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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April 3, 2020

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M.K. v. Aviva General Insurance (18-009319)

The claimant sought reconsideration of the Tribunal's decision that she was not entitled to NEBs. Adjudicator Grant dismissed the reconsideration. He held that new evidence could not be admitted on reconsideration, since there was no explanation why the evidence was not available for the hearing. He also held that the exclusion of the family physician...

April 2, 2020

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S.K. v. Aviva Insurance Canada (19-003326)

The claimant sought entitlement to IRBs, removal from the MIG, and three treatment plans for chiropractic therapy. Adjudicator Conway concluded that the claimant suffered soft tissue injuries, which fell within the MIG. She also denied the claim for IRBs due to insufficient evidence regarding the claimant's inabilities.

April 1, 2020

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Applicant v. Aviva General Insurance (19-002362)

The claimant sought a catastrophic impairment determination. The insurer argued that the claimant's impairment were a result of degenerative changes to the claimant's spine rather than the accident. Vice Chair Flude agreed with the insurer, and found that the claimant's accident-related impairments were not sufficient to meet a 55 percent WPI. He held that the...

March 31, 2020

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Sonnet Insurance Company v. L.O. (19-004559)

The insurer sought repayment of income replacement benefits because of error, wilful misrepresentation or fraud, and interest. Adjudicator Conway held that the insurer was entitled to repayment of IRBs plus interest. The insurer made IRB payments based on the representations of the claimant. The documents submitted to the insurer by the claimant stating that he...

March 31, 2020

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K.D. v. Aviva Insurance Company (18-011646)

The claimant applied to the LAT seeking entitlement to IRBs. The issue in dispute was the calculation of the quantum of the weekly IRB. Vice Chair Farlam found that the claimant was self-employed at the time of the accident, and his gross self-employment income must be calculated according to the income declared in the last...

March 30, 2020

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T.I. v. TD Insurance Meloche Monnex (18-002932)

The claimant brought a motion for the insurer to provide an explanation for each and every redaction in the adjusting log notes that was sufficient enough to potentially allow the claimant to challenge any claim of solicitor-client privilege. Adjudicator Johal found that the claimant was entitled to a reasonable explanation for each redaction, and that...

March 30, 2020

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D.Y. v. Aviva General Insurance Company (18-011171)

The claimant sought entitlement to NEBs, medical treatment, various assessments, and a special award. In addition, the claimant sought entitlement to the balance of proposed catastrophic impairment assessments, which had been proposed in the amount of $26,400.00 and approved up to $12,400.00. The claimant was found entitled to NEBs, chiropractic and physiotherapy treatment, concussion management,...

March 27, 2020

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Q.S.Z. v. TD General Insurance Company (19-000403)

The insurer sought a preliminary issue hearing to determine whether the claimant was statute-barred from proceeding with her application for income replacement benefits for failing to dispute that insurer's denial within the 2 year limitation. Adjudicator Derek Grant found that the insurer had failed to properly deny the claimant's application for IRBs and the claimant...

March 27, 2020

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I.W. v. Coachman Insurance Company (18-010935)

The claimant sought reconsideration of the Tribunal's decision that he was not involved in an accident. Adjudicator Grant rejected the reconsideration, holding that there was no error law regarding the purpose or causation test. The claimant had been the victim of an assault, which was an intervening act and the dominant cause of his injuries.

March 27, 2020

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K.Y.C. v. Unica Insurance Inc. (19-000494)

The claimant sought entitlement to a series of catastrophic impairment assessments. The insurer argued that the medical benefits available to the claimant had been exhausted and that the assessments were therefore not payable. Adjudicator Grant disagreed with the insurer and held that the medical benefits limits did not apply to catastrophic impairment assessments because such...

March 27, 2020

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I.W. v. Coachman Insurance Company (18-010935)

The claimant sought reconsideration of the Tribunal's decision that he was not involved in an accident. Adjudicator Grant rejected the reconsideration, holding that there was no error law regarding the purpose or causation test. The claimant had been the victim of an assault, which was an intervening act and the dominant cause of his injuries.

