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.

March 17, 2021

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Butler v. Allstate Insurance (19-013444)

The claimant applied to the LAT disputing entitlement to attendant care benefits and medical benefits. The dispute proceeded by written hearing. Adjudicator Lake held that the claimant was not entitled to ACBs for the three periods claimed. For the first period, Adjudicator Lake dismissed the claim as the claimant sought benefits prior to submission of...

March 17, 2021

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J.T. v. Aviva Insurance Company (18-003238)

The claimant submitted a request for reconsideration arising out of a decision which granted entitlement to some benefits, interest, and an award of 25 percent of the disputed amounts for three treatment plans unreasonably withheld by the insurer. The decision determined the cost of the withheld treatment plans and the percentage to be applied, but...

March 16, 2021

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Patchett v. Optimum Insurance Company (19-008902)

The claimant sought reconsideration of a LAT decision denying that she met the catastrophic impairment definition because her accident-related impairment did not result in a permanent mobility score on the Spinal Cord Independence Measure III ("SCIM"). Adjudicator Boyce dismissed the claimant's request for reconsideration. The issue in this case was whether the claimant's mobility impairment...

March 16, 2021

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

The claimant sought entitlement to physical treatment and various assessments, as well as a special award. Adjudicator Grant determined that the claimant was entitled to the disputed physical treatment plan, finding that the claimant's pre and post-accident visit history with her family doctor was indicative of significant and ongoing accident-related pain complaints and noting that...

March 12, 2021

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A.W.A. v Certas Home and Auto Insurance (18-007207)

The claimant sought reconsideration of a LAT decision denying the $24,000 cost of catastrophic impairment assessments. Adjudicator Gosio dismissed the claimant's request for reconsideration. Adjudicator Gosio agreed with the claimant that the hearing adjudicator failed to consider that the OCF-18 for CAT assessments concerned both Criterion 7 and 8. Adjudicator Gosio held that irrespective of...

March 12, 2021

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Allstate Canada v. Leroy Staglon (19-008347)

The claimant was riding his bicycle when he wound up in front of a vehicle operated by Allstate's insured. The insurer argued that the automobile was not involved in the incident, and that the claimant had fallen independent of the automobile. Adjudicator Farlam held that the incident was not an accident. The claimant rode his...

March 11, 2021

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A.S. v. BelairDirect (19-000539)

The claimant was injured when he tripped and fell on a raised ledge at an auto show near a display vehicle. He argued that the incident qualified as an accident. Vice Chair Farlam held that the trip and fall was not an accident under the SABS. The fact that the claimant was walking towards a...

March 11, 2021

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Edmonds v. COSECO Insurance Company (20-006226)

The claimant was injured when she slipped and fell while trying to enter her vehicle. The insurer denied that the incident qualified as an accident. Adjudicator Mazerolle agreed with the insurer and held that the incident was not an accident. The claimant slipped and fell on ice as she walked from her trunk to the...

March 10, 2021

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Yan v. Certas Home and Auto Insurance Company (20-000630)

The claimant sought entitlement to IRBs, disputing both the quantum of benefits paid prior to termination and whether he was entitled to IRBs on an ongoing basis. The insurer calculated the claimant's IRB quantum based on his income tax return for the year prior to the accident, as opposed to paystubs which showed higher earnings....

March 10, 2021

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Smith v. Intact Insurance Company (19-014019)

The insurer brought a preliminary issue motion for an order staying the claimant's IRB claim, as she had failed to file a mandatory form prior to applying to the Tribunal - the OCF-3. Vice Chair Flude found that the claimant had not filed her OCF-3 prior to commencing a proceeding before the Tribunal, and as...

March 10, 2021

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P.W. v. Aviva Insurance Canada (18-000854)

In an April 2020 decision, the Tribunal found that the claimant was entitled to an attendant care assessment based on an argument that was not raised by either party. The insurer's request for reconsideration was granted, and the issue was re-heard. Adjudicator Gosio found that the attendant care assessment at issue met the requirements of...

