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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July 31, 2020

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Z.R. v. Certas Direct Insurance Company (18-001468)

The minor claimant sought a determination that he suffered a catastrophic impairment as a result of the accident due to traumatic brain injury under the post-2016 definitions. Section 3.1(1)5.i. of the SABS required that a person under 18 years of age be accepted for admission on an in-patient basis to a public hospital with positive...

July 31, 2020

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B.H.X. v. Aviva General Insurance (19-002556)

The claimant sought entitlement to NEBs, a psychological assessment, and the cost of a plastic surgery consult. Adjudicator Norris dismissed the claims for NEBs and plastic surgery consult, but awarded the psychological assessment. The claimant failed to provide evidence supporting NEB entitlement, and his self-reporting suggested he was in fact more active after the accident,...

July 31, 2020

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F.G. v. Aviva General Insurance (19-002587)

A preliminary issue hearing was held to address whether the limitation period barred the claimant's IRB dispute. Adjudicator Norris held that the limitation period applied. The IRB denial was clear and unequivocal, and the limitation period did not "restart" when the insurer re-iterated its denial of IRBs in subsequent correspondence. Adjudicator Gosio did not extend...

July 31, 2020

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F.K. v. TD Home and Auto Insurance Company (18-008114)

The claimant sought entitlement to NEBs, ACBs, and psychological treatment. Adjudicator Gosio rejected the claims for NEBs and ACBs, and found that the psychological treatment plan was disputed more than two years after the denial. The claimant failed to lead sufficient evidence that the accident was the cause of her impairments, as she had extensive...

July 30, 2020

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R.L. (Litigation Guardian) v. Allstate Insurance Company of Canada (18-005036)

A preliminary issue was heard as to whether the claimant's NEBs appeal was barred by the limitation period. Adjudicator Johal concluded that the limitation period barred the appeal and that the case did not warrant an extension under section 7 of the LAT Act. The claimant argued that she did not have the requisite mental...

July 30, 2020

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N.F. v. Aviva Insurance Canada (18-007077)

The claimant sought entitlement to IRBs and a chronic pain assessment. In addition to denying entitlement to the claimed benefits, the insurer disputed what the weekly quantum of IRBs would be. Adjudicator Mazerolle concluded that the claimant was entitled to IRBs and the chronic pain assessment. The claimant worked as a restaurant manager and his...

July 30, 2020

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K.A. v. Aviva General Insurance Company (19-002676)

The claimant sought entitlement to IRBs. The insurer argued that the claimant had failed to attend IE, and failed to comply with section 33 requests. Adjudicator Johal held that the claimant was barred from proceeding due to the IE non-attendance, reasoning that the IEs were reasonably required for determining entitlement to post-104 week IRBs even...

July 30, 2020

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A.L. v. The Guarantee Company of North America (19-003474)

The claimant initially sought entitlement to NEBs and the cost of two assessments. The insurer argued that the dispute was time barred. Prior to the preliminary hearing regarding the limitations argument the claimant withdrew her claim; the insurer still sought costs. Adjudicator Johal rejected the claim for costs, even though the claimant had made a...

July 30, 2020

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C.G. v. Pembridge Insurance Company (19-010979)

The claimant disputed entitlement to IRBs. The insurer raised a preliminary issue that the claimant had not applied for IRBs within the first 104 weeks following the accident and therefore could not receive IRBs. Adjudicator Johal agreed with the insurer. The claimant had not submitted a Disability Certificate within the first 104 weeks after the...

July 29, 2020

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Levey v. Aviva Insurance Company (19-006014)

The claimant applied to the LAT seeking entitlement to psychological services and the balance of a partially approved OCF-18 for driving lessons. Adjudicator Parish found that the claimant was not entitled to the disputed benefits. Adjudicator Parish noted that the OCF-18 for psychological services was completed by a psychologist, but the claimant previously received and...

