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.

January 11, 2021

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Kapustin v. Aviva General Insurance (19-013976)

The claimant applied to the LAT disputing entitlement to a treatment and assessment plan for chiropractic treatment. The insurer denied the plan and requested the claimant attend an IE, noting the plan had been submitted four years post-accident and no additional medical documentation had been provided. The claimant attended the IE, but refused to sign...

January 8, 2021

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Hasford v. Aviva General Insurance (19-010256)

A preliminary issue hearing was held to determine whether the claimant was barred from appealing a denial of benefits claimed for MIG determination, IRBs, ACBs, housekeeping, medical benefit expense claims, a CAT determination and a special award. Vice-Chair Boyce held the claimant was statue-barred from appealing the denials due to the claimant's failure to dispute...

January 8, 2021

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Syrovy v. Aviva Insurance Company (19-012498)

The claimant applied to the LAT seeking entitlement to a treatment plan for physiotherapy and sought a special award. Adjudicator Boyce found the claimant was entitled to the treatment plan, plus interest, and given a special award in the amount of $250.00. Adjudicator Boyce found that the insurer's denial letter did not comply with section...

January 8, 2021

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Hodge v. Aviva Insurance Canada (19-005751)

The claimant sought entitlement to IRBs from June 25, 2018 to March 2, 2019. Vice Chair Mather first heard a preliminary issue with respect to the Tribunal's font and spacing specifications. Vice Chair Mather stated that it is open to a party to request an increase in page limits if they do not feel that...

January 8, 2021

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Pollitt v. Certas Home and Auto Insurance Company (19-009201)

The claimant sought entitlement to IRBs in the amount of $885.21 per week, in excess of the statutory maximum of $400.00 per week as set out in the SABS. The insurer initially paid IRBs at the statutory maximum of $400.00 per week, and subsequently reduced payments to $16.00 per week based on the appropriate ""ramp...

January 8, 2021

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White v. Travelers Insurance (19-010567)

The claimant disputed her entitlement to two treatment plans for vision-related services. The insurer denied the treatment plans on the basis that the claimant's vision impairments were not caused by the accident, as the claimant had pre-existing issues with her vision and the neuro-optometry IE assessor found that the claimant's visual impairments were natural history...

January 6, 2021

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N.C. v. Aviva General Insurance Company (19-004666)

The claimant sought reconsideration of the Tribunal's decision dismissing entitlement to medical benefits. Adjudicator McGee noted that the claimant filed her reconsideration submissions nearly a month after the deadline for submissions. Vice Chair McGee did not make any findings on procedural issues for the late findings, as she dismissed the reconsideration application on its merits....

January 6, 2021

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Choi v. Aviva General Insurance Company (20-003741)

The claimant disputed a catastrophic impairment designation. The insurer argued that the claimant failed to attend IEs, and that he was barred from proceeding with the LAT dispute. Adjudicator Lake dismissed the preliminary issue, holding that the insurer failed to prove the claimant failed to attend IEs. According to the documentary record, the claimant did...

January 6, 2021

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H.O. v. Aviva General Insurance (19-002362)

The claimant sought reconsideration of the Tribunal's decision that he did not suffer a catastrophic impairment as a result of the accident. In particular, he challenged the Tribunal's conclusion regarding a 40 percent WPI for cauda equina-like syndrome, and argued that it should have applied. He argued that the Tribunal did not allow procedural fairness...

January 6, 2021

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N.P. v. Wawanesa Mutual Insurance Company (18-010628)

The claimant filed a request for reconsideration of Adjudicator Norris' decision that found the claimant was entitled to a physiotherapy treatment plan but not entitled to a chiropractic treatment plan, nor a second physiotherapy treatment plan. The claimant submitted that Adjudicator Norris made a significant error of law and that he misinterpreted section 38(11). Adjudicator...

December 31, 2020

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Mahoney v. Co-Operators General Insurance Company (19-007708)

The preliminary issue at this hearing was whether the claimant was involved in an "accident" as defined within s. 3(1) of the SABS. The claimant submitted that she was involved in an accident because she was stepping out of her automobile when she slipped on ice and suffered injuries. The claimant's body did not strike...

