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.

April 30, 2021

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Polat v. TD Home and Auto Insurance Company (20-002912)

The insurer raised two preliminary issues in advance of the hearing: (1) to bar the claimant from proceeding with her claim for IRBs due to failure to commence her application withing the two year limitation period; and (2) to dismiss the application for procedural delay and awarding costs. Vice Chair Boyce found the applicant was...

April 30, 2021

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A.J. v. Security National Insurance Co (18-007658)

The claimant sought a special award on the basis that the insurer unreasonably withheld and delayed payment of her claim for NEBs. The insurer failed to acknowledge receipt of the claimant's OCF-3, and ignored several requests from the claimant requesting confirmation and updates on the status of payments. The insurer had no explanation as to...

April 29, 2021

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Bagla v. TD Insurance Meloche Monnex (20-004159)

The preliminary issue in this matter was to determine whether the claimant was limitation-barred from disputing entitlement to ACBs in relation to two accidents due to his failure to dispute the denials within two years. Adjudicator Boyce concluded that the claimant was limitation-barred on both ACB claims. Pursuant to s. 56 of the Schedule, an...

April 29, 2021

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M.N. v. Aviva General Insurance (19-001788)

The insurer raised a preliminary issue in respect to whether the claimant was involved in two accidents. Adjudicator McGee found that the claimant was involved in both an April 8, 2016 accident and an October 4, 2016 accident. The facts of this case are unusual. At the time of both accidents, the claimant was incarcerated...

April 28, 2021

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Porter v. Aviva Insurance Company of Canada (2021 ONSC 3107)

The insurer appealed the Tribunal's decision that the claimant was involved in an accident. The claimant slipped and fell on ice while making her way to a Lyft vehicle in her driveway. The Court granted the appeal and concluded that the facts of loss did not qualify as an accident. The Tribunal erred by conflating...

April 28, 2021

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Harsanyi v. The Co-operators General Company (20-001245)

A preliminary issues hearing was held to determine whether the claimant's claim for IRBs was barred pursuant to s. 31(1)(a)(ii) of the SABS, which provides that an insurer is not required to pay an IRB if the claimant was driving an automobile without a valid driver's licence. The claimant asserted that he was unaware at...

April 28, 2021

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B.F. v. Certas Direct Insurance Company (19-004944)

The claimant applied to Certas for accident benefits. Certas brought an application to the LAT arguing that the claimant was not involved in an "accident" and sought repayment of accident benefits because the claimant wilfully misrepresented facts in relation to her application for benefits. Adjudicator Maleki-Yazdi agreed that the claimant was not involved in an...

April 27, 2021

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Borsato v. Pembridge Insurance (19-013826)

A preliminary issues hearing was held to determine whether the claimant was involved in an "accident" as defined in s. 3(1) of the SABS. The claimant and insurer agreed on the following facts: On the day of the accident, the claimant drove to a feed store with her husband to purchase horse feed. The claimant...

April 27, 2021

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F.C. v. Aviva General Insurance (19-003936)

The claimant disputed her MIG determination and her entitlement to medical benefits. In regard to the MIG, Adjudicator Moten found the claimant's prior injury to her coccygeal region prevented maximal recovery if she were limited to the $3,500 minor injury limits. Adjudicator Moten also found there was compelling evidence in the claimant's health practitioners' medical...

April 26, 2021

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Silvera v. Aviva General Insurance (20-000483)

The claimant sought entitlement to NEBs and medical benefits; the insurer required the claimant to attend s. 44 insurer's examinations. The claimant did not attend the IEs and submitted an application to the LAT. The insurer requested a preliminary issue hearing and Adjudicator Farlam found that the claimant was barred from proceeding with her application...

April 26, 2021

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Singh v. Aviva Insurance Company (20-001519)

The claimant was involved in a accident on October 21, 2017, and was paid an IRB for one year. The insurer terminated the claimant's IRB on the basis that they did not suffer a substantial inability to perform the tasks of their pre-accident employment. The claimant filed a LAT Application disputing IRBs up to the...

