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 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...

December 9, 2020

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Fariad v. Intact Insurance Company (20-001379)

The claimant was involved in an "incident" as an Uber driver in which he was verbally assaulted by passengers who kicked his vehicle upon exiting. The driver claimed accident benefits based on allegations of psychological injuries and a knee injury as a result of his knee hitting the steering wheel as he swerved away from...

December 8, 2020

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Mayers v. Aviva Insurance Company (19-012033)

The claimant sought entitlement to IRBs. The claimant had failed to attend IEs, and the insurer argued that the claimant could not proceed with the LAT dispute. The claimant argued that the insurer supplied boilerplate statements which failed to give meaningful notice. Vice Chair McGee concluded that the operative part of the court's holding in...

December 8, 2020

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Z.K. v. Allstate Insurance Company Canada (17-006929)

The claimant sought entitlement to a catastrophic impairment designation, further chiropractic treatment, and the cost of denied neuropsychological and triage CAT assessments. Adjudicator Johal accepted that the claimant suffered three Class 4 marked impairments in each of activities of daily living; concentration, persistence, and pace; and adaptation in work or work-like settings. Prior to the...

December 7, 2020

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R.P. v. Aviva General Insurance (18-000131)

The claimant requested reconsideration of the Tribunal's decision denying IRBs. Specifically, the claimant alleged that the Tribunal made a significant error in fact or law by failing to fully consider medical evidence and the claimant's testimony. The claimant requested that an Order be made cancelling the decision and that IRBs be awarded with interest. Adjudicator...

December 4, 2020

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C.M. v. Intact Insurance Company (18-008995)

This is a reconsideration decision of Adjudicator Manigat. The insurer sought reconsideration of Adjudicator Manigat's initial decision wherein she found that the claimant was entitled to the balance of a psychological treatment plan in the amount of $887.93 plus interest. The insurer submitted that the Tribunal considered the wrong issue in dispute and did not...

December 4, 2020

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P.W. v. Wawanesa Mutual Insurance Company (18-007187)

The claimant sought reconsideration of the Tribunal's decision which found that her injuries fell within the Minor Injury Guideline. The claimant argued that the Tribunal erred in law by creating and applying an incorrect test to decide the issues in dispute. Specifically, the claimant stated that she was not taken out of the MIG despite...

December 4, 2020

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Mattina v. Federated Insurance Company of Canada (19-011267)

The claimant sought entitlement to a treatment plan for physiotherapy. The insurer argued that it was not liable to pay the disputed treatment plan because it was not signed by the claimant or a health care professional as required by section 38(3). The insurer had not raised the issue of noncompliance with section 38(3) in...

December 4, 2020

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A.M. v. Aviva Insurance Company of Canada (18-008059)

The claimant requested reconsideration of the Tribunal's decision denying NEBs and holding the claimant in the MIG. Adjudicator Norris denied the reconsideration. The claimant argued the insurer gave no evidence to subject the claimant to the MIG and the insurer's reports did not provide an opinion on the application of the MIG. The insurer submitted...

December 3, 2020

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R.K. v. Allstate Insurance (19-000502)

This is a reconsideration decision of Adjudicator Shapiro. The claimant sought reconsideration of the LAT's dismissal of the claimant's dispute for medical benefits. There was also a procedural issues as Adjudicator Shapiro made a finding on attendant care benefits entitlement in the first instance, despite the fact that this issue was withdrawn by the claimant....

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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