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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June 25, 2020

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S.M. v. Unica Insurance Inc. (18-010164)

The Tribunal had found the claimant entitled to (among other things) $6,000 per month in ACBs and granted a 25 percent special award. The insurer sought reconsideration. Adjudicator Boyce granted the reconsideration and reduced the payable ACBs and concluded that no special award was payable on ACBs or an awarded home modification. With regard to...

June 24, 2020

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A.A. v. Aviva Insurance Company (18-011152)

The claimant sought entitlement to attendant care benefits of $2,442.67 per month for a seven month period. Adjudicator Boyce concluded that the services identified on the claimant's Form 1 could not reasonable be associated with the claimant's accident-related impairments when he continued to work in his pre-accident employment, had not seen his family physician, and...

June 23, 2020

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S.S. v. RSA Insurance (19-005229)

The claimant sought removal from the MIG and entitlement to two medical benefits. The claimant refused to attend IEs and applied to the LAT more than two years after the denials. Adjudicator Boyce held that the limitation period applied and that he would not exercise discretion under section 7 of the LAT Act. The claimant...

June 22, 2020

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M.M.R. v. Travelers Insurance Company of Canada (18-009122)

The claimant sought entitlement to ongoing IRBs. The insurer approved IRBs prior to the hearing. The claimant argued that she was entitled to a special award. Adjudicator Chakravarti held that a special award was not payable. The insurer had notified the claimant that an OCF-2 was required in order to determine the quantum of IRBs...

June 19, 2020

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S.K. v. Technology Insurance Company Inc. (19-003749)

The claimant sought entitlement to social work services, HST on treatment plans, and the cost of CAT assessments. Adjudicator Chakravarti held that the limitation period applied to the social work services because the denial of the proposed rate was clear and unequivocal. Section 7 of the LAT Act did not apply because the claimant did...

June 19, 2020

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F.S. v. The Dominion of Canada General Insurance Company (19-007563)

The claimant sought removal from the MIG and entitlement to four medical benefits. Adjudicator Johal found that three of the four medical benefits were barred by the limitation period. The denials were clear and unequivocal. Section 7 of the LAT Act did not apply because the claimant failed to show a bona fide intention to...

June 19, 2020

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A.M. v. Wawanesa Mutual (18-008775)

The claimant sought a catastrophic impairment determination, as well as entitlement to NEBs, ACBs, various medical benefits, and the denied portion of catastrophic impairment assessments. The insurer argued that the claimant's psychological injuries and epilepsy were not accident-related, but resulted from pre-existing conditions. Adjudicator Lake agreed with the insurer and dismissed all claims. She found...

June 17, 2020

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R.K.K. v. Cooperators General Insurance Co. (19-002834)

The claimant sought entitlement to IRBs and a series of assessments to address the "complete inability" test, and removal from the MIG. Adjudicator Watt did not accept the opinions of the claimant's medical experts as they relied upon the claimant's self-reporting, which was not credible. The claimant had reported to Ontario Works that she had...

June 16, 2020

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B.Y. v. Economical Insurance Company (19-005084)

The claimant sought entitlement to IRBs and various medical benefits. Adjudicator Watt dismissed all of the claims. He held that the claimant was able to return to work based on medical evidence and based on surveillance evidence. The claimed medical benefits were similar to treatment that the claimant said did not reduce his symptoms or...

June 15, 2020

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P.W. v. Certas Home and Auto Insurance Company (19-002813)

The claimant disputed entitlement to IRBs. The insurer denied IRB entitlement in March 2014. Adjudicator Farlam held that the denial of IRBs was clear and unequivocal and that the limitation period expired in March 2016. The insurer's subsequent communications requesting further information regarding work status did not restart the limitation clock, nor did each subsequent...