March 8, 2021

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L.D. v. Gore Mutual Insurance Company (17-002762)

Vice Chair Flude released a decision in which he found the claimant's motion moot, and requested submissions on costs from the insurer. The LAT Rules consider costs as a deterrent for a party that "has acted unreasonably, frivolously, vexatiously, or in bad faith" in a proceeding. Vice Chair Flude concluded that the claimant acted unreasonably...

March 5, 2021

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Unica Insurance Inc v. Girwall (19-007804)

The insurer sought repayment for the total amount of IRBs paid ($10,428.55) pursuant to section 52 of the SABS, as the respondent failed to notify it of his return to work shortly after the accident, resulting in an overpayment of IRBs. The claimant did not participate in the proceedings. Vice Chair Boyce found that the...

March 5, 2021

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Dhanji v. Aviva Insurance Company of Canada (19-010138)

The claimant disputed his entitlement to denied dental services and the remaining balance of a partially approved psychological treatment plan. Adjudicator Lake found that the claimant was not entitled to the proposed dental services or to the unapproved portion of psychological treatment. With respect to the dental services, she concluded that the claimant had not...

March 5, 2021

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Miller v. Motor Vehicle Accident Claims Fund (20-001029)

The claimant's spouse was involved in an accident while a pedestrian. The claimant observed her spouse's injuries later in the day while in hospital. Neither the claimant nor the spouse were named insureds at the time of the accident, so they applied to the Fund for accident benefits. Vice Chair McGee held that the claimant...

March 5, 2021

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Pinera v. Motor Vehicle Accident Claims Fund (21-001681)

The claimant was injured while crossing an intersection in downtown Toronto late at night. He sustained soft tissue injuries and a fractured clavicle. The Fund argued that no vehicle was involved in the incident, and the claimant was therefore not entitled to accident benefits. The claimant argued there was a vehicle that struck him, though...

March 4, 2021

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Biro v. Unica Insurance Inc. (20-003720)

The claimant was involved in an accident in 2007. In 2017, FSCO issued a decision granting the applicant ACBs and certain medical benefits. FSCO determined the claimant was not catastrophically impaired and denied a claim for NEBs. The claimant appealed the FSCO decision. The appeal was denied. In April 2020, the self-represented claimant applied to...

March 3, 2021

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K.W. v. Intact Insurance Company (19-003168)

The claimant sought entitlement to benefits and the parties attended a case conference where the insurer raised the preliminary issue of whether the claimant was statute barred from proceeding with her claim for the non-earner benefit and assistive devices pursuant to section 55 of the Schedule because the claimant failed to attend the insurer's section...

March 3, 2021

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Hayek v. Unifund Assurance Company (19-008856)

The claimant applied to the LAT claiming lost educational expenses in the amount of $15,153. Adjudicator Paluch awarded the claim in part, finding that the claimant was not entitled to education expenses incurred before the accident, but was entitled to lost education expenses of room and board in the amount of $862.69, which she incurred...

March 3, 2021

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Moran v. Aviva General Insurance (19-008529)

The claimant applied to the LAT seeking entitlement to psychological and chiropractic treatment, an orthopaedic mattress, and various assessments. Causation was an issue as the claimant had a slip and fall incident and a second motor vehicle accident after the subject accident. Adjudicator Lake held that the "but for" test was the appropriate test for...

March 2, 2021

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R.K.K. v. Cooperators General Insurance Co (19-002834)

The claimant sought reconsideration of a decision dismissing the claimant's claim for IRBs and medical benefits. Adjudicator McGhee allowed the reconsideration. Adjudicator McGhee found that the hearing adjudicator's reasons did not identify key factual findings or demonstrate how the relevant legal tests applied to the facts. The hearing adjudicator failed to explain how he assigned...

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

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

416.507.1850

eodonnell@tgplawyers.com