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 29, 2020

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S.V. v. Aviva Insurance Company (19-005032)

The insurer initially denied a treatment plan based on the MIG, but did not respond to it for three weeks. The insurer later acknowledged that the denial was late and offered to pay for all incurred treatment, but did not provide an explanation for the delay. The claimant sought interest on the incurred treatment and...

July 27, 2020

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A.S. v. Intact Insurance Company (19-000979)

The claimant was involved in a motor vehicle accident in Alberta. At the time of the accident, he had an insurance policy that was sold in Alberta and was driving a vehicle that was registered in Alberta. He received benefits pursuant to the Alberta Automobile Accident Insurance Benefits and then claimed benefits under the SABS....

July 24, 2020

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K.P. v. Aviva General Insurance (19-001985)

The claimant disputed his entitlement to a treatment plan for medical cannabis, which the insurer denied based on an IE report that determined that medical cannabis was not reasonable and necessary to treat the claimant's chronic pain. The insurer further noted that the claimant smoked marijuana daily for several years prior to the accident (and...

July 24, 2020

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S.R. v. Traders General Insurance Company (17-004556)

The claimant was involved in a motor vehicle accident in 2014. She applied to the LAT seeking entitlement to pre- and post-104 IRBs. Adjudicator Reilly found that the claimant proved on a balance of probabilities that she sustained a substantial inability to perform her pre-accident employment as a result of the accident, and was entitled...

July 24, 2020

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W.E. v. Aviva Insurance Company (19-003285 and 19-009617)

This decision relates to two LAT files. The issues in dispute were whether the claimant's initial LAT application should be dismissed as abandoned for the claimant's failure to make written hearing submissions pursuant to a LAT Order, whether the claimant was entitled to ongoing IRBs, and whether the insurer was entitled to a repayment of...

July 24, 2020

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R.A. v. Aviva Insurance Company (19-002890)

The claimant applied to the LAT for entitlement to ACBs, a variety of OCF-18s for treatment and assessments, the cost of a psychological pre-screen, the cost of two OCF-3s, and a special award. Based on monthly invoices for ACBs (all in the same amount), which did not particularize the exact dates or times services were...

July 24, 2020

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K.P. v. Aviva General Insurance (19-001985)

The claimant applied to the LAT seeking entitlement to a treatment plan for cannabis therapy. The claimant argued that the proposed benefits were reasonable and necessary for treatment of chronic pain and disturbed sleep. The insurer argued that the cannabis treatment was not reasonable and necessary as a result of the accident, as the claimant...

July 22, 2020

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J.R. v. Aviva Insurance Company (19-006160)

The claimant disputed his MIG determination, as well as entitlement to attendant care benefits in the amount of $138.09 per month and various medical benefits. Adjudicator Boyce found the claimant to be unsuccessful on all of the disputed issues. The claimant's argument for removal from the MIG centred around his psychological impairments, relying on a...

July 22, 2020

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V.F. v. Aviva Insurance Company of Canada (19-004249)

The claimant disputed his entitled to a treatment plan for physiotherapy services. Adjudicator Leslie found that the treatment plan was not reasonable and necessary, emphasizing the claimant's significant pre-accident history of back pain (for which he was receiving regular physiotherapy treatment prior to the accident) and the fact that the insurer had approved ongoing physiotherapy...

July 20, 2020

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K.W. v. Aviva General Insurance (18-006969)

The claimant requested a reconsideration of the Tribunal's decision denying various medical benefits and IRBs, seeking an order quashing the decision and ordering a rehearing on all parts of the matter. Adjudicator Watt dismissed the applicant's request, noting that his decision set out the evidence, the law, and why he gave more weight to some...

July 20, 2020

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A.D. v. TD General Insurance Company (19-005432)

The claimant disputed his entitlement to in-home attendant care assessment. Section 20(2)(a) of the SABS states that no attendant care benefits are payable for expenses incurred more than 104 weeks post-accident unless the claimant sustained a catastrophic impairment. Given that the proposed assessment was requested over 6 years post-accident and the claimant was not catastrophically...

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...

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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