April 26, 2021

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Aviva General Insurance v. Mehdi Najmialdin (20-001336)

Aviva brought an application arguing that the claimant was not involved in an accident and sought repayment of IRBs in the amount of $22,647.59. Aviva relied on surveillance showing the claimant attending his place of employment on several occasions as well as review of the police report from the January 11, 2019 accident that showed...

April 26, 2021

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Aviva General Insurance Company v. Fynn-Williams (20-002276)

Aviva brought an application seeking repayment of IRBs because the claimant wilfully misrepresented facts in relation to her return to work and receipt of maternity benefits while she received IRBs. Adjudicator Boyce found that Aviva was entitled to repayment in the amount of $14,568.36 due to overpayment of IRBs. Adjudicator Boyce agreed with Aviva that...

April 23, 2021

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Bhavsar v. Aviva Insurance Company of Canada (19-006756)

The preliminary issue in this matter was whether the claimant was statute barred from disputing the attendant care benefit and treatment plans for physiotherapy due to the expiry of the limitation period in s. 56 of the Schedule. Adjudicator Johal concluded that the claimant was entitled to dispute these denials at the Tribunal. Adjudicator Johal...

April 23, 2021

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B.K. v. Guarantee Company of North America (18-003505)

The claimant was deemed catastrophically impaired on the basis of his Glasgow Coma Scale. Issues arose between the parties concerning the claimant’s entitlement to rehabilitation benefits under the Schedule. The insurer denied payment and the claimant appealed to the LAT for payment of these benefits. Adjudicator Kowal concluded that the claimant was not entitled to...

April 23, 2021

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G.T. v. The Guarantee Company of North America (18-003334)

The insurer sought reconsideration of a decision in which the Tribunal found that the claimant had sustained a catastrophic impairment based on Criteria 7. The Tribunal concluded that the claimant had sustained 54% WPI. After rounding up, as permitted by the Guides, the claimant met the threshold of 55%. The insurer submitted that the Tribunal...

April 22, 2021

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Bansal v. Aviva General Insurance (19-013174)

The insurer denied the claimant's claim for NEBs on the basis that he did not suffer from a complete inability to carry on a normal life. The claimant disagreed and applied to the Tribunal for dispute resolution. Adjudicator Paluch concluded that the claimant was not entitled to receive NEBs applying the principles outlined in Heath...

April 22, 2021

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T.A.K. v. Aviva General Insurance Company (18-008232)

The insurer sought reconsideration of the Tribunal's decision granting a special award of 35% on IRBs. The insurer argued that the Tribunal erred in finding that the insurer received the claimant's employment file in August of 2018, his CPP file by March 12, 2018, and his tax returns by August 2018. The insurer argued that...

April 21, 2021

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Yatar v. TD Insurance Meloche Monnex (2021 ONSC 2507)

The claimant appealed and sought judicial review of the Tribunal's decision that her claims were barred by the limitation period. The Court dismissed both the appeal and the judicial review. The Court explained that statutory appeals are limited to strict questions of law, and the claimant had failed to identify an error of law on...

April 21, 2021

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Howe v. The Commonwell Mutual Insurance Group (19-010824)

This motion decision arose in the context of a LAT hearing relating to a catastrophic impairment determination. On the third day of the hearing during direct examination of one of the claimant's expert witnesses, counsel for the insurer objected on the ground that the expert's testimony was beyond the scope of her written report. The...

April 20, 2021

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Rida v. Wawanesa Mutual Insurance Company (19-013934)

The claimant was declared catastrophically impaired and sought payment of attendant care benefits and housekeeping benefits provided by her daughters. The insurer ultimately accepted that the claimant was entitled to payment of the benefits, and argued that since it agreed with the claim, there was no basis upon which a special award could be granted....

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

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Contact Us

150 York Street, Suite 1800
Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com