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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January 13, 2022

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Pafco Insurance Company v. Sahadeo (2022 ONSC 328)

The insurer appealed the Tribunal's preliminary order excluding surveillance at an upcoming hearing. Justice Corbett dismissed the appeal, holding that it was premature and an abuse of process. If the insurer is ultimately unsuccessful at the hearing and if it decides to appeal, it will be open to the insurer to raise the issue of...

January 11, 2022

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McCormick v. Allstate Canada (21-001362)

The claimant failed to attend four separate IEs arranged by the insurer to address post-104 IRBs. The insurer filed a Notice of Motion requesting that the claimant's application be dismissed. The insurer argued that insufficient medical evidence had been provided by the claimant, and an independent medical opinion was needed in order to properly address...

January 11, 2022

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Mosa v. BelairDirect Insurance Company (21-011987)

The claimant brought a motion to: (1) compel the insurer to provide particulars clarifying a statement made by a claims representative in an email regarding a job site analysis; and (2) excluding the claims representative from representing the insurer before the Tribunal. Vice Chair Maedel dismissed both motions. Whether the claims representative stated something different...

January 11, 2022

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Lockyear v. Wawanesa Mutual Insurance Company (2022 ONSC 94)

The claimant appealed the Tribunal's decision that he did not suffer a catastrophic impairment due to a GCS score less than 9. The primary grounds for appeal were the Tribunal's refusal to admit video evidence of the accident and treatment by EMS, and the Tribunal's decision to allow an IE expert to comment on matters...

January 10, 2022

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Viran v. Aviva General Insurance Company (19-008488)

The insurer filed a request for reconsideration following a decision in which the Tribunal found that the claimant was entitled to various medical benefits and a special award. Adjudicator Grant granted the insurer's request for reconsideration in part, and the order for a special award was set aside. Adjudicator Grant was persuaded by the insurer's...

January 4, 2022

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Yousuf v. Waterloo Insurance (20-011053)

The insurer sought to have this claimant's application dismissed or stayed due to the claimant's failure to attend an IE relating to the MIG and a treatment plan. The insurer had not performed an IE of the claimant in the four years that the claim had been active, and had been prejudiced by being unable...

January 4, 2022

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Bobak v. Travelers Insurance (21-004004)

The Tribunal was asked to determine whether the claimant's injuries were within the Minor Injury Guideline, but no benefits were disputed. Prior to the case conference, the insurer filed a motion to dismiss the claim without a hearing on the basis that the subject matter of the application fell outside of the Tribunals jurisdiction. The...

December 30, 2021

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Patchett v. Optimum Insurance Company (2021 ONSC 8466)

The claimant appealed the Tribunal's decision that she did not suffer a catastrophic impairment under the Spinal Cord Independence Measure III ("SCIM"), also known as Criteria 2(iii). The Court upheld the Tribunal's decision, concluding that Adjudicator Boyce was correct in law to dismiss the catastrophic impairment application because the claimant did not suffer a permanent...

December 29, 2021

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Yusuf v. Aviva General Insurance (19-010940)

The claimant was involved in an accident and sustained various minor injuries. Approximately five months post-accident, the claimant's immediate family members flew from the United Kingdom to visit. The cost of the return flight was GBP £2,650. The claimant submitted the expense to the insurer as an accident-related visitors expense, which was denied. The claimant...

December 21, 2021

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Joaquim v. Intact Insurance Company (20-011042)

The preliminary issue in this matter is whether the claimant was barred from commencing a proceeding for certain medical benefits because she failed to comply with s. 44 of the Schedule by not attending an insurer's examination. The claimant submitted an OCF-6 for cannabis prescription expenses and the insurer denied the expense pending a s....

December 21, 2021

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Mijatovic v. The Co-operators (19-012215)

The claimant applied to the LAT disputing entitlement to IRBs. The insurer brought a preliminary motion arguing that the claimant was barred by the two-year limitation period. The claimant applied to the LAT on November 1, 2019 after 5:00 pm. The insurer denied IRBs on November 2, 2017. The insurer argued that the claimant's LAT...

December 17, 2021

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Aviva General Insurance v. Simmonds (19-010035)

The insurer sought repayment of IRBs in the amount of $12,731.87 for the period from July 10, 2017 to April 26, 2019 plus interest and costs. At the time of the accident, the claimant was employed at a shoe store and at a jewellery store. The insurer spoke with the jewellery store on September 26,...

December 17, 2021

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Tetruashvili v. Toronto Transit Commission (20-005001)

The claimant sought entitlement to an OCF-18 seeking funding for CAT assessments, including a neurology assessment, physiatry assessment, psychology assessment, and two occupational therapy assessments. The insurer denied the CAT assessments on the basis that the claimant sustained soft tissue injuries in the accident and argued that the claimant's complaints were not accident-related (but rather...

December 16, 2021

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Ritchie v. Economical Insurance (20-013296)

The claimant was walking to her vehicle when she slipped and fell on ice. The fall happened as she was turning towards the driver's side door and had activated the key fob to unlock the vehicle. The Tribunal accepted that the claimant had satisfied the purpose test, as the accident arose from the ordinary and...

December 15, 2021

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Opoku v. Jevco Insurance (20-003302)

The preliminary issue in this matter was whether the insurer's denials of the disputed treatment plans complied with s. 38(8) of the Schedule. Adjudicator Kaur found that the insurer's denials of the disputed treatment plans did not comply with s. 38(8) because they did not reference the claimant's injuries or the medical documentation that was...

December 15, 2021

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Qazi v. Aviva Insurance Company of Canada (19-007943)

The claimant was involved in a motor vehicle accident in 2015. As a result of the accident, she sustained multiple injuries, including a head injury with a GCS score of 5/15. The insurer determined the claimant had a catastrophic impairment as defined in the SABS. The claimant returned to work on a part-time basis in...

December 14, 2021

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Varriano v. Allstate (2021 ONSC 8242)

The claimant was in an accident in September 2015. He was paid IRBs until December 2015. In a December 30, 2015 EOB letter, the insurer notified the claimant that: “Your Income Replacement Benefit has been stopped on December 2, 2015, as you returned to work full-time on December 2, 2015. No further Income Replace Benefit...

December 7, 2021

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Awada v. Allstate Insurance Company (2021 ONSC 8108)

The insurer appealed a production order made by the Tribunal in advance of ongoing proceedings. The Court dismissed the appeal as premature, holding there were no exceptional circumstances justifying appellate intervention by the Court. The insurer's arguments were premised on the possibility of unfairness rather than any inevitable substantive unfairness, which could justify review of...

December 6, 2021

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Bagla v. TD Insurance Meloche Monnex (20-004158 and 20-004159)

The claimant sought reconsideration of a decision that his claims for ACBs were barred due to the limitation period. He made no submissions on the original decision because his counsel at the time unilaterally removed himself as counsel without notice. Four months after the decision was issued, the claimant retained new counsel, who filed a...

December 6, 2021

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Abdi v. TD General Insurance Company (19-008845)

The claimant sought a determination that he suffered a catastrophic impairment under the Extended Glasgow Outcome Scale (GOS-E). The parties agreed that the claimant sustained a mild traumatic brain injury and a fractured pelvis as a result of the accident, and agreed that the brain injury was evidenced on medical imaging. To receive a catastrophic...

December 6, 2021

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Xin v. Aviva Insurance Company of Canada (19-009204)

The claimant was in international student from China. She came to Canada in 2014 to attend school and was involved in a motor vehicle accident in 2017. She sustained injuries to her head, neck, arm, knee, shoulder, back and left side. She did not report the accident to the police or seek medical attention on...

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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