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.

November 12, 2020

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Thompson v. Aviva Canada Inc. (19-005493)

A preliminary issue hearing was brought by the insurer for an order barring the claimant from proceeding with an application for IRBs due to the expiration of the limitation period. The insurer had notified the claimant on November 8, 2016 of stoppage of IRBs effective November 22, 2016 per IEs. The claimant requested payment on...

November 12, 2020

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J.T. v. TD General Insurance Company (19-003389)

The claimant filed a request for reconsideration to dispute the finding that he was not entitled to interest, an award, or costs related to an approved treatment plan. The request for reconsideration was denied. Adjudicator Grant found that the LAT had not made a significant error of fact or law in the hearing decision. He...

November 11, 2020

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P.W. v. Aviva Insurance Canada (18-000854)

Both the claimant and the insurer sought reconsideration of the Tribunal's decision which found that the claimant was not entitled to an income replacement benefit but was entitled to an examination expense for an attendant care assessment. Adjudicator Gosio dismissed the claimant's request for reconsideration, but granted the insurer's request for reconsideration by ordering that...

November 11, 2020

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M.G. v. Aviva General Insurance Company (19-003062)

The claimant applied to the LAT seeking entitlement to housekeeping and home maintenance expenses, the cost of a chronic pain assessment, and the cost of two OCF-3s. Adjudicator Farlam dismissed the claimant's dispute. The claimant had purchased optional HK expenses in her policy. The insurer paid HK expenses for February 11, 2017 to April 12,...

November 11, 2020

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P.W. v. Aviva Insurance Canada (18-000854)

Both the claimant and the insurer sought reconsideration of the Tribunal's decision which found that the claimant was not entitled to an income replacement benefit but was entitled to an examination expense for an attendant care assessment. Adjudicator Gosio dismissed the claimant's request for reconsideration, but granted the insurer's request for reconsideration by ordering that...

November 10, 2020

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W.A. v. Aviva General Insurance (19-000287)

The claimant sought reconsideration of the Tribunal's decision denying his entitlement to income replacement benefits. Vice Chair Farlam dismissed the claimant's reconsideration request, noting that reconsideration is only warranted in cases where an adjudicator has made a significant legal or evidentiary mistake preventing a just outcome, where false evidence has been admitted, or where genuinely...

November 10, 2020

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B.D. v Aviva General Insurance (18-010618)

The claimant asked for a reconsideration of part of the Tribunal's decision regarding the denial of an orthopaedic assessment. Vice Chair Farlam was satisfied that the decision did not contain any errors of law or fact. Having accepted some of the evidence in the orthopaedic assessment did not obligate the adjudicator to find that the...

November 10, 2020

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W.A. v. Aviva General Insurance (19-000287)

The claimant sought reconsideration of the Tribunal's decision denying his entitlement to income replacement benefits. Vice Chair Farlam dismissed the claimant's reconsideration request, noting that reconsideration is only warranted in cases where an adjudicator has made a significant legal or evidentiary mistake preventing a just outcome, where false evidence has been admitted, or where genuinely...

November 9, 2020

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L.D. v. Gore Mutual Insurance Company (17-002762)

The claimant brought two motions: (1) that Vice-Chair Flude recuse himself from making a decision that he already made on May 27, 2020; and (2) that he then reconsider the same decision. Claimant's counsel had previous requested that Vice-Chair Flude recuse himself, alleging bias stemming from a comment that was interpreted to be insensitive, for...

November 9, 2020

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L.D. v. Gore Mutual Insurance Company (17-002762)

The claimant brought two motions: (1) that Vice-Chair Flude recuse himself from making a decision that he already made on May 27, 2020; and (2) that he then reconsider the same decision. Claimant's counsel had previous requested that Vice-Chair Flude recuse himself, alleging bias stemming from a comment that was interpreted to be insensitive, for...