March 26, 2020

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C.A. v. Aviva Insurance Canada (18-005878)

The claimant sought reconsideration of the Tribunal's decision that she was not entitled to IRBs beyond the 104 week mark. Adjudicator Lake dismissed the reconsideration. The claimant's arguments were primarily an attempt to have the Tribunal re-weigh the evidence and expert opinions in a more favourable light. This did not constitute an error in law.

March 26, 2020

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C.A. v. Aviva Insurance Canada (18-005878)

The claimant sought reconsideration of the Tribunal's decision that she was not entitled to IRBs beyond the 104 week mark. Adjudicator Lake dismissed the reconsideration. The claimant's arguments were primarily an attempt to have the Tribunal re-weigh the evidence and expert opinions in a more favourable light. This did not constitute an error in law.

March 25, 2020

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F.E. v. Intact Insurance Company (18-011405)

The claimant sought entitlement to IRBs, various medical benefits, and two assessments. The insurer brought motions for section 33 non-compliance for failure to provide records in the Case Conference Order, and a section 55 defence for IE non-attendance. Both motions were dismissed. Section 33 was not found to apply because the claimant's breach was of...

March 25, 2020

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Applicant v. Dominion of Canada General Insurance Company (18-004952)

The claimant sought a determination that he suffered a catastrophic impairment due to a Class 4 marked impairment. Adjudicator Lake accepted that the claimant sustained a mental or behavioural disorder as a result of the accident, but that he did not suffer a Class 4 marked impairment in any sphere of function (his impairments ranged...

March 25, 2020

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Y.K. v. Aviva General Insurance Company (18-003926)

The claimant suffered a brain injury and was deemed catastrophically impaired as a result of a 2011 accident. He received personal care from his brother, who left multiple part-time jobs to care for him. The Form 1 supported $6,000 per month in ACBs, but the claimant's brother suffered an economic loss of $2,100 per month...

March 24, 2020

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N.C. v. TD Insurance Meloche Monnex (18-003656)

The claimant sought a determination that he suffered a catastrophic impairment due to a Class 4 marked impairment or 55 percent WPI, ACBs, HK expenses, and various medical benefits. The insurer sought repayment of IRBs. Adjudicator Neilson concluded that the claimant did not suffer a catastrophic impairment. She first noted that the claimant would only...

March 20, 2020

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M.G. v. Certas Direct Insurance Company (18-006807)

The claimant sought to add a claim for a physiatry assessment to the issues in dispute. The claimant had died one day after the physiatry assessment took place. The insurer argued that the issue should not be added because the claimant failed to attend the IE (after he had died). Vice Chair Marzinotto permitted the...

March 20, 2020

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Applicant v. TD Home and Auto Insurance Company (17-008493)

The claimant sought reconsideration of the Tribunal's decision that his claim for ACBs and HK expenses was barred by the limitation period. Adjudicator Boyce granted the reconsideration request based on the Court of Appeal's decision in Tomec v. Economical. The claimant's ACBs and HK expenses had been denied in 2005. In 2015, the insurer accepted...

March 19, 2020

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A.G. v. Aviva Insurance Canada (19-001973)

The claimant sought a special award in relation to the cost for medical cannabis. The insurer had requested information from the claimant regarding the costs for the medical cannabis in order to consider payment. The claimant responded, but only provided some of the information requested by the insurer. Adjudicator Parish noted the insurer should have...

March 19, 2020

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M.N.T. v. Certas Direct Insurance Company (19-000031)

The claimant sought non-earner benefits. An Tribunal Order of June 24, 2019, determined that the issues in dispute were NEBs and interest on overdue payments. In the claimant's submissions, she included 2 additional issues: (1) status under the MIG and (2) a medical rehabilitation benefit. The claimant provided physiotherapy records, which included only one page...

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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