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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October 2, 2019

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J.V. v. TD Insurance Meloche Monnex (18-008337)

The claimant disputed his entitlement to IRBs, but had not submitted a Disability Certificate. The insurer argued that the failure to submit an OCF-3 barred the claim from proceeding. Adjudicator Ferguson agreed with the insurer and barred the dispute from proceeding. He held that section 36 created a strict requirement to provide an OCF-3. Section...

October 2, 2019

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J.G. v. Co-operators General Insurance Company (18-012430)

The claimant sought entitlement to NEBs. The insurer argued that the limitation period barred the dispute. Adjudicator Boyce agreed with the insurer. He concluded that while the denial of NEBs could be considered "pre-emptive" it was still a valid denial, following the Court of Appeal's decisions in Bonaccorso and Sietzema. The insurer's post-denial conduct in...

October 2, 2019

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Applicant v. Certas Direct Insurance Company (17-008853)

The claimant sought removal from the MIG, and entitlement to ACBs and various medical benefits. The insurer argued that the claimant was barred from proceeding to a hearing due to his failure to attend an IE addressing attendant care benefits. Vice Chair Helt concluded that the claimant was not barred from proceeding with his claim...

September 30, 2019

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G.J. v. Aviva General Insurance Company (18-006663)

This preliminary issue hearing was brought to determine whether the claimant was statute barred from proceeding with his appeal of a number of medical benefits and expenses because he did not submit treatment plans before incurring the expenses, and because he did not attend an IE that the respondent had determined was necessary for it...

September 30, 2019

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G.M.K. v. Aviva Insurance Company of Canada(18-009487)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to a psychological assessment. Adjudicator Manigat concluded that the claimant's injuries fell within the MIG. The claimant relied on a section 25 psychological report, in which he was diagnosed with PTSD and Major Depressive Disorder. The respondent relied on a...

September 26, 2019

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Applicant v. Certas Direct Insurance Company (18-000563)

The minor claimant sought a catastrophic impairment determination following an accident in which he sustained a concussion and developed behavioural disorders, including post-traumatic stress disorder and obsessive-compulsive disorder. Adjudicator Daoud found that the claimant suffered a Class 4 Marked Impairment in adaptation as a result of his injuries. She accepted the evidence of the claimant's...

September 24, 2019

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B.M. v. Allstate Insurance (18-008410)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to a chronic pain assessment. Adjudicator Maleki-Yazdi concluded that the claimant's injuries fell outside of the MIG due to chronic pain, and that the claimant was entitled to the cost of the chronic pain assessment. The claimant continued to reported...

September 23, 2019

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J.E. v. Intact Insurance Company (18-011314)

The claimant sought entitlement to two treatment plans proposing a psychological assessment and a physiatry assessment. Adjudicator Boyce concluded that neither cost of examination was payable, noting that the claimant had already received approval for a slate of nine catastrophic impairment examinations. As such, the examinations were duplicative, and not reasonable and necessary.

September 23, 2019

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Hedley v. Aviva Insurance Company of Canada (2019 ONSC 5318)

Aviva sought reconsideration of the Tribunal's reconsideration that its section 38 denial did not provide sufficient "medical and any other reasons for the examination," and that the claimant was not required to attend the IE. The Court upheld the reconsideration decision as falling within the range of reasonableness. The Court wrote: "where reasons are required,...

September 18, 2019

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Applicant v. Unica Insurance Inc. (18-009767)

This preliminary issue hearing was brought to determine whether the claimant was precluded from applying for post-104 week income replacement benefits, as the issue had already been dealt with as a result of a prior application to the Tribunal. An extensive hearing had previously been conducted and a final decision dealing with both pre and...

September 17, 2019

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C.G. v. Travelers Insurance (18-001021)

The claimant applied to the Tribunal seeking entitlement to IRBs and medical benefits. The insurer raised a preliminary issue requesting that the Tribunal bar the claimant's dispute over IRBs due to his failure to attend a s. 44 FAE with a kinesiologist. Adjudicator Létourneau concluded that the claimant was entitled to IRBs for the pre-104...

