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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September 22, 2020

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Watters v. Aviva Insurance Company (19-005152)

The sole issue in dispute was whether the claimant was entitled to a special award under Ontario Regulation 664. The insurer changed its decision with respect to all of the treatment plans in dispute shortly prior to the hearing. The claimant alleged that the insurer ought to be liable for an award because the decisions...

September 22, 2020

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M. R. v Wawanesa Insurance (19-007921)

This is a preliminary decision over the definition of "accident" in the SABS. The claimant was swapping his winter tires to his summer tires when he injured his back. The claimant took the position that this was an "accident" because seasonally changing tires constituted the normal use and operation of a motor vehicle. Adjudicator Flude...

September 22, 2020

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C.K.D. v. Wawanesa Mutual Insurance (18-006988)

The claimant slipped and fell in the process of getting into his vehicle at a gas station. The insurer argued that the incident did not qualify as an accident. Adjudicator Makhamra concluded that the incident qualified as an accident. The claimant was just next to his driver's door and was reaching out with his left...

September 18, 2020

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M.M. v. Aviva Insurance Co. (17-006475)

The claimant requested reconsideration of Adjudicator Boyce's decision in which he determined that the claimant was not entitled to IRBs (among other things). Adjudicator Boyce again reviewed the submissions and evidence before him and upheld his previous decision. The claimant alleged that accepting the surveillance evidence presented by the insurer did not show psychological or...

September 18, 2020

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P.M. v. Aviva General Insurance (19-002717)

The claimant sought removal from the MIG and entitlement to medical benefits for physiotherapy, massage therapy as well as the cost of psychological and physiatry assessments, and completion of an OCF-3. The claimant also sought a special award. Adjudicator Lake found the claimant's injuries were outside of the MIG due to her chronic pain, but...

September 18, 2020

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P.B. v. The Co-operators Insurance Company (19-008343)

The claimant was receiving IRBs of $400 per week. She settled her action against her LTD provider. The LTD release indicated that it covered all claims being made against the LTD provider, including punitive damages and costs. The insurer argued that it was entitled to deduct from IRBs the amounts received from the LTD settlement....

September 17, 2020

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N.S. v TD General Insurance Company (19-002494)

The claimant applied to the LAT disputing entitlement to various treatment plans and interest. The claim was outside the MIG, so Adjudicator Norris had to determine whether the treatment plans were reasonable and necessary. Adjudicator Norris found that the physical therapy and OT treatment plans were reasonable and necessary. Adjudicator Norris noted that with his...

September 17, 2020

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S.M. v Wawanesa Mutual Insurance Company (18-008474)

The insurer and claimant sought reconsideration of Adjudicator Johal's decision that: (1) the claimant was only entitled to 120 minutes of ACBs per day and 60 minutes of ACBs per week, and (2) the claimant was not entitled to retroactive ACBs. Adjudicator Johal dismissed the reconsideration and noted that she properly applied the law to...

September 17, 2020

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Aquino v Aviva Insurance Company (19-006577)

A minor claimant applied to the LAT disputing entitlement to medical benefits and the cost of an examination. The insurer argued that the claimant was statute-barred, as the claimant filed her LAT dispute more than 2 years after the denials of benefits. The claimant argued that as she was a minor, she was not statute-barred...

September 17, 2020

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S.M. v. Mutual Insurance Company (18-008474)

The claimant sought reconsideration of the LAT's denial of retroactive ACBs and the decision regarding the amount of ACBs that were found payable. The accident occurred prior to September 1, 2010. Interpretation of the transitional provisions in the 2010 SABS and 1996 SABS was an issue in dispute, including interpretation of provisions relating to interest...

September 17, 2020

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C.J. v. Aviva Insurance Canada (18-007905)

The claimant sought entitlement to NEBs. The claimant submitted that virtually all her activities of daily living were affected by the accident. She was unable to perform her self care, cultural homemaking activities, socialize, or go to the gym, causing her weight gain and affecting her ability to have a child - all contributing to...

September 16, 2020

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I.A. v. TD General Insurance Company (19-006142)

The claimant disputed entitled to 7 treatment plans for chiropractic treatment. The insurer argued that the claimant had filed his submissions two and half months late and requested that the submissions be excluded in their entirety, and sought costs. Adjudicator Grant noted that excluding the claimant's submissions in their entirety would be severely prejudicial to...

September 16, 2020

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Omar v. Co-operators General Insurance Company (20-000085)

The insurer brought a motion to dismiss the LAT application for failure to attend IEs and failure to disclose relevant documents in a timely matter. Adjudicator Flude found that the claimant's failure to attend properly scheduled IEs was grounds for dismissal of the LAT application. A reasonable explanation for non-compliance with the IE had not...

September 14, 2020

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J.C. v. Aviva General Insurance Company (19-004734)

The claimant sought entitlement to various medical benefits, including medical cannabis, physical treatment, and a chronic pain program. The insurer argued that the claimant could not dispute two of the treatment plans due to IE non-attendance. The claimant responded that it wasn't reasonable to request a psychiatric assessment for the medical cannabis. Adjudicator Johal found...

September 8, 2020

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M.K. v. TD General Insurance Company (19-003616)

The claimant sought reconsideration of the Tribunal's decision that she was statute-barred from proceeding with her application for NEBs because she did not appeal within the two-year limitation period. The claimant submitted her Reconsideration Request two days after the limitation period had expired, relying on the state of emergency arising out of the COVID-19 pandemic,...

September 8, 2020

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S.A. v. Aviva Insurance Canada (18-004334)

The claimant sought entitlement to IRBs in the amount of $195.81 per week, the cost of an IRB calculation report, interest and a special award. The claimant submitted that from March 9, 2016 to April 30, 2016, he suffered a substantial inability to perform the essential tasks of his pre-accident employment as a floor installer...

September 3, 2020

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Aviva Insurance Canada v. K.B. (19-008307)

The claimant was involved in an accident on November 10, 2015. The insurer paid the claimant IRBs from November 17, 2015 until December 10, 2018, based upon the OCF-1 and OCF-2 submitted by the claimant. The insurer terminated IRBs based upon multiple IE reports. The claimant disputed the insurer's termination and in turn provided tax...

September 2, 2020

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K.G. v. Aviva Insurance Company of Canada (19-006535)

The claimant withdrew her LAT Application on June 7, 2019, three days before the scheduled written hearing. On June 18, 2019, the claimant filed another Application disputing the same medical/rehabilitation benefits (but without the original claim for income replacement benefits or attendant care). At the case conference, the insurer raised a preliminary issue that the...

September 2, 2020

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S.M. v Certas Home and Auto Insurance Company (18-010866)

The insurer brought a preliminary motion to bar the claimant from proceeding with his dispute as he did not attend multiple IEs. Adjudicator Moten held that the respondent's requests for IEs to assess the claimant's entitlement to benefits were reasonable and that the claimant could not proceed with his LAT dispute.

September 2, 2020

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Y.G. v. TD General Insurance Company (18-012431)

The claimant sought entitlement to the cost of psychological and orthopaedic assessments. The insurer argued that the disputes were barred by the limitation period. The insurer denied the claimed assessments by letter dated March 1, 2016 due to insufficient medical documentation to support injuries outside of the MIG. The letter also advised the claimant that...

September 2, 2020

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M.C. and M.C. v. Pembridge Insurance Company (18-006473 and 18-006682)

The husband and wife claimants were involved in a motorcycle accident and required amputation of their right legs. Both claimants were entitled to catastrophic impairment level benefits. Because the cost of both the claimant's and insurer's plan outpaced the cost of building a new home, neither plan was carried out. Instead, a new home was...

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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