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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May 16, 2019

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D.M. v. Wawanesa Mutual Insurance Company (18-003314)

The claimant was catastrophically impaired as a result of a motorcycle accident. He sought entitlement to $6,000 per month in ACBs and entitlement to further physiotherapy. Adjudicator Hines awarded $3,047.29 per month in ACBs. The primary dispute was whether the claimant required 24/7 care. The adjudicator concluded that the claimant did not require 24/7 care....

May 15, 2019

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A.R. v. Certas Direct Insurance Company (18-005035)

The claimant sought entitlement to IRBs; the insurer argued that the claimant failed to attend an IE. Adjudicator Johal concluded that the claimant was barred from proceeding with the LAT dispute until attending an IE. Although the claimant was justified in not attending the initially scheduled IE based on a note from his family doctor,...

May 15, 2019

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M.G. v. Intact Insurance Company (17-008078)

The only issue in dispute regarded payment of an accounting report. The insurer had requested an oral hearing; the Tribunal ordered that the matter be heard in writing. The insurer sought reconsideration. Adjudicator Jovanovich held that the Tribunal had not violated the rules of natural justice. The Tribunal had considered the "efficient, proportional, and timely...

May 15, 2019

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F.C. v. Intact Insurance Company (18-005079)

The claimant had applied to the Tribunal for accident benefits, and commenced an action for property damage in the Superior Court. The insurer alleged that the claimant had committed material misrepresentations, and sought a stay of the LAT proceedings until the Superior Court decision was rendered or a preliminary hearing addressing the material misrepresentations. The...

May 14, 2019

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S.M. v. Aviva General Insurance Company (17-008818)

Vice-Chair Helt dismissed the insurer's request for reconsideration. The insurer alleged that the LAT violated the rules of natural justice and procedural fairness and made significant errors of law. The parties had agreed upon a document exchange deadline. The claimant brought a motion following the deadline, requesting an opportunity to file an affidavit. The LAT...

May 14, 2019

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M.K. v. Aviva Insurance Canada (18-001128)

The claimant sought entitlement to the balance of a partially approved psychological assessment. Adjudicator Punyarthi held that the claimant was not entitled to the remaining balance as there was no evidence substantiating the claimant's entitlement. The adjudicator specifically noted that the treatment plan at issue was vague and unparticularized, and there was no justification as...

May 14, 2019

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C.S. v. Certas Home and Auto Insurance (18-003463)

The claimant was injured in an icy parking lot. She was a few feet from her vehicle when she slipped and fell. She applied for accident benefits. The insurer denied coverage on the basis that the incident was not an "accident" under the SABS. Adjudicator Ferguson concluded that the facts of loss were not an...

May 14, 2019

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J.M. v. Aviva General Insurance (17-007215)

The insurer sought reconsideration of the Tribunal's decision that catastrophic impairment assessments are payable outside of the medical benefits limits. Vice Chair Flude held that the Tribunal's decision did not contain a significant error of law, and was correct. He concluded that earlier FSCO decisions addressing the same issue were correct, and that catastrophic impairment...

May 14, 2019

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P.K. v. Certas Direct Insurance Company (18-003184)

The claimant twice adjourned a hearing, and then failed to attend the rescheduled hearing. The insurer sought a dismissal of the application. Adjudicator Parish granted the dismissal on the basis the claimant had abandoned the claim.

May 13, 2019

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A.A. v. Unifund Assurance Company (18-008999)

The insurer raised a preliminary issue and argued that the claimant's attendant-care benefit appeal was statute-barred. Adjudicator Ferguson held that the ACB claim was not barred, as the insurer had not provided the claimant with an unequivocal denial at least 2 years prior to the appeal. In November 2012, the insurer initially advised the claimant...

May 13, 2019

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W.H. v. Allstate Insurance (18-004037)

The claimant sought entitlement to three treatment plans for further physical therapy, assistive devices, and a chronic pain treatment program. Adjudicator Boyce awarded some of the assistive devices and denied the remainder of the claim. He held further physical therapy was not reasonable and necessary for the claimant's impairment, and that the proposed chronic pain...

May 10, 2019

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N.F. v. North Blenheim Mutual Insurance Company (16-002606)

The claimant sought reconsideration of the Tribunal's decision that he was barred from seeking entitlement to certain benefits due to the limitation period. In particular, he argued that section 7 of the LAT Act applied in extending the time by which he had to apply to the LAT. Vice Chair Kershaw granted the reconsideration and...

May 10, 2019

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A.F. v. North Blenheim Mutual Insurance Company (16-002336)

The claimant sought reconsideration of the Tribunal's decision that he was barred from seeking entitlement to certain benefits due to the limitation period. In particular, he argued that section 7 of the LAT Act applied in extending the time by which he had to apply to the LAT. Vice Chair Kershaw granted the reconsideration and...

May 10, 2019

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G.S. v. Aviva General Insurance Company (17-004847)

The insurer sought reconsideration of the Tribunal's decision that the claimant's injuries fell outside of the MIG due to chronic pain. Vice Chair Mather dismissed the reconsideration and held that the Tribunal had not made a significant error in law and had not violated the rules of natural justice. The Tribunal had considered the medical...

May 10, 2019

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T.T. v. Aviva Insurance Company (17-002535)

The insurer sought reconsideration of the Tribunal's award of $300 in costs related to the failure to comply with production of documents. Vice Chair Kershaw granted the reconsideration. She held that the Case Conference Order did not provide a disclosure deadline for the production of documents, so the insurer was not in breach by delivering...

May 9, 2019

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V.M. v. Aviva General Insurance Company (17-007475)

The claimant sought reconsideration of the Tribunal's decision denying a claimed assessment. Vice Chair Barry denied the reconsideration, holding that the claimant failed to provide particulars as to the error in fact or law. Further, the reconsideration request was made outside of the time frame for making the request.

May 9, 2019

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N.R. v. Aviva Insurance Canada (17-00912)

The claimant sought removal from the MIG and entitlement to further physical therapy and a psychological assessment. Adjudicator Mather concluded that the claimant suffered from chronic pain syndrome, which adversely affected his wellbeing; the MIG did not apply to his injuries. Further physical therapy was awarded based on the goal of reducing pain and increasing...

May 8, 2019

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G.E. v. Co-operators General Insurance Company (18-007928)

The Tribunal ordered the insurer to produce the adjuster's log notes, the complete accident benefits file, and raw data from IE assessors. The insurer sought reconsideration. Vice Chair Batty dismissed the request, reasoning that the disputed orders were not decisions that finally disposed of the appeal.

May 8, 2019

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H.R. v. TD Insurance Meloche Monnex (18-004179)

The Tribunal granted the claimant's request to have two applications heard together. The insurer sought reconsideration. Vice Chair Batty dismissed the request on the basis that the Tribunal's order was not an order that finally disposed of an appeal. Because the proceeding was ongoing, the insurer could not yet seek reconsideration.

May 8, 2019

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S.R. v. Aviva Insurance Company (17-004556)

The claimant sought reconsideration of the Tribunal's decision that the IRB claim was not barred by the limitation period. The request was made more than 12 months after the Tribunal's decision. Vice Chair Batty dismissed the request, holding that it was made outside of the required time period, and that the LAT Rules did not...

May 8, 2019

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M.F.X. v. Certas Home and Auto Insurance Company (18-004282)

The claimant argued that he suffered a non-minor injury due to chronic pain and sought entitlement to further chiropractic treatment. Adjudicator Norris rejected the claims. He reviewed the six factors outlined by the American Medical Association Guides in determining whether the claimant suffered chronic pain syndrome. The claimant failed to submit evidence regarding any of...

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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