September 17, 2019

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Applicant v. Wawanesa Mutual Insurance Company (18-004984)

The claimant sought entitlement to a medical benefit, interest, and a special award. Adjudicator Chakravarti found that the proposed medical benefit was reasonable and necessary. Adjudicator Chakravarti noted that in a separate and earlier LAT hearing, Adjudicator Gueller removed the claimant from the MIG. Adjudicator Chakravarti held that she was persuaded by the claimant's treating...

September 17, 2019

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Applicant v. Wawanesa Mutual Insurance Company (18-003314)

The claimant sought reconsideration of the Tribunal's decision on narrow issue of the quantum of attendant care awarded. The Tribunal awarded the claimant $3,047.27 in monthly attendant care, despite the claimant's Form 1 listing $6,000 in monthly attendant care and the respondent's Form 1 listing $3,243.95 in monthly attendant care. The claimant argued that the...

September 16, 2019

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S.H.S.K v. Allstate Canada (18-003699)

The claimant applied to the Tribunal disputing his entitlement to four treatment plans and interest. Of the four disputed treatment plans, the claimant disputed his entitlement to an orthopaedic assessment and MRI. Adjudicator Kaur concluded that the claimant did not prove that the orthopaedic assessment and MRI were reasonable and necessary as he failed to...

September 16, 2019

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P.Y. v Aviva General Insurance Company (17-003692)

The claimant sought reconsideration of the Tribunal's decision based on there being new evidence that the claimant could not have reasonably obtained earlier and based on the insurer's concession at the close of the proceedings that the MIG did not apply. Adjudicator Grieves granted the claimant's reconsideration request. Adjudicator Grieves accepted that the new evidence,...

September 16, 2019

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C.E. v. Aviva General Insurance Company (18-002591)

The claimant disputed his entitlement to three medical benefits and his MIG designation. Adjudicator Neilson held that the claimant's injuries fell within the MIG and the disputed medical benefits were not reasonable or necessary. The claimant submitted his OHIP summary, which showed pre-accident entries for psychological impairments and a medical letter from his treating psychiatrist...

September 16, 2019

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F.J.H. v. Unica Insurance Inc. (18-008249)

The claimant disputed his entitlement to a medical benefit and the MIG. Adjudicator Lester held that the claimant's injuries fell within the MIG and that he was not entitled to the disputed medical benefit. Adjudicator Lester held that while the claimant suffered from pain and poor sleep pre-accident, the claimant had not submitted compelling evidence...

September 16, 2019

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L. Y. v Aviva Insurance Company (17-008847)

The insurer sought reconsideration of the Tribunal's decision, arguing that it had made a significant error of law or fact by referring to evidence not before it, placed the onus on the insurer, and failing to adhere to case law. On reconsideration, Adjudicator Norris held that he did not err in law in his decision....

September 13, 2019

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H.M. v. Aviva Insurance Canada (18-004734)

The claimant sought reconsideration of the Tribunal's decision finding that he was not entitlement to Non-Earner Benefits. Upon receipt of the reconsideration request, the Tribunal invited both parties to submit supplementary submissions. Neither party delivered supplementary submissions. Adjudicator Lake dismissed the claimant's request for reconsideration. Adjudicator Lake found that the claimant's request for reconsideration was...

September 11, 2019

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Travelers Insurance v. C.B. (18-007878)

The insurer sought repayment of IRBs paid to the claimant for a period she was working in a job with similar job duties to her pre-accident employment. Adjudicator Paluch granted repayment of $13,134.06 in IRBs. He held that the claimant's return to work suggested that she did not suffer a substantial inability to engage in...

September 3, 2019

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C.A. v. Intact Insurance Company (18-000579)

The claimant sought reconsideration of the Tribunal's denial of the cost of catastrophic impairment assessments. Adjudicator Lester held that section 25(1)(5) only obligates an insurer to pay the reasonable fees charged in connection with filling out the application for the catastrophic determination rather than the assessments themselves. She also agreed that the reasonable and necessary...

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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