reconsideration and at the Divisional Court. There was no new...

October 2, 2019

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K.P. v. Security National Insurance Company (18-007561)

The claimant sought removal from the MIG and entitlement to various medical benefits. Adjudicator Sharda found that the claimant failed to prove that her injuries fell outside of the MIG. There was little evidence of psychological impairment causing a loss of functional ability.

October 2, 2019

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J.A. v. Aviva Insurance Company (18-005595)

The claimant sought removal from the MIG and entitlement to three treatment plans and two assessments. Adjudicator Grant concluded that the claimant suffered from psychological injuries which was not a minor injury. He awarded the proposed psychological assessment, but rejected the proposed treatment plans for physical therapy and the proposed attendant care assessment.

October 2, 2019

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J.A. v. Aviva General Insurance Company (18-008207)

The claimant sought removal from the MIG and entitlement to two medical benefits. Adjudicator Grant found that the claimant suffered from minor injuries. He rejected the argument that the claimant suffered from chronic pain syndrome because there was no evidence of the claimant having impaired functionality.

October 2, 2019

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J.V. v. TD Insurance Meloche Monnex (18-008337)

The claimant disputed his entitlement to IRBs, but had not submitted a Disability Certificate. The insurer argued that the failure to submit an OCF-3 barred the claim from proceeding. Adjudicator Ferguson agreed with the insurer and barred the dispute from proceeding. He held that section 36 created a strict requirement to provide an OCF-3. Section...

October 2, 2019

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J.G. v. Co-operators General Insurance Company (18-012430)

The claimant sought entitlement to NEBs. The insurer argued that the limitation period barred the dispute. Adjudicator Boyce agreed with the insurer. He concluded that while the denial of NEBs could be considered "pre-emptive" it was still a valid denial, following the Court of Appeal's decisions in Bonaccorso and Sietzema. The insurer's post-denial conduct in...

October 2, 2019

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Applicant v. Certas Direct Insurance Company (17-008853)

The claimant sought removal from the MIG, and entitlement to ACBs and various medical benefits. The insurer argued that the claimant was barred from proceeding to a hearing due to his failure to attend an IE addressing attendant care benefits. Vice Chair Helt concluded that the claimant was not barred from proceeding with his claim...

September 30, 2019

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G.J. v. Aviva General Insurance Company (18-006663)

This preliminary issue hearing was brought to determine whether the claimant was statute barred from proceeding with his appeal of a number of medical benefits and expenses because he did not submit treatment plans before incurring the expenses, and because he did not attend an IE that the respondent had determined was necessary for it...

September 30, 2019

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G.M.K. v. Aviva Insurance Company of Canada(18-009487)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to a psychological assessment. Adjudicator Manigat concluded that the claimant's injuries fell within the MIG. The claimant relied on a section 25 psychological report, in which he was diagnosed with PTSD and Major Depressive Disorder. The respondent relied on a...

September 26, 2019

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Applicant v. Certas Direct Insurance Company (18-000563)

The minor claimant sought a catastrophic impairment determination following an accident in which he sustained a concussion and developed behavioural disorders, including post-traumatic stress disorder and obsessive-compulsive disorder. Adjudicator Daoud found that the claimant suffered a Class 4 Marked Impairment in adaptation as a result of his injuries. She accepted the evidence of the claimant's...

September 26, 2019

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G.R. v. Travelers Canada (18-007870)

The claimant sought entitlement to attendant care benefits. Adjudicator Watt dismissed the claim. He held that the claimant had failed to submit a Form 1, that she had not incurred and attendant care expenses, and that she did not require attendant care services from a medical perspective.

September 24, 2019

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E.M. v. The Guarantee Company of North America(18-000674)

The claimant sought entitlement to non-earner benefits and the cost of multidisciplinary non-earner assessments. Adjudicator Punyarthi found that the evidence at the hearing supported the overall finding that the relevant impairments in the claimant's life were not caused by the subject accident. The claimant had significant pre-existing physical and psychological impairments, and was also involved...

September 24, 2019

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B.M. v. Allstate Insurance (18-008410)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to a chronic pain assessment. Adjudicator Maleki-Yazdi concluded that the claimant's injuries fell outside of the MIG due to chronic pain, and that the claimant was entitled to the cost of the chronic pain assessment. The claimant continued to reported...

September 23, 2019

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J.E. v. Intact Insurance Company (18-011314)

The claimant sought entitlement to two treatment plans proposing a psychological assessment and a physiatry assessment. Adjudicator Boyce concluded that neither cost of examination was payable, noting that the claimant had already received approval for a slate of nine catastrophic impairment examinations. As such, the examinations were duplicative, and not reasonable and necessary.

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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