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.

March 8, 2021

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L.D. v. Gore Mutual Insurance Company (17-002762)

Vice Chair Flude released a decision in which he found the claimant's motion moot, and requested submissions on costs from the insurer. The LAT Rules consider costs as a deterrent for a party that "has acted unreasonably, frivolously, vexatiously, or in bad faith" in a proceeding. Vice Chair Flude concluded that the claimant acted unreasonably...

March 5, 2021

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Unica Insurance Inc v. Girwall (19-007804)

The insurer sought repayment for the total amount of IRBs paid ($10,428.55) pursuant to section 52 of the SABS, as the respondent failed to notify it of his return to work shortly after the accident, resulting in an overpayment of IRBs. The claimant did not participate in the proceedings. Vice Chair Boyce found that the...

March 5, 2021

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Dhanji v. Aviva Insurance Company of Canada (19-010138)

The claimant disputed his entitlement to denied dental services and the remaining balance of a partially approved psychological treatment plan. Adjudicator Lake found that the claimant was not entitled to the proposed dental services or to the unapproved portion of psychological treatment. With respect to the dental services, she concluded that the claimant had not...

March 5, 2021

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Miller v. Motor Vehicle Accident Claims Fund (20-001029)

The claimant's spouse was involved in an accident while a pedestrian. The claimant observed her spouse's injuries later in the day while in hospital. Neither the claimant nor the spouse were named insureds at the time of the accident, so they applied to the Fund for accident benefits. Vice Chair McGee held that the claimant...

March 5, 2021

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Pinera v. Motor Vehicle Accident Claims Fund (21-001681)

The claimant was injured while crossing an intersection in downtown Toronto late at night. He sustained soft tissue injuries and a fractured clavicle. The Fund argued that no vehicle was involved in the incident, and the claimant was therefore not entitled to accident benefits. The claimant argued there was a vehicle that struck him, though...

March 4, 2021

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Biro v. Unica Insurance Inc. (20-003720)

The claimant was involved in an accident in 2007. In 2017, FSCO issued a decision granting the applicant ACBs and certain medical benefits. FSCO determined the claimant was not catastrophically impaired and denied a claim for NEBs. The claimant appealed the FSCO decision. The appeal was denied. In April 2020, the self-represented claimant applied to...

March 3, 2021

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K.W. v. Intact Insurance Company (19-003168)

The claimant sought entitlement to benefits and the parties attended a case conference where the insurer raised the preliminary issue of whether the claimant was statute barred from proceeding with her claim for the non-earner benefit and assistive devices pursuant to section 55 of the Schedule because the claimant failed to attend the insurer's section...

March 3, 2021

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Hayek v. Unifund Assurance Company (19-008856)

The claimant applied to the LAT claiming lost educational expenses in the amount of $15,153. Adjudicator Paluch awarded the claim in part, finding that the claimant was not entitled to education expenses incurred before the accident, but was entitled to lost education expenses of room and board in the amount of $862.69, which she incurred...

March 3, 2021

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Moran v. Aviva General Insurance (19-008529)

The claimant applied to the LAT seeking entitlement to psychological and chiropractic treatment, an orthopaedic mattress, and various assessments. Causation was an issue as the claimant had a slip and fall incident and a second motor vehicle accident after the subject accident. Adjudicator Lake held that the "but for" test was the appropriate test for...

March 2, 2021

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R.K.K. v. Cooperators General Insurance Co (19-002834)

The claimant sought reconsideration of a decision dismissing the claimant's claim for IRBs and medical benefits. Adjudicator McGhee allowed the reconsideration. Adjudicator McGhee found that the hearing adjudicator's reasons did not identify key factual findings or demonstrate how the relevant legal tests applied to the facts. The hearing adjudicator failed to explain how he assigned...