July 29, 2020

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S.V. v. Aviva Insurance Company (19-005032)

The insurer initially denied a treatment plan based on the MIG, but did not respond to it for three weeks. The insurer later acknowledged that the denial was late and offered to pay for all incurred treatment, but did not provide an explanation for the delay. The claimant sought interest on the incurred treatment and...

July 27, 2020

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A.S. v. Intact Insurance Company (19-000979)

The claimant was involved in a motor vehicle accident in Alberta. At the time of the accident, he had an insurance policy that was sold in Alberta and was driving a vehicle that was registered in Alberta. He received benefits pursuant to the Alberta Automobile Accident Insurance Benefits and then claimed benefits under the SABS....

July 24, 2020

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K.P. v. Aviva General Insurance (19-001985)

The claimant disputed his entitlement to a treatment plan for medical cannabis, which the insurer denied based on an IE report that determined that medical cannabis was not reasonable and necessary to treat the claimant's chronic pain. The insurer further noted that the claimant smoked marijuana daily for several years prior to the accident (and...

July 24, 2020

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S.R. v. Traders General Insurance Company (17-004556)

The claimant was involved in a motor vehicle accident in 2014. She applied to the LAT seeking entitlement to pre- and post-104 IRBs. Adjudicator Reilly found that the claimant proved on a balance of probabilities that she sustained a substantial inability to perform her pre-accident employment as a result of the accident, and was entitled...

July 24, 2020

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W.E. v. Aviva Insurance Company (19-003285 and 19-009617)

This decision relates to two LAT files. The issues in dispute were whether the claimant's initial LAT application should be dismissed as abandoned for the claimant's failure to make written hearing submissions pursuant to a LAT Order, whether the claimant was entitled to ongoing IRBs, and whether the insurer was entitled to a repayment of...

July 24, 2020

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R.A. v. Aviva Insurance Company (19-002890)

The claimant applied to the LAT for entitlement to ACBs, a variety of OCF-18s for treatment and assessments, the cost of a psychological pre-screen, the cost of two OCF-3s, and a special award. Based on monthly invoices for ACBs (all in the same amount), which did not particularize the exact dates or times services were...

July 24, 2020

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K.P. v. Aviva General Insurance (19-001985)

The claimant applied to the LAT seeking entitlement to a treatment plan for cannabis therapy. The claimant argued that the proposed benefits were reasonable and necessary for treatment of chronic pain and disturbed sleep. The insurer argued that the cannabis treatment was not reasonable and necessary as a result of the accident, as the claimant...

July 22, 2020

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J.R. v. Aviva Insurance Company (19-006160)

The claimant disputed his MIG determination, as well as entitlement to attendant care benefits in the amount of $138.09 per month and various medical benefits. Adjudicator Boyce found the claimant to be unsuccessful on all of the disputed issues. The claimant's argument for removal from the MIG centred around his psychological impairments, relying on a...

July 22, 2020

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V.F. v. Aviva Insurance Company of Canada (19-004249)

The claimant disputed his entitled to a treatment plan for physiotherapy services. Adjudicator Leslie found that the treatment plan was not reasonable and necessary, emphasizing the claimant's significant pre-accident history of back pain (for which he was receiving regular physiotherapy treatment prior to the accident) and the fact that the insurer had approved ongoing physiotherapy...

July 20, 2020

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K.W. v. Aviva General Insurance (18-006969)

The claimant requested a reconsideration of the Tribunal's decision denying various medical benefits and IRBs, seeking an order quashing the decision and ordering a rehearing on all parts of the matter. Adjudicator Watt dismissed the applicant's request, noting that his decision set out the evidence, the law, and why he gave more weight to some...

July 20, 2020

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A.D. v. TD General Insurance Company (19-005432)

The claimant disputed his entitlement to in-home attendant care assessment. Section 20(2)(a) of the SABS states that no attendant care benefits are payable for expenses incurred more than 104 weeks post-accident unless the claimant sustained a catastrophic impairment. Given that the proposed assessment was requested over 6 years post-accident and the claimant was not catastrophically...

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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