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.

February 4, 2021

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Z.R. v. Gore Mutual Insurance (18-000017)

The insurer sought reconsideration of the Tribunal's decision that the claimant suffered a catastrophic impairment, and that he was entitled to NEBs. Adjudicator Hines dismissed the reconsideration. She accepted that the Tribunal ought not to have counted 3 percent WPI for medication use because the medication did not have the effect of cancelling out the...

February 3, 2021

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J.J. v. Economical Insurance Company (19-003835)

A preliminary issue 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 riding on the back of an ATV down a laneway on the way to his home when he fell off the back and suffered a...

February 3, 2021

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Escobar v. The Guarantee Company of North America (20-000259)

The claimant sought entitlement to two treatment plans, including a medical benefit for dental treatment and a rehabilitation benefit for a hot tub. The claimant also sought a special award. Adjudicator Grant found that the claimant was entitled to the OCF-18 for dental treatment, but was not entitled to the OCF-18 for a hot tub,...

February 3, 2021

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Shih v. Economical Insurance (20-005669)

The claimant sought entitlement to Income Replacement benefits and three treatment plans. The insurer raised a limitation defence in accordance with s. 56 of the Schedule. The insurer argued that the claimant failed to challenge the denial of the IRB and two of the three treatment plans within the two-year limitation period. Adjudicator Mazerolle found...

February 1, 2021

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Corpuz v. Aviva General Insurance (19-014198)

The claimant applied to the LAT seeking entitlement to medical benefits proposed in two treatment plans. The insurer sought an award of costs in the amount of $1,000.00 on the grounds that the claimant acted vexatiously and in bad faith in the proceeding. The insurer argued that the claimant had misled the LAT by misrepresenting...

February 1, 2021

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Jeyakumar v. Aviva General Insurance (19-010878)

The claimant applied to the LAT seeking entitlement to pre-104 week income replacement benefits. The claimant had returned to work at the time of the hearing and was seeking entitlement to IRBs for the period before he returned to work. Adjudicator Boyce found that the claimant failed to demonstrate that he had a substantial inability...

January 29, 2021

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McQueen v. Aviva Insurance Canada (19-011429)

A preliminary issue hearing was held to determine whether the claimant's application was statute-barred from appealing the denial of IRBs and medical benefits because the claimant failed to commence her appeal within two years. Adjudicator Paluch found that the claimant was statute barred from proceeding with her claim for IRBs and medical benefits . In...

January 29, 2021

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Campbell v. Aviva Insurance Company (19-012095)

The claimant sought entitlement to three treatment plans for chiropractic treatment. Adjudicator Lake found that the claimant was entitled to all three of the treatment plans, plus interest as a result of the insurer's failure to comply with section 38(8). The claimant cited the decision of T.F. v. Peel Mutual Insurance Company, stating that an...

January 29, 2021

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Iqbal v. Gore Mutual Insurance Company (20-005901)

A preliminary issue hearing was held to determine whether the claimant was disentitled to accident benefits because he did not have a reasonable explanation for providing the insurer with notice of the accident and/or failing to apply for benefits within the time limits imposed by section 32(1) of the SABS. Adjudicator Lake held that the...

January 29, 2021

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Aviva General Insurance Company v. Gurung (20-000592)

The insurer sought repayment of all IRBs paid to the claimant, totaling $36,456, based on the claimant failing to notify the insurer that she was earning income as the owner of a restaurant. The insurer argued that it was entitled to repayment of more than one year of IRBs because the overpayment was due to...

January 28, 2021

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Jama v. Unifund (20-005328)

The insurer brought a preliminary issue hearing seeking an order that the claimant was not entitled to receive an IRB pursuant to section 57, which outlines an insured person's responsibility to pursue reasonable, necessary, and available forms of treatment if the insured person continues to receive a weekly benefit, such as an IRB. Adjudicator Mazerolle...

January 28, 2021

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Zhao v. Allstate Canada (20-000134)

The claimant filed a LAT application seeking entitlement to an attendant care assessment, various other treatment plans, and an award under Regulation 664. The claimant's hearing submissions noted that the dispute over medical benefits other than the attendant care assessment were resolved prior to the hearing. While the case conference order referenced a claim for...

January 26, 2021

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G.W.R. v. Commonwell Mutual Insurance (19-002647)

The claimant applied to the LAT disputing entitlement to four treatment plans. The insurer raised a preliminary issue that the disputed treatment plans were barred from litigation under section 55 of the SABS due to the claimant's failure to attend section 44 IE assessments to address the disputed issues without a reasonable explanation. In response,...

January 26, 2021

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Terrio v. Aviva General Insurance (20-000524)

The claimant disputed entitlement to NEBs. The claimant had a number of pre-existing health conditions. The claimant's affidavit indicated that she was independent prior to the accident, had managed her various medical conditions well, and was looking for employment. Adjudicator Farlam found that the documentary evidence did not prove the claimant's position. The medical records...

January 22, 2021

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Hastings v. Royal Sun Alliance insurance (20-001485)

The claimant sought entitlement to two treatment plans, including chiropractic services and physiotherapy. Adjudicator Mazerolle found that the claimant was not entitled to payment for either of the disputed treatment plans. The claimant alleged that the treatment plans were not denied within the ten-day timeline required by section 38(8) and that the insurer relied on...

January 22, 2021

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Delagrammatikas v. Aviva General Insurance (19-013365)

The claimant sought entitlement to a treatment plan for dietician services, a treatment plan for physiotherapy, a rehabilitation benefit for rehabilitation support worker services, and interest. The claimant submitted that he gained weight after the accident which has been a barrier to his recovery. The parties disagreed as to the amount of weight the claimant...

January 21, 2021

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Manoharan v. Allstate Canada (19-010782)

The claimant sought entitlement to various medical benefits, which the insurer had denied based on the MIG. At the LAT case conference, the insurer removed the claimant from the MIG and approved some of the treatment plans. At the LAT hearing, the claimant disputed entitlement to one treatment plan plus interest on the previously approved...

January 21, 2021

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Drew v. Travelers Insurance Company of Canada (20-007200)

This is a motion decision made prior to a written preliminary hearing that was scheduled to determine whether the claimant was barred from proceeding with her application to the LAT pursuant to section 55 of the SABS for failure to submit an OCF-1 in accordance with section 32. The insurer filed the motion after the...

January 20, 2021

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H.V. v. Certas Direct Insurance Company (18-008349)

The claimant sought a catastrophic impairment based on a Class 4 Marked Impairment in adaptation. Vice Chair Marzinotto rejected the claimant's position, and concluded that he did not suffer a catastrophic impairment. She began by noting that a comparison of the claimant pre-accident and post-accident over a long period should be considered, rather than the...

January 19, 2021

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Budhram v. Aviva General Insurance (19-014428)

The claimant sought entitlement to two treatment plans, including massage therapy and a chronic pain assessment. Adjudicator Lake found that the claimant was entitled to a portion of the remaining amount for the massage therapy, but was not entitled to the chronic pain assessment. The claimant submitted that the insurer failed to comply with its...

January 19, 2021

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N.M. v. Aviva Insurance Canada (18-008710)

The claimant was involved in two accidents. He sought entitlement to NEBs for the second accident, and sought various medical benefits for both accidents. Adjudicator Paluch held that the claimant was entitled to NEBs up to the two-year mark because the insurer failed to properly stop entitlement. The insurer had stopped payment of NEBs after...

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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