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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August 26, 2020

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B.S. v. Aviva Insurance Canada (19-001828)

The claimant sought removal from the MIG and entitlement to physiotherapy and two assessments. Adjudicator Maleki-Yazdi found that the claimant's injuries fell outside of the MIG and that the claimant was entitled to all three treatment plans. Additionally, she concluded that the insurer's section 38 notices were deficient. All three denials were similarly worded and...

August 26, 2020

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A.G.S. v. Echelon General Insurance Company (18-001994)

The claimant was a fetus in utero at the time of the accident and born prematurely four days after the accident. She was diagnosed with cerebral palsy as a result of her premature birth. The insurer initially paid accident benefits based on a medical opinion, but subsequently questioned causation based on an opinion of an...

August 25, 2020

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D.L. v. Aviva Insurance Canada (19-001860)

The claimant sought entitlement to CAT assessments totalling more than $26,000, as well as four treatment plans for passive physical therapy, and a psychological assessment. Vice Chair Farlam rejected the claims. While accepting that assessments are speculative in nature, the claimant failed to prove that there was any reasonable basis to investigate whether the he...

August 21, 2020

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M.V. v. Aviva General Insurance Company (18-011523)

The claimant sought entitlement to IRBs and removal from the MIG. Vice Chair Farlam concluded that the claimant was not entitled to IRBs and that his injuries fell within the MIG. The medical evidence provided showed only soft tissue injuries, and insufficient objective evidence was led regarding chronic pain or psychological impairment. There were also...

August 21, 2020

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N.V. v. Allstate Insurance Company of Canada (18-008774)

The claimant sought reconsideration of the Tribunal's decision that the limitation barred the IRB claim and that section 7 of the LAT Act should not apply to extend the limitation period. Adjudicator Boyce rejected the reconsideration request. He held that no error was made by the Tribunal in concluding that the insurer's denial was clear...

August 21, 2020

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N.V. v. Allstate Insurance Company of Canada (18-008774)

The claimant sought reconsideration of the Tribunal's decision that the limitation barred the IRB claim and that section 7 of the LAT Act should not apply to extend the limitation period. Adjudicator Boyce rejected the reconsideration request. He held that no error was made by the Tribunal in concluding that the insurer's denial was clear...

August 20, 2020

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S.W. v. Aviva General Insurance Company (19-002127)

The insurer sought reconsideration of the Tribunal's decision to allow the claimant to extend the limitation period under section 7 of the LAT Act. The insurer argued that the Tribunal did not have jurisdiction to extend the limitation period, or alternatively, that the facts of the case did not warrant the extension. Adjudicator Boyce dismissed...

August 19, 2020

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B.A. v. Economical Mutual Insurance Company (18-005968)

The insurer denied the claim for IRBs pursuant to section 31(1)(b), arguing that the claimant had made a material misrepresentation that induced the insurer to enter into the contract. In particular, the claimant allegedly misrepresented her address for the purpose of obtaining a lower premium. As a preliminary issue, the claimant sought to exclude audio...

August 17, 2020

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H.K.C. v. Aviva Insurance Company (18-011956)

The insurer sought reconsideration of the Tribunal's decision that a formal psychological diagnosis was not required for removal from the MIG. Adjudicator Johal dismissed the reconsideration. She found no error in the Tribunal's decision and noted that the Supreme Court's decision in Saadati v Moorhead supported the conclusion. She also rejected the insurer's argument that...

August 17, 2020

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F.C. v. Aviva Insurance Canada (18-001359)

The insurer sought reconsideration of the Tribunal's decision awarding NEBs and a treatment plan for failure to comply with sections 36 and 38, respectively. Adjudicator Boyce dismissed the reconsideration. He held that Stranges v Allstate was not good law in relation to the current version of the SABS, which required payment of NEBs until a...

