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.

Search

Generic filters

September 3, 2020

/

tgp-admin

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

/

tgp-admin

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

/

tgp-admin

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

/

tgp-admin

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...

August 31, 2020

/

tgp-admin

G.R. v. Aviva General Insurance Company (18-004375)

Both the claimant and the insurer sought reconsideration of the Tribunal's decision awarding seven medical benefits, denying attendant care expenses, and granting a special award on a functional impairment assessment, which had been deemed incurred. The claimant argued that ACBs should have been awarded and should have been deemed incurred under section 3(8). Adjudicator Mazerolle...

August 28, 2020

/

tgp-admin

S.S. v. The Personal Insurance Company (19-004026)

The claimant sought entitlement to IRBs and removal from the MIG. Adjudicator Lake concluded that the claimant was not entitled to IRBs, but that his injuries fell outside of the MIG. With regard to IRBs, the claimant failed to prove that he was substantially unable to perform the essential tasks of his pre-accident employment. A...

August 27, 2020

/

tgp-admin

L.A. v. Wawanesa Mutual Insurance Company (19-007357)

The claimant sought entitlement to IRBs. While he was unemployed at the time of the accident, he argued that he was receiving EI benefits. The insurer argued that the claimant's EI benefits had expired one week before the accident and he was therefore not entitled to IRBs. Adjudicator Johal agreed with the insurer. The claimant...

August 26, 2020

/

tgp-admin

J.T. v. Primmum Insurance Company (18-009043)

The self-represented claimant argued that he suffered a catastrophic impairment following a collision in a parking lot. The insurer's position was that the claimant suffered a minor injury. Adjudicator Manigat concluded that the claimant suffered a minor injury and dismissed the catastrophic impairment determination. No medical evidence was provided by the claimant in support of...

August 26, 2020

/

tgp-admin

B.S. v. Aviva Insurance Canada (19-001828)

The claimant sought removal from the MIG and entitlement to physiotherapy and two assessments. Adjudicator Maleki-Yazdi found that the claimant's injuries fell outside of the MIG and that the claimant was entitled to all three treatment plans. Additionally, she concluded that the insurer's section 38 notices were deficient. All three denials were similarly worded and...

August 26, 2020

/

tgp-admin

A.G.S. v. Echelon General Insurance Company (18-001994)

The claimant was a fetus in utero at the time of the accident and born prematurely four days after the accident. She was diagnosed with cerebral palsy as a result of her premature birth. The insurer initially paid accident benefits based on a medical opinion, but subsequently questioned causation based on an opinion of an...

August 25, 2020

/

tgp-admin

D.L. v. Aviva Insurance Canada (19-001860)

The claimant sought entitlement to CAT assessments totalling more than $26,000, as well as four treatment plans for passive physical therapy, and a psychological assessment. Vice Chair Farlam rejected the claims. While accepting that assessments are speculative in nature, the claimant failed to prove that there was any reasonable basis to investigate whether the he...

August 21, 2020

/

tgp-admin

M.V. v. Aviva General Insurance Company (18-011523)

The claimant sought entitlement to IRBs and removal from the MIG. Vice Chair Farlam concluded that the claimant was not entitled to IRBs and that his injuries fell within the MIG. The medical evidence provided showed only soft tissue injuries, and insufficient objective evidence was led regarding chronic pain or psychological impairment. There were also...

August 21, 2020

/

tgp-admin

N.V. v. Allstate Insurance Company of Canada (18-008774)

The claimant sought reconsideration of the Tribunal's decision that the limitation barred the IRB claim and that section 7 of the LAT Act should not apply to extend the limitation period. Adjudicator Boyce rejected the reconsideration request. He held that no error was made by the Tribunal in concluding that the insurer's denial was clear...

August 20, 2020

/

tgp-admin

S.W. v. Aviva General Insurance Company (19-002127)

The insurer sought reconsideration of the Tribunal's decision to allow the claimant to extend the limitation period under section 7 of the LAT Act. The insurer argued that the Tribunal did not have jurisdiction to extend the limitation period, or alternatively, that the facts of the case did not warrant the extension. Adjudicator Boyce dismissed...

August 19, 2020

/

tgp-admin

B.A. v. Economical Mutual Insurance Company (18-005968)

The insurer denied the claim for IRBs pursuant to section 31(1)(b), arguing that the claimant had made a material misrepresentation that induced the insurer to enter into the contract. In particular, the claimant allegedly misrepresented her address for the purpose of obtaining a lower premium. As a preliminary issue, the claimant sought to exclude audio...

August 17, 2020

/

tgp-admin

H.K.C. v. Aviva Insurance Company (18-011956)

The insurer sought reconsideration of the Tribunal's decision that a formal psychological diagnosis was not required for removal from the MIG. Adjudicator Johal dismissed the reconsideration. She found no error in the Tribunal's decision and noted that the Supreme Court's decision in Saadati v Moorhead supported the conclusion. She also rejected the insurer's argument that...

August 17, 2020

/

tgp-admin

F.C. v. Aviva Insurance Canada (18-001359)

The insurer sought reconsideration of the Tribunal's decision awarding NEBs and a treatment plan for failure to comply with sections 36 and 38, respectively. Adjudicator Boyce dismissed the reconsideration. He held that Stranges v Allstate was not good law in relation to the current version of the SABS, which required payment of NEBs until a...

August 17, 2020

/

tgp-admin

P.M. v. Aviva General Insurance (18-009518)

The insurer was paying the claimant IRBs for over a year after the accident when it suspended IRBs due to the claimant's failure to obtain necessary treatment and in providing relevant information under section 33 (the status of recommended psychological treatments and the updated clinical notes and records from the family physician). IRBs were reinstated...

August 17, 2020

/

tgp-admin

M.L. v. Unifund Assurance Company (19-009999)

The claimant applied to the LAT seeking IRBs following her 2015 accident. She had returned to work after the accident, and the insurer denied entitlement to IRBs. After the 104 week mark, the claimant stopped working and submitted an Election to the insurer claiming IRBs. The insurer again denied IRBs, arguing that IRBs had been...

August 17, 2020

/

tgp-admin

M.O. v. Jevco Insurance Company (19-003520)

The minor claimant was involved in an accident in 2002. Only in 2016 did the claimant apply for accident benefits when he retained his current counsel (his former counsel sent a tort action letter to the insurer in 2014, but did not make an accident benefits claim.) Around three months after the AB application, the...

August 17, 2020

/

tgp-admin

R.T. v. Aviva General Insurance (19-007347)

The claimant sought entitlement to IRBs and further physiotherapy treatment. Adjudicator Watt dismissed both claims. He held that the claimant failed to submit evidence that would prove that pain prevented her from returning to work. He also noted that the claimant was self-limiting in assessments and that objective testing showed full ranges of motion. The...

Contact Us

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

416.507.1850

smilne@tgplawyers.com

© 2020 Thomas Gold Pettingill LLP Disclaimer | Privacy Policy | Statement of Principles

Powered by Crow & Pitcher

Subscribe to get TGP’s case summaries straight to your inbox

Subscribe to get TGP’s case summaries straight to your inbox

Contact Us

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

416.507.1850

smilne@tgplawyers.com

© 2020 Thomas Gold Pettingill LLP