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 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....

October 28, 2020

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H.M.L. v. Northbridge Personal Insurance Company (19-000375)

The claimant requested reconsideration of the Tribunal's decision that she did not meet the post-104 week IRB test. The claimant argued that she received catastrophic impairment assessments that were not available at the time of the decision and which would change the Tribunal's decision. Vice Chair Mather dismissed the reconsideration request. The claimant had received...

October 28, 2020

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H.M.L. v. Northbridge Personal Insurance Company (19-000375)

The claimant requested reconsideration of the Tribunal's decision that she did not meet the post-104 week IRB test. The claimant argued that she received catastrophic impairment assessments that were not available at the time of the decision and which would change the Tribunal's decision. Vice Chair Mather dismissed the reconsideration request. The claimant had received...

October 27, 2020

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M.G. v. Echelon General Insurance Company (18-002005)

The claimant sought entitlement to a neuropsychological assessment, physiotherapy, occupational therapy, attendant care assessment, and assistive devices, a special award. As a preliminary matter, the claimant sought to exclude surveillance evidence and bar the insurer from cross-examining her on an affidavit from an earlier proceeding. Adjudicator Neilson allowed the insurer to cross-examine the claimant on...

October 27, 2020

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Salvi v. CUMIS General Insurance Company (19-005573)

The claimant sought entitlement to ACBs and various medical benefits for occupational therapy services, assistive devices, and chiropractic services. Adjudicator Paluch rejected the claim for ACBs and most of the medical benefits, but allowed the claims for assistive devices and one of the occupational therapy services. Regarding the ACBs claim, the claimant failed to prove...

October 27, 2020

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L.P.C. v. Aviva Insurance Canada (19-001009)

The claimant applied to the LAT requesting ongoing IRBs, removal from the MIG, various medical benefits, and a special award. Before the hearing, the insurer removed the claimant from the MIG, approved the four disputed treatment plans, and approved IRBs up to the 104 week mark. The claimant continued with the claim for post-104 week...

October 27, 2020

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Wright v. Northbridge General Insurance Company (20-000248)

The claimant was riding an ATV when she was shot in her left hand in a hunting incident. The ATV was stationary at the time, and the claimant did not fall or hit any part of her body on the ATV. She made a claim for accident benefits. The insurer argued that the incident did...

October 26, 2020

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K.A. v. Intact Insurance Company (19-004459)

The claimant was in an accident in May 2017. He submitted an Election choosing NEBs in July 2018. He submitted an OCF3 supporting NEBs in September 2019, more than 104 weeks after the accident. The insurer denied entitlement to NEBs based on the failure to provide an OCF3 within 104 weeks of the accident. The...

October 22, 2020

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V.B. v. Economical Insurance Company

The claimant slipped and fell in a grocery parking lot as he was disembarking his vehicle. There was black ice on the ground. The claimant slipped before he had shut his door. The insurer argued that the incident was not an accident for the purposes of the SABS. Adjudicator McGee held that the incident qualified...

October 22, 2020

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The Personal Insurance Co. v. Jia (2020 ONSC 6361)

The insurer appealed the LAT's decision that counsel acting in a priority matter could not also act in the LAT dispute, and the decision excluding the transcript from the priority EUO from the LAT hearing. The Court dismissed the appeal and concluded that the LAT's decision was reasonable. It held that a conflict could arise...

October 21, 2020

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N.A. v. Aviva General Insurance (19-003283)

The claimant applied to the LAT for NEBs, ACBs, and various medical benefits. The insurer argued that the claimant failed to attend IEs and was not permitted to proceed with the LAT dispute until attending. Adjudicator Hines held that the claimant could not proceed with her claims for ACBs, an in home-assessment, or on treatment...

October 21, 2020

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E.C. v. Northbridge Commercial Insurance Company (18-006384)

The claimant sought reconsideration of the Tribunal's rejection of catastrophic impairment costs. Adjudicator Grant rejected the reconsideration request. He acknowledged two typos / misnomers, but neither affected the Tribunal's decision. He maintained that the Tribunal applied the correct legal test, which required the claimant to prove that the disputed assessments were reasonable and necessary. The...

October 21, 2020

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O.A. v. TD Insurance Meloche-Monnex

The claimant disputed entitlement to additional funding for catastrophic impairment assessments. The insurer had approved $12,000 for an executive summary, psychological assessment, neurocognitive assessment, orthopaedic assessment, and occupational therapy assessments. The claimant sought a further $11,533.24. Adjudicator Boyce concluded that the denied assessments were not reasonable and necessary. The denied items were psychometric testing, scoring,...

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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