August 17, 2020

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P.M. v. Aviva General Insurance (18-009518)

The insurer was paying the claimant IRBs for over a year after the accident when it suspended IRBs due to the claimant's failure to obtain necessary treatment and in providing relevant information under section 33 (the status of recommended psychological treatments and the updated clinical notes and records from the family physician). IRBs were reinstated...

August 17, 2020

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M.L. v. Unifund Assurance Company (19-009999)

The claimant applied to the LAT seeking IRBs following her 2015 accident. She had returned to work after the accident, and the insurer denied entitlement to IRBs. After the 104 week mark, the claimant stopped working and submitted an Election to the insurer claiming IRBs. The insurer again denied IRBs, arguing that IRBs had been...

August 17, 2020

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M.O. v. Jevco Insurance Company (19-003520)

The minor claimant was involved in an accident in 2002. Only in 2016 did the claimant apply for accident benefits when he retained his current counsel (his former counsel sent a tort action letter to the insurer in 2014, but did not make an accident benefits claim.) Around three months after the AB application, the...

August 17, 2020

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R.T. v. Aviva General Insurance (19-007347)

The claimant sought entitlement to IRBs and further physiotherapy treatment. Adjudicator Watt dismissed both claims. He held that the claimant failed to submit evidence that would prove that pain prevented her from returning to work. He also noted that the claimant was self-limiting in assessments and that objective testing showed full ranges of motion. The...

August 14, 2020

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N.Z. v. Economical Insurance (18-009611)

The self-employed claimant disputed entitlement to IRBs, which the insurer was not paying because it had requested further income documentation which the claimant failed to provide. The insurer had suspended IRBs under section 33 until the claimant complied with the requests. As a preliminary matter, Adjudicator Mazerolle allowed the insurer to submit late surveillance reports...

August 14, 2020

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A.Q. v. Wawanesa Mutual Insurance Company (19-006903)

The claimant sought entitlement to ACBs and various medical benefits. The insurer argued that the limitation period barred the ACBs claim and that the claimant failed to attend IEs related to the medical benefits claimed and was unable to dispute entitlement until attending the IEs. Adjudicator Boyce held that the insurer's denial of ACBs in...

August 14, 2020

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A.D.W. v. Aviva Insurance Company (18-012150)

The claimant sought entitlement to NEBs and one treatment plan for physiotherapy. Adjudicator Watt dismissed both claims. The claimant did not provide evidence of the comparison of his pre-accident and post-accident life. Further, the claimant admitted to doctors that he was independent with personal care, gardening, cooking, and yard work. With regard to physical treatment,...

August 13, 2020

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A.M. v. Aviva General Insurance Company (19-004182)

The claimant sought entitlement to IRBs. The insurer argued that the limitation period applied. Adjudicator Grant agreed with the insurer and dismissed the claim. He found that the insurer clearly and unequivocally denied IRBs in January 2017 when she returned to work. The LAT application was filed in April 2019. Adjudicator Grant did not extend...

August 13, 2020

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C.G. v. The Guarantee Company of North America (17-007300)

The claimant had a number of pre-accident injuries and impairments. She suffered an exacerbation of her conditions in the accident. She sought entitlement to NEBs, removal from the MIG, and two assessment costs. The insurer argued that the claimant's impairments were not caused by the accident. Adjudicator Johal accepted that the accident did cause an...

August 13, 2020

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M.R. v. Aviva General Insurance Company (18-006946)

The claimant sought payment of treatment plans seeking chiropractic treatment and a chronic pain program. The claimant argued that some of the denials were non-compliant with section 38 of the SABS. The insurer argued that some of the treatment plans were denied more than two years after the denial and were time barred. Adjudicator Norris...

August 13, 2020

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C.G. v. The Guarantee Company of North America (17-007300)

The claimant had a number of pre-accident injuries and impairments. She suffered an exacerbation of her conditions in the accident. She sought entitlement to NEBs, removal from the MIG, and two assessment costs. The insurer argued that the claimant's impairments were not caused by the accident. Adjudicator Johal accepted that the accident did cause an...

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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