June 15, 2020

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L.P. v. Aviva General Insurance (19-012718)

The claimant sought entitlement to NEBs, removal from the MIG, and various medical benefits. The insurer argued that the claimant's failure to attend IEs barred her right to proceed with a hearing. Adjudicator Farlam agreed with the insurer and dismissed the application. The insurer had requested IEs to address the claims, and the claimant did...

June 15, 2020

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E.L. v. Wawanesa Mutual Insurance Company (19-003212)

The insurer argued that the claimant could not proceed with a LAT hearing because of his failure to attend an IE. The claimant argued that the IE notice was deficient and that the IE request was not reasonable. Adjudicator Punyarthi held that the IE request was reasonable and that the insurer was not required to...

June 15, 2020

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S.V. v. State Farm Mutual Automobile Insurance Company (18-000605)

The claimant sought reconsideration of the Tribunal's decision regarding certain denied ACBs for feeding, bathroom cleaning, and basic supervisory care. She also sought interest on ACBs from the retroactive date of the Form 1, rather than the date the Form 1 was submitted. Adjudicator Parish granted the reconsideration in relation to the quantum payable for...

June 11, 2020

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M.M. v. Aviva Insurance Canada (18-000467)

The claimant sought reconsideration of the Tribunal's decision that a special award was not payable on a psychological assessment that was initially denied but approved just before the hearing. Adjudicator Punyarthi granted the reconsideration and ordered a special award of 45 percent be paid on the denied assessment. She explained that the Tribunal had made...

June 11, 2020

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Z.M. v. State Farm Mutual Automobile Insurance Company (18-012546)

A preliminary issue hearing was held to determine whether the claimant was barred from proceeding with her application for non-earner benefits because the two-year limitation period had expired. The claimant argued that she did not discover that she was able to dispute the non-earner benefit until she retained a lawyer five years after the accident...

June 11, 2020

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B.N. v. The Co-Operators Insurance Company (19-006455)

The claimant sought removal from the MIG and entitlement to three treatment plans for psychology services and chiropractic treatment. This case also raised the issue of whether an insurer can properly deny medical benefits for a psychological assessment and psychological treatment without requiring the claimant to attend an in-person IE for a psychological assessment. With...

June 10, 2020

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Z.P. v. Certas Direct Insurance Company (19-003226)

The claimant suffered a catastrophic impairment and sought entitlement to three treatment plans for home modifications and assistive devices. With respect to a $9,025.30 home modification assessment, the insurer had already paid $2,000 and argued that it was the maximum payable under the SABS. Vice Chair McQuaid agreed that the maximum payable was limited to...

June 9, 2020

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L.H. v. Aviva General Insurance (19-004132)

The claimant sought entitlement to ongoing NEBs and interest. The IE assessors concluded that the claimant did not suffer a complete inability to carry on a normal life. Adjudicator Kaur determined that there was limited evidence to refute the findings in these reports. Further, the claimant had not submitted any medical evidence to substantiate her...

June 9, 2020

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F.A. v. Aviva General Insurance (18-0011952)

The claimant sought entitlement to various medical benefits and payment for the cost of examinations. Adjudicator Johal ruled that all disputed plans were not reasonable or necessary based upon the evidence provided. Further, the claimant had not satisfied her onus to prove on a balance of probabilities that the treatment and assistive devices were effective...

June 8, 2020

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L.D. v. Certas Home and Auto Insurance Company (19-001472)

The claimant disputed entitlement to four treatment plans for physical treatments and a chronic pain assessment, an invoice for completion of an OCF-3, a MIG determination, interest and a special award. The claimant alleged that he suffered from chronic pain as a result of the accident. In support of his claims, the claimant submitted medical...

June 8, 2020

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A.T. v. Aviva Insurance Canada (18-010303)

The claimant sought entitlement a treatment plan for $14,804.51 for medical services, which he claimed was not properly denied in accordance with section 38 of the SABS. The claimant further argued that the insurer's denial was deficient as it referenced a different health provider than the one listed on the disputed plan, and it did...

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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