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.

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...

December 17, 2020

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Boyle v. Travelers Canada (19-014423)

The claimant was a witness to a fatal motor vehicle accident. He applied for accident benefits based on claims of psychological impairments as a result of rushing to the scene to assist following the collision. The insurer determined that the claimant was not an "insured" who was "involved" in an "accident" under s. 3(1) of...

December 17, 2020

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Jones v. Aviva Insurance Canada (19-013768)

The insurer requested reconsideration of a preliminary issue hearing in which the Tribunal found that the claimant's application for a non-earner benefit was not barred pursuant to section 56 of the SABS. Vice Chair McGee dismissed the insurer's request for reconsideration, on the basis that Rule 18 of the LAT Rules provides that the Tribunal...

December 16, 2020

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T.P. v. Wawanesa Insurance Company (18-003718)

The claimant sought entitlement to IRBs. Adjudicator Boyce found that the claimant was not entitled to payment of IRBs as he did not demonstrate that he met the substantial inability test. While the adjudicator accepted that the claimant was not working during the period in dispute, the claimant failed to provide any objective medical evidence...

December 15, 2020

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Sniderman v. Aviva Insurance Company (19-006657)

Prior to the accident the claimant worked in two jobs. The parties agreed that she was self-employed with respect to a bridal boutique company. The parties disagreed on whether the claimant was employed or self-employed with respect to a television and stereo repair shop owned and run by her husband. Adjudicator Johal concluded that the...

December 15, 2020

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Mohamud v. Certas Home and Auto Insurance Company (19-005153)

The claimant disputed entitlement to four treatment plans for various assessments and assistive devices, and a special award. The insurer raised a preliminary issue, claiming that the disputed dental assessment was barred by the limitation period. The insurer denied the plan on April 6, 2017, provided a clear and unequivocal denial and warned of the...

December 14, 2020

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Salim v. Aviva General Insurance (19-006944)

The claimant was involved in a serious accident. He was skateboarding and was hit by a vehicle and suffered nasal, left elbow, pelvic, and sacral fractures, and psychological injuries. The claimant applied to the LAT disputing entitlement to NEBs, ACBs, and the full cost of partially approved medical benefits. Adjudicator Farlam dismissed the claimant's dispute...

December 14, 2020

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Nash v. Aviva General Insurance Company (19-010799)

The claimant sought entitlement to IRBs. The insurer brought a preliminary motion to strike evidence found in the claimant's document brief, arguing that the evidence was hearsay of unproven allegations and irrelevant to the matters to be determined at the hearing. Adjudicator Farlam dismissed the insurer's motion, stating that evidence is rarely excluded prior to...

December 14, 2020

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Halstead v. Aviva Insurance Company (19-01394)

The claimant sought a medical benefits in the amount of $12,341.56 proposing that the insurer pay the cash difference between her old vehicle, a 2016 Volkswagen Jetta, and a new vehicle, a 2017 Hyundai Tucson, which was a larger and more spacious SUV. The claimant and her treating OT argued that the new vehicle was...

December 11, 2020

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Rattan v. Aviva Insurance Company (19-006304)

The claimant applied to the LAT disputing his entitlement to three medical benefits and interest. The insurer argued that the doctrine of res judicata prevented the claimant from re-litigating his entitlement to two of the disputed benefits, which the LAT had dismissed in a previous decision. Adjudicator Grant agreed with the insurer that res judicata...

December 11, 2020

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Dawkins v. TD General Insurance Company (19-011161)

The claimant alleged that she was a passenger in a vehicle involved in an accident. The insurer argued that the claimant was not a passenger in the vehicle when the accident occurred. A preliminary hearing was held to determine whether the claimant was involved in an accident as defined in s. 3(1) of the SABS....

December 11, 2020

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M.M. v. Royal & Sun Alliance Insurance Company of Canada (18-007290)

Vice Chair Flude released a preliminary issue decision that the claimant had filed his LAT application disputing the insurer's denial of his entitlement to NEBs beyond the two-year limitation period. Following the preliminary decision, Vice Chair Flude gave the parties an opportunity to make submissions on section 7 of the LAT Act. Upon review of...

December 10, 2020

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Nijjar v. Pembridge Insurance Company (19-011065)

The claimant disputed his entitlement to IRBs for an 18 month period and interest on medical benefits that had been resolved. Adjudicator Lake dismissed the claim for IRBs. She placed little weight on a “Physical Description of Job” sheet and a job description attached to an employer’s confirmation form that indicated a physically demanding job,...

December 10, 2020

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R.J. v. Certas Direct Insurance Company (19-009603)

The claimant sought payment for a housing accessibility assessment in excess of the $2,000 approved by the insurer, and sought a special award on cognitive training sessions that had been denied in 2017 but approved shortly before the hearing. Adjudicator Grant held that the $2,000 limit for assessments in section 25 applied to housing accessibility...

December 10, 2020

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Higashi v. Western Assurance Company (2020 ONSC 7616)

The claimant appealed the Tribunal's decision that her claim for IRBs was barred by the limitation period. She argued that the insurer's denials were invalid because the insurer did not provide copies of the IE reports to the practitioners who completed the Disability Certificates. The Court agreed with the Tribunal that the insurer's failure to...

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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