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 16, 2020

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J.A. v. Intact Insurance Company (19-005110)

The claimant disputed two treatment plans and sought removal from the MIG. The insurer requested IEs, which the claimant did not attend. Adjudicator Farlam held that the claimant was barred from proceeding with the dispute. She rejected the argument that the insurer could not request an IE to address the MIG. He unreasonably failed to...

July 15, 2020

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N.M. v. The Guarantee Company of North America (18-009017)

The claimant filed for reconsideration of the Tribunal's award of $1,000 in costs to the insurer. Vice Chair Hunter denied the reconsideration. Costs had been awarded after the claimant twice withdrew his dispute on the eve of the scheduled hearing. He rejected the claimant's arguments that the Tribunal exhibited bias or that it made its...

July 14, 2020

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S.J. v. Allstate Canada (19-001156)

The claimant sought entitlement to ACBs. The insurer argued that the claim was barred by the limitation period. Adjudicator Johal agreed that the claim was brought after the expiry of the limitation period, but extended the limitation period under section 7 of the LAT Act. The claimant showed a bona fide intention to dispute future...

July 14, 2020

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V.A.D. v. Intact Insurance Company (19-003332)

The claimant sought entitlement to IRBs. The insurer argued that the section 31(b) exclusion applied because the claimant intentionally failed to notify the insurer of a material change in risk. The claimant had moved from Quebec to Ontario but did not notify the insurer; the insurer argued that this resulted in the claimant lower premiums...

July 10, 2020

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D.M.A.M. v. Aviva Insurance Canada (19-005566)

The claimant sought entitlement to ACBs. Adjudicator Johal concluded that attendant care benefits were not reasonable and necessary. The claimant did not submit contemporaneous evidence showing that the claimant had limitations or restrictions that would require assistance with activities of daily living, and no treatment providers recommended personal care. Further, the claimant's pain complaints were...

July 10, 2020

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O.D. v. Allstate Insurance Company of Canada (19-008965)

The claimant sought entitlement to NEBs. The insurer argued that the dispute was barred by the limitation period. Adjudicator Johal concluded that the claimant was out of time to dispute NEBs. Although the denial of NEBs was not technically correct (the claimant, as a self-employed person, could nevertheless claim NEBs), the denial did not need...

July 9, 2020

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A.N. v. Aviva Insurance Company of Canada (19-000685)

Following her removal from the MIG, the claimant sought entitlement to ACBs. The claimant conceded that she did not incur and attendant care expenses, but argued that the expenses should be deemed incurred because she was kept in the MIG until the Case Conference which was after the 104 week mark and the insurer failed...

July 9, 2020

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K.D. v. TD Insurance Meloche Monnex (18-008965)

The claimant sought reconsideration of the Tribunal's decision that she was barred from pursuing her claim for caregiver benefits and housekeeping expenses. Adjudicator Norris rejected the reconsideration request. He reiterated that the insurer was not required to wait for a new Disability Certificate before requesting an IE, and that the IE report did not need...

July 8, 2020

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C.K. v. TD General Insurance Company (18-007496)

The claimant sought a determination that she suffered a catastrophic impairment. She suffered serious physical injuries as a pedestrian struck by a vehicle. Vice Chair Flude held that the claimant suffered a Class 4 marked impairment in adaptation and therefore had a catastrophic impairment. The claimant was largely housebound since the accident due to tiredness...

July 8, 2020

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A.L. v. Unica Insurance Inc. (18-008890)

The claimant sought a determination of a catastrophic impairment based on a WPI in excess of 55 percent. He also sought entitlement to ACBs, the denied portion of CAT assessments, and various medical benefits. Adjudicator Lake concluded that the claimant did not suffer a catastrophic impairment. She rejected the claimant's experts opinions on WPI for...