December 30, 2020

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C.W. v. Jevco Insurance Company ( 18-000790)

This is a reconsideration decision of Adjudicator Shapiro. The insurer requested reconsideration of Adjudicator Shapiro's initial decision wherein he found the claimant entitled to retroactive ACBs with interest. The facts of this case were unusual. The claimant was a pedestrian struck by a vehicle. She did not have her own insurance. The driver of the...

December 30, 2020

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T.H. v. Allstate Insurance Company of Canada (19-004567)

The insurer sought reconsideration of the Tribunal's decision to award two treatment plans. The main argument for reconsideration was that the Tribunal considered an affidavit from the claimant that the insurer did not have an opportunity to cross-examine the claimant on. Adjudicator Paluch granted the reconsideration, holding that the Tribunal violated the rules of procedural...

December 29, 2020

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Chen v. Chubb Insurance Company of Canada (19-008582)

The claimant disputed her entitlement to NEBs, three medical benefits for treatment, and an attendant care assessment. Adjudicator Grant dismissed all of the claims. He found that the claimant was not prevented from engaging in substantially all of the activities in which she ordinarily had prior to the accident. The claimant had not provided a...

December 23, 2020

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M.L. v. The Dominion of Canada General Insurance Company (19-011699)

The claimant requested reconsideration of a preliminary issues decision in which the LAT adjudicator found that the claimant was barred from proceeding with her application for certain benefits because she failed to commence her application within two years of the insurer's refusal to pay the benefits claimed. The claimant submitted that the LAT acted outside...

December 22, 2020

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Namasivayam v. Certas Direct Insurance Company (19-010862)

This was the claimant's second LAT dispute. The claimant sought entitlement to NEBs, removal from the MIG, and various medical benefits. The insurer argued that the claimant could not re-litigate the applicability of the MIG. Adjudicator Farlam agreed with the insurer that the applicability of the MIG was res judicata and that the claimant could...

December 22, 2020

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Gomes v. Aviva General Insurance (19-005653)

The claimant applied to the LAT disputing 10 medical benefits. The claimant and her legal representative failed to attend two case conferences, and the legal representative subsequently removed himself from the record. The LAT issued a Notice of Dismissal to the claimant, and the parties were advised to make written submissions on the Tribunal's intention...

December 21, 2020

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A.M. v. Aviva Insurance Company (19-004182)

The claimant requested reconsideration of the Tribunal's preliminary issue decision barring the claimant from disputing IRBs. Adjudicator Grant dismissed the reconsideration. The claimant submitted that the Tribunal erred in equating the OCF-10 as a request for IRBs for less than the mandated seven working days lost. The claimant submitted the OCF-10 and she did not...

December 21, 2020

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Khashi v. Travelers Insurance Company of Canada (19-005457)

The claimant disputed his MIG determination and entitlement to non-earner benefits. With respect to the MIG, Adjudicator Norris found that the claimant's psychological symptoms were sequelae of minor injuries and did not meet the threshold to warrant removal from the MIG. He noted that the psychological IE assessor's conclusions aligned with the family doctor records,...

December 18, 2020

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Berisha v. Certas Home and Auto Insurance Company (19-012869)

The claimant sought entitlement to medical benefits and interest. The claimant had earlier been accepted as catastrophically impaired. The insurer disputed the overall costs of assessments, which it had partially approved. Vice Chair Boyce concluded the claimant was not entitled to any of the partially denied assessments. The claimant claimed entitlement to the assessor's denied...

December 17, 2020

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A.C. v. Aviva Insurance Canada (19-002793)

The claimant disputed her entitlement to NEBs and brought a claim for a special award. Adjudicator Shapiro found the claimant’s evidence was not consistent with a complete inability to carry on her pre-accident activities, which had been limited by a recent, prior unrelated fall, and did not establish that the motor vehicle accident was the...

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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