November 5, 2020

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P.K. v. Coseco Insurance Company (19-004126)

The claimant sought entitlement to various medical benefits for physiotherapy services, representing the balances owing on several treatment plans approved by the insurer and invoiced some months after the services were incurred by the claimant. The insurer did not dispute the reasonableness and necessity of the disputed benefits, but rather that payment of the benefits...

November 5, 2020

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Gareau v. Economical Mutual Insurance Company (19-011520)

This is a preliminary decision over whether a claimant could apply to the Tribunal and dispute his claim for a housekeeping and home maintenance expenses denied by the insurer prior to receiving a catastrophic impairment designation, despite the claimant not yet being found to suffer a catastrophic impairment. Adjudicator Johal held that based on the...

November 4, 2020

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Unifund Assurance Co. v. M.D.C. (19-010729)

The insured applied to the LAT for various benefits. The insurer added repayment of an overpayment of IRBs to the issues in dispute. The insured failed to attend multiple case conferences, and his application was dismissed without a hearing as the LAT determined he had abandoned his claim. The matter proceeded to a written hearing...

November 4, 2020

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H.C. v. Aviva Insurance Company of Canada (19-003063)

The claimant sought attendant care and medical benefits for chiropractic treatment and a psychological assessment plus interest. The insurer had paid various medical and rehab benefits as well as ACBs. It denied the ACBs after the 104 week mark as the claimant was not deemed catastrophically impaired. The insurer also denied the chiropractic treatment and...

November 3, 2020

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P.P. v. Wawanesa Mutual Insurance Company (18-000957)

The claimant sought a catastrophic impairment based on a 55 percent impairment, IRBs, housekeeping expenses, and medical benefits. The insurer argued that the claimant's impairment arose from an earlier workplace accident, and that he was not entitled to any of the claimed benefits or a catastrophic impairment designation. Adjudicator Flude agreed with the insurer and...

November 3, 2020

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Pereira v. Aviva General Insurance Company (19-010861)

The claimant sought entitlement to two medical benefits for chiropractic treatment and interest. In addition to the two treatment plans that the parties agreed would be addressed in the written hearing, the claimant's initial submissions addressed a number of new issues that were not contained in his application to the Tribunal, that were not raised...

November 2, 2020

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K.K. v. Aviva Insurance Canada (19-001300)

The self-represented claimant sought IRBs, medical benefits, interest, and a special award. Adjudicator Lake dismissed the claims. With respect to the claim for IRBs, Adjudicator Lake found that the insurer's surveillance was persuasive as it showed the claimant working at a construction site completing various physical tasks, including carrying two cinderblocks. Adjudicator Lake also noted...

November 2, 2020

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Y.D. v. Certas Home and Auto Insurance Company (18-003066)

The claimant requested reconsideration of a previous Tribunal decision denying the cost of CAT assessments in the amount of $24,400. The claimant argued that the Tribunal violated the rules of procedural fairness by failing to properly address the initial submissions and failed to assess crucial evidence. The claimant was represented by two lawyers who both...

November 2, 2020

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Y.D. v. Certas Home and Auto Insurance Company (18-003066)

The claimant requested reconsideration of a previous Tribunal decision denying the cost of CAT assessments in the amount of $24,400. The claimant argued that the Tribunal violated the rules of procedural fairness by failing to properly address the initial submissions and failed to assess crucial evidence. The claimant was represented by two lawyers who both...

October 29, 2020

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Baskaran v. Co-operators General Insurance Company (19-012169)

The claimant applied to the LAT disputing entitlement to IRBs and two medical benefits. The insurer had requested IEs to address the post-104 week IRB test, which the claimant refused to attend. The insurer argued that the claimant could not proceed with the dispute until attending IEs. The claimant argued that she had attended IEs...

October 28, 2020

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S.K. v. Aviva Insurance Canada (19-001127)

The claimant sought entitlement to ACBs, the balance of a partially approved social work assessment (seeking a higher hourly rate), and the cost of catastrophic impairment assessments. The insurer had denied ACBs on the basis that the claimant had not received the claims services and that insufficient information was provided regarding the services allegedly provided....

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

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Contact Us

150 York Street, Suite 1800
Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com