July 7, 2020

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C.A. v. Allstate Insurance Company of Canada (19-005816)

The claimant sought entitlement to IRBs. The insurer argued that the dispute was initiated beyond the two year limitation period. The claimant applied to the LAT two days late because of an earlier faxing error. The insurer was provided with the LAT application 10 days thereafter. Adjudicator Johal held that the dispute was not brought...

July 6, 2020

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T.A. v. Aviva General Insurance Company (18-006820)

The Tribunal awarded NEBs, a psychological assessment, and a 25 percent special award. The Tribunal had ordered the insurer to pay NEBs due to its failure to respond to the claimant's application, and such order required the insurer to pay NEBs before the conclusion of the 26 week waiting period. The insurer sought reconsideration. Adjudicator...

July 6, 2020

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T.A. v. Aviva General Insurance Company (18-006820)

The Tribunal awarded NEBs, a psychological assessment, and a 25 percent special award. The Tribunal had ordered the insurer to pay NEBs due to its failure to respond to the claimant's application, and such order required the insurer to pay NEBs before the conclusion of the 26 week waiting period. The insurer sought reconsideration. Adjudicator...

July 3, 2020

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M.M. v. Aviva General Insurance (19-002201)

The claimant sought entitlement to IRBs and three medical benefits. Adjudicator Chakravarti held that the claimant was not entitled to any of the claimed benefits. She found that the claimant was not credible, and that insufficient evidence was put forward to show that the claimant was working or had worked 26 of the past 52...

July 3, 2020

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F.M. v. Aviva Insurance Canada (18-008127)

The claimant sought entitlement to post-104 week IRBs. Adjudicator Létourneau concluded that the claimant did not meet the complete inability test and denied the claim. The claimant's background and education qualified him for manual labour type positions, but not customer-service type jobs due to lack of English language skills. The adjudicator concluded that the claimant...

July 3, 2020

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Y.R. v. Coachman Insurance Company (19-006234)

The claimant disputed a determination of catastrophic impairment and entitlement to attendant care benefits. The insurer argued that the claimant failed to attend an IE and was barred from proceeding with the hearing. Adjudicator Chakravarti permitted the claimant to proceed. The request for the IE to address attendant care benefits was not made in accordance...

July 3, 2020

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Z.A. v. Certas Home and Auto Insurance Company (19-001119)

The claimant sought entitlement to transportation expenses and a special award. Adjudicator Boyce dismissed both claims. The claimant failed to provide evidence regarding the transportation expenses, her home address, the address of the clinic, or an invoice for the transportation. Looking to the OCF-18, the longest one-way route between the addresses listed was well under...

July 3, 2020

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A.A.J. v. Echelon General Insurance Company (19-000961)

The claimant sought entitlement to IRBs for a one month period when he was in non-compliance with IE requests, and a treatment plan for chiropractic services. Adjudicator Boyce rejected all of the excuses provided by the claimant for his non-attendance as being unreasonable or not believable. The insurer rescheduled the IEs on multiple occasions and...

July 3, 2020

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H.A. v. Aviva General Insurance Company (18-012325)

The claimant sought entitlement to the cost of an EMG study. Adjudicator Hines concluded that the insurer's section 38 notice was non-compliant because it was too vague. However, the EMG study had been incurred 10 days (rather than 10 business days) after submission of the OCF-18. Because it was incurred too soon after submission of...

July 2, 2020

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D.L. v. Aviva Insurance Company (17-006056)

The claimant initially disputed entitlement to various assessments which were denied based on the MIG. The insurer later approved the assessments following an IE which concluded that the claimant suffered a psychological impairment as a result of the accident. The claimant requested a special award based on the earlier denials. Adjudicator Goela granted a special...

June 30, 2020

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B.M. v. Aviva Insurance (18-009182)

The Tribunal had awarded two of three treatment plans for chiropractic services, and denied the third as being duplicative. The claimant sought reconsideration on the denied treatment plan; the insurer sought reconsideration of the two approved treatment plans. Adjudicator Johal dismissed the claimant's reconsideration request and attempt to introduce new evidence. Adjudicator Johal granted the...

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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