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 12, 2020

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S.S.L. v. Certas Direct Insurance Company (19-004473)

The claimant sought removal from the MIG and entitlement to IRBs, two treatment plans for chiropractic services, and cost of examination. Prior to the hearing, the claimant withdrew her claims for the medical benefits and the costs of examinations. Adjudicator Norris held that the claimant could not dispute the MIG if no medical or rehabilitation...

August 12, 2020

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K.H. v. Gore Mutual Insurance (18-009689)

The claimant filed a Request for Reconsideration arising out of a decision in which the Tribunal found the claimant entitled to medical benefits proposed in a treatment plan, but not entitled to a special award. The claimant argued that Adjudicator Norris erred in law or fact when considering her entitlement to a special award. Adjudicator...

August 12, 2020

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A.S. v. Certas Home and Auto Insurance Company (19-004994)

The claimant was involved in a 2009 accident. She sought entitlement to three assessments and a series of CAT assessments. An initial issue was raised as to whether section 25 of the post-2010 SABS applied, or if section 24 of the earlier SABS applied. The adjudicator held that section 25 of the 2010 SABS applied,...

August 11, 2020

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A.M. v. Certas Home and Auto Insurance (19-002869)

The claimant disputed entitlement to numerous treatments plans and ACBs in the amount of $6,142.59 per month from November 29, 2018 and ongoing. The claimant was diagnosed with Parkinson's Disease and Dementia pre-accident, as well as headaches and ear pain. The insurer argued that the benefits claimed were for the claimant's pre-existing conditions, and that...

August 11, 2020

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E.C. v. Northbridge Commercial Insurance Corporation (18-006384)

The claimant was involved in an accident on February 9, 2006 and disputed entitlement to a treatment plan for $25,659.25 proposing catastrophic assessments. The insurer argued that the claimant had sustained only minor, soft tissue injuries as a result of the subject accident and had not established that catastrophic assessments were either reasonable or necessary...

August 11, 2020

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V.O. v. Aviva General Insurance (19-002218)

The claimant sought entitlement to the cost of a psychological assessment. The insurer argued that the limitation period barred the claim. Adjudicator Driesel agreed that the proposed assessment was denied more than two years before the LAT application. The denial was mailed to the claimant, which is a permitted method under the SABS. While no...

August 11, 2020

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T.L.D. v. Aviva General Insurance Company (19-009050)

The claimant sought IRB, removal from the MIG, and various medical benefits. Adjudicator Grant held that the claimant failed to prove that the accident results in injuries preventing him from returning to his pre-accident employment in food delivery. He also concluded that the claimant's injuries fell within the MIG. With regard to a hospital expense,...

August 10, 2020

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K.V. v. Aviva General Insurance Company (19-006030)

The claimant sought entitlement to one treatment plan for chiropractic services. Adjudicator Cavdar concluded that the claimant had not adduced sufficient evidence to demonstrate that the proposed treatment plan was both reasonable and necessary. The decision was based on the fact that the treatment plans did not shed light on how the proposed chiropractic services...

August 10, 2020

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N.P. v. Western Assurance Company (19-012841)

The claimant sustained a significant impairment as a result of an accident on November 24, 2013. The insurer accepted that the claimant was catastrophically impaired on February 24, 2014. The insurer denied ACBs and HK expenses on May 23, 2014. The claimant disputed entitlement in a FSCO arbitration, and the benefits were settled via a...

August 6, 2020

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I.D.F. v. Aviva General Insurance Company (19-008993)

The claimant sought entitlement to four treatment plans for physiotherapy and other goods and services. The claimant submitted that he suffered from chronic back pain and required constant treatment. He argued that without treatment and medication, his condition would regress and his daily activities and function were reduced. Adjudicator Boyce found that the claimant's reports...

