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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December 20, 2018

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S.A. v. Guarantee Insurance (18-002962)

The claimant sought entitlement to NEBs. Adjudicator Boyce dismissed the claim. He found that the claimant's evidence regarding physical limitations was undermined by surveillance video and photographic evidence. He also concluded that the claimant failed to prove that her reported impairments were caused by the accident. Finally, the claimant did not pursue any therapy in...

December 19, 2018

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Applicant v. Aviva Insurance Canada (18-000725)

This is a preliminary hearing decision regarding whether the claimant was statute barred from proceeding with an application to the LAT for failure to attend a s. 44 examination. The claimant's position was that he was unable to attend further s. 44 assessments due to mental and physical health impairments. Adjudicator Watt held that the...

December 19, 2018

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Applicant v. Aviva General Insurance (17-004258)

The insurer sought reconsideration of the Tribunal's decision that the claimant could apply to the LAT to dispute a catastrophic impairment determination without any other benefits being in dispute. Vice Chair Flude rejected the insurer's arguments and held that the Insurance Act permitted the Tribunal to hear the claimant's dispute.

December 18, 2018

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Applicant v. Aviva Insurance Company (17-008198)

The claimant alleged that a stroke six weeks after the accident was caused by the accident. She sought entitlement to IRBs and an electric scooter. The parties agreed that the "but for" test was the appropriate test for causation. Adjudicator Parish concluded that the medical evidence did not prove that the stroke was caused by...

December 18, 2018

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J.E.C.L. v. Allstate Insurance Company of Canada (17-006909)

The claimant sought entitlement to NEBs and a chronic pain assessment. Adjudicator Boyce concluded that the claimant's activities remained largely the same after the accident. Although he suffered from pain, he was not practically prevented from the majority of his activities. Adjudicator Boyce also noted that the claimant failed to prove that his reported injuries...

December 17, 2018

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J.R. v . Coachman Insurance Company (17-001337 and 17-001154)

The claimant was involved in a major 2002 workplace accident and was then in two motorcycle accidents in 2011 and 2012. The claimant applied to the LAT seeking a determination that he sustained a catastrophic impairment as a result of one or both of the motor vehicle accidents. Adjudicator Shapiro found that the claimant was...

December 13, 2018

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K.W. v. Certas Direct Insurance Company (17-008502)

The claimant sought entitlement to two treatment plans for physical therapy. Adjudicator Ferguson dismissed both claims. He held that the claimant had reached maximum medical improvement and that the claimant had returned to a high degree of function. Furthermore, the claimant was not reporting pain relief as a result of passive physical therapy.

December 11, 2018

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M.Y. v. Aviva Insurance Company (17-007683)

The Insurer filed a Request for Reconsideration of a hearing decision that allowed the claimant to proceed with her application despite non-attendance at insurer examinations requested under s. 44 of the SABS. The hearing adjudicator had ordered the respondent to attend the insurer examinations as a condition to allowing the claimant to proceed. The insurer...

December 11, 2018

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C.C. v. Economical Insurance Co. (18-003633)

The claimant sought entitlement to IRBs; the insurer argued that the dispute was barred by the limitation period. Adjudicator Ferguson agreed with the insurer and held that the denial of IRBs had been more than two years prior to the LAT application, and that the denial was clear and unequivocal. The claimant's argument that he...

December 11, 2018

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D.S. v. Wawanesa Mutual Insurance Company (17-008334)

The claimant sought entitlement to medical benefits for various dental work. Adjudicator Norris concluded that the dental work was partly reasonable and necessary. He also concluded that the claimant did not need to submit the dental work on an OCF-18. The awarded dental work related only to the teeth that were damaged in the accident....

December 10, 2018

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M.K. v. Certas Direct (17-008725)

The claimant sought removal from the MIG and entitlement to two treatment plans. Adjudicator Mather dismissed the claim. She held that the claimant suffered predominantly minor injuries, and that the claimant failed to prove that she suffered chronic pain or psychological injuries.

December 10, 2018

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Applicant v. The Guarantee Company of North America (18-002753)

The claimant sought the raw test data from the insurer's psychologist. The request was denied during the Case Conference. On reconsideration, Vice Chair Marzinotto also dismissed the request. She wrote that the claimant failed to provide any basis for reconsideration, and there were no supporting facts for the reconsideration.

December 7, 2018

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D.B. v. Wawanesa Mutual Insurance Company (18-000506)

The claimant sought removal from the MIG and entitlement to five medical benefits. Adjudicator Mather concluded that the claimant suffered minor injuries. There was no evidence of psychological impairment, and the claimant's self-reports of pain did not substantiate a diagnosis of chronic pain syndrome. There was also no evidence of pre-existing conditions.

December 7, 2018

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L.H. v. Aviva Insurance Company of Canada (17-008904)

The claimant failed to make written submissions. The insurer sought the dismissal of the application and costs. Adjudicator Norris concluded that the matter should be dismissed due to the claimant's default. He also awarded costs of $125 because the claimant's behaviour was unreasonable and frivolous (she had failed to comply with the Case Conference Order...

December 6, 2018

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Aviva Insurance Canada v. R.R. (16-004445)

The insurer sought repayment of $9,673.38 in IRBs and accountant fees of $2,353.93. Adjudicator Ferguson concluded there was an overpayment of IRBs because the claimant had misrepresented his pre-accident income and that the insurer's payment of IRBs was therefore made in error. He held that he had no jurisdiction to order the claimant to reimburse...

December 6, 2018

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Applicant v. Aviva Insurance Canada (17-008304)

The claimant sought entitlement to a chronic pain program and a special award. Adjudicator Maleki-Yazdi found the chronic pain program reasonable and necessary. She preferred the evidence of the claimant's treatment providers and noted that the insurer had not put forward evidence from appropriate experts. A special award was not granted because the claimant failed...

December 5, 2018

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V.D. v. United Assurance Canada (17-005656)

The claimant sought entitlement to medical benefits proposed in treatment plans for chronic pain treatment and assistive devices (a self-propelled lawnmower and snow blower). The claimant had a pre-existing health history that included two back surgeries, and causation was an issue when determining whether the proposed benefits were reasonable and necessary as a result of...

December 5, 2018

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J.W.C. v. Certas Direct Insurance Company (17-007593)

The claimant was involved in an accident in British Columbia. He sought accident benefits through a policy held by his sister, argued that he was financially dependent upon her. Adjudicator Ferguson held that the claimant failed to provide evidence supporting financial dependency. The claimant was married, had a daughter, and worked in various jobs in...

December 5, 2018

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F.A. v. Belairdirect Insurance Company (17-007534)

The claimant sought entitlement to five proposed assessments. Adjudicator Norris concluded that the proposed impairment assessment and chronic pain assessment was reasonable and necessary. The psychological, orthopaedic, and physiatry assessments were not awarded.

December 5, 2018

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O.M. v. Aviva Insurance Company of Canada (18-001929)

The claimant applied for accident benefits after suffering injury on a city bus. The insurer denied that he was entitled to accident benefits because there was no collision; rather, the claimant fell when the bus driver accelerated. The claimant suffered from various disabilities prior to the accident and sought a seat in the priority seating...

December 4, 2018

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R.M. v. Unica Insurance Inc. (17-007500)

The claimant exhausted his medical benefits coverage and sought payment of catastrophic impairment assessment outside of the medical benefits limits. He sought a total of $9,718. The insurer argued that it was not required to pay for assessments outside of the medical limits, and in the alternative, that one of the proposed assessments was not...

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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