March 2, 2021

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Kazmi v. Pembridge Insurance Company (19-010107 and 20-001345)

The claimant applied to the LAT disputing entitlement to IRBs and two medical benefits. The matter proceeded by way of written hearing. Adjudicator Farlam found that the claimant was entitled to an IRB at the rate of $291 per week and awarded the two medical benefits plus interest. With respect to IRBs, the parties agreed...

March 2, 2021

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Kargol v. Aviva General Insurance (19-011590)

The claimant sought entitlement to pre- and post-104 week IRBs and a special award. Adjudicator Grant awarded IRBs from the date of loss and ongoing, holding that the claimant met both disability tests. The claimant had worked two jobs in the year before the accident. The first was as a sheet metal fabricator. The second...

March 2, 2021

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Thomas v. Coseco Insurance Company (20-001397)

The claimant applied to the LAT seeking a determination that her accident-related impairments were outside of the MIG and entitlement to psychological and chronic pain assessments. The insurer argued the claimant was barred from proceeding with the application for MIG determination as the issue had already been adjudicated and decided by the LAT in a...

March 1, 2021

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D.C. v. Allstate Canada (19-005260)

The claimant sought entitlement to post-104 week IRBs, ACBs, and various medical benefits, as well as a special award. Vice-Chair McGee dismissed the application on the basis that the claimant had not established that the accident was the cause of the impairment giving rise to the claim. She found that the claimant sustained soft tissue...

February 26, 2021

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Jeevakumaran v. Unifund (20-001025)

The claimant sought to be removed from the MIG and entitlement to medical benefits. Adjudicator Mazerolle concluded that the claimant established that he suffered from an accident-related psychological impairment. As such, he was no longer held to the funding and treatment limits of the MIG and s. 18(1) of the Schedule. Adjudicator Mazerolle found that...

February 26, 2021

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Branden v. Co-operators General Insurance Company (19-008343)

The insurer sought reconsideration of the Tribunal's decision that it was not entitled to deduct a long-term disability settlement from IRBs; the claimant sought reconsideration of the Tribunal's decision that a special award was not payable. Vice Chair Boyce rejected both reconsideration requests. He found no error of law relating to the Tribunal's conclusions about...

February 26, 2021

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Beaudin v. Travelers Insurance Company of Canada (2021 ONSC 1389)

The insurer appealed the Tribunal's decision that the dirt bike involved in the accident was an automobile for the purposes of the SABS. The Tribunal had concluded that the dirt bike was required to be insured under the Off-Road Vehicles Act and was not exempt from insurance through the regulation that allowed off-road vehicles to...

February 25, 2021

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Chance-Guppy v. Aviva General Insurance Company (19-004820)

The insurer requested a reconsideration of a hearing decision in which the claimant was found entitled to NEBs with interest. The insurer argued, among other things, that the LAT erred by ordering payment of NEBs beyond the 104-week mark and erred in its application of the Heath test by not requiring the claimant to present...

February 25, 2021

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Rochford v. Unifund Assurance Company (19-007743)

The claimant was assaulted when he exited his vehicle while attempting to park. A written 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 submitted that he was assaulted when he initially exited his vehicle to speak to people...

February 25, 2021

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Security National Insurance Company v. Balgobin (20-003118)

The insurer requested repayment as a result of IRB payments made in error due to the claimant's failure to notify the insurer that she had already returned to work. The claimant did not participate in the hearing. Vice Chair Boyce found that the insurer acted diligently upon receipt of information that the claimant was no...

February 25, 2021

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Jevco Insurance v. Owusu-Achiaw (19-012474)

The insurer requested repayment as a result of IRB payments made based on the claimant's material misrepresentation over his address and the resulting insurance premiums. The claimant did not participate in the hearing. Vice Chair Boyce found that the claimant made a willful misrepresentation in failing to disclose his correct address in order to attract...

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Contact Us

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

416.507.1850

eodonnell@tgplawyers.com

© 2020 Thomas Gold Pettingill LLP