August 6, 2020

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R.M. v. Certas Home and Auto Insurance Company (18-007521)

The claimant disputed entitlement to the cost of CAT assessments in the amount of $22,400. The claimant argued that the proposed assessments were reasonable and necessary to determine whether or not she sustained a catastrophic impairment because "it is possible [she] may be catastrophically impaired, either under s. 3.1 of the Schedule, criteria 7 (whole...

August 6, 2020

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L.L. v Aviva Insurance Canada (18-001329)

Requests for reconsideration were filed by the claimant and the insurer in relation to a special award of $550 on a $2,200 assessment. The claimant sought an increase in the quantum awarded; the insurer argued that no special award ought to have been granted. Adjudicator Kepman dismissed both reconsideration requests, writing that the insurer had...

August 5, 2020

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M.Y. v. Wawanesa Mutual Insurance Company (19-003973)

The claimant sought reconsideration of the Tribunal's decision that she was barred from litigating her claim due to failure to attend two IEs. The insurer argued that the claimant's request for reconsideration was filed beyond the 21 as required in the Rules. Vice Chair Farlam noted that the request was only a single business days...

August 5, 2020

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S.D-T. v. Wawanesa Mutual Insurance Company (19-009280)

The claimant sought entitlement to IRBs and psychological treatment. A preliminary hearing was held to determine whether the claimant was statute barred from proceeding with her claim for failure to dispute the following issues within the two year limitation period. Vice Chair Farlam found the claimant's application was statute-barred and dismissed the claims. She found...

August 4, 2020

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H.M. v. Wawanesa Mutual Insurance Company (18-011655)

The claimant sought entitlement to pre-104 and post-104 weeks IRBs. The claimant was self-employed as a steel worker at the time of the accident and he owned 75 percent of a small steel fabrication business. Adjudicator Hans determined that the claimant established that he was substantially unable to perform the essential tasks of his pre-accident...

July 31, 2020

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M.L. v. Primmum Insurance Company (17-002915)

The claimant sought a determination that she suffered a catastrophic impairment due to a Class 4 marked impairment due to somatic symptom disorder. The insurer argued that the claimant had made functional improvement and that the impairments described by her assessors were brought on by the stressful nature of assessments. Adjudicator Mazerolle concluded that the...

July 31, 2020

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C.B. v. Allstate Canada (18-009967)

The claimant sought an order for the particulars of redaction in the adjuster log notes, the complete files from IE assessors, further log notes after the date of the LAT application related to section 33 requests and further IE requests, an updated payment summary, the particulars of whether the cost claimant's catastrophic impairment assessments were...

July 31, 2020

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Z.R. v. Certas Direct Insurance Company (18-001468)

The minor claimant sought a determination that he suffered a catastrophic impairment as a result of the accident due to traumatic brain injury under the post-2016 definitions. Section 3.1(1)5.i. of the SABS required that a person under 18 years of age be accepted for admission on an in-patient basis to a public hospital with positive...

July 31, 2020

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B.H.X. v. Aviva General Insurance (19-002556)

The claimant sought entitlement to NEBs, a psychological assessment, and the cost of a plastic surgery consult. Adjudicator Norris dismissed the claims for NEBs and plastic surgery consult, but awarded the psychological assessment. The claimant failed to provide evidence supporting NEB entitlement, and his self-reporting suggested he was in fact more active after the accident,...

July 31, 2020

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F.G. v. Aviva General Insurance (19-002587)

A preliminary issue hearing was held to address whether the limitation period barred the claimant's IRB dispute. Adjudicator Norris held that the limitation period applied. The IRB denial was clear and unequivocal, and the limitation period did not "restart" when the insurer re-iterated its denial of IRBs in subsequent correspondence. Adjudicator Gosio did not extend...

July 31, 2020

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F.K. v. TD Home and Auto Insurance Company (18-008114)

The claimant sought entitlement to NEBs, ACBs, and psychological treatment. Adjudicator Gosio rejected the claims for NEBs and ACBs, and found that the psychological treatment plan was disputed more than two years after the denial. The claimant failed to lead sufficient evidence that the accident was the cause of her impairments, as she had extensive...

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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