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.

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,...

October 21, 2020

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D.A.S. v. Western Assurance Company (19-010526)

The claimant applied to the LAT for NEBs. The claimant's OCF3 indicated that she met the tests for IRBs and NEBs. The insurer requested an election pursuant to section 35 of the SABS. The claimant did not return the election and instead applied to the LAT two years later. About six months into the LAT...

October 21, 2020

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Viera v. Aviva General Insurance (19-007227)

The claimant sought entitlement to a chronic pain assessment, and argued that the insurer's denial did not comply with section 38(8). Adjudicator Lake agreed that the insurer's denial did not comply with section 38(8), as none of the denials included any specific details about the claimant's condition forming the basis of the insurer's decision and...

October 20, 2020

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T.M. v. Aviva General Insurance (18-010477)

The claimant sought reconsideration of the Tribunal's decision dismissing his claim for IRBs. The insurer sought reconsideration of the Tribunal's decision that it was not entitled to repayment. Both requests for reconsideration were denied. Regarding the claimant's reconsideration request, Adjudicator Grant held that the Tribunal did not make an error of law in finding that...

October 20, 2020

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T.M. v. Aviva General Insurance (18-010477)

The claimant sought reconsideration of the Tribunal's decision dismissing his claim for IRBs. The insurer sought reconsideration of the Tribunal's decision that it was not entitled to repayment. Both requests for reconsideration were denied. Regarding the claimant's reconsideration request, Adjudicator Grant held that the Tribunal did not make an error of law in finding that...

October 14, 2020

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Baranov v. Aviva General Insurance (19-011094)

The claimant applied to the LAT disputing the quantum of IRBs he was entitled to. He also claimed the denied portions of two psychological treatment plans. The claimant was self-employed prior to the accident as a renovation contractor. He elected to use the 52 weeks of earnings prior to the accident rather than the last...

October 14, 2020

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B.E.T. v. Wawanesa Mutual Insurance Company (19-008722)

The claimant applied to the LAT in relation to NEBs, which had been denied on January 28, 2016. In January 2019 the claimant submitted an OCF-19 for a catastrophic impairment designation. The IEs agreed with the OCF-19 and the claimant was granted a catastrophic impairment. The LAT application was made in December 2019 for NEBs....

October 13, 2020

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K.K. v. Aviva General Insurance (18-012611)

The claimant sought entitlement to post-104 week IRBs, physiotherapy, and a special award. Adjudicator Mather granted the claim for ongoing IRBs, but dismissed the claim for further physical therapy. She also granted a special award of 50 percent on IRBs. The claimant was a self-employed taxi driver for over a decade prior to the accident....

October 13, 2020

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Basi v. RSA Insurance (19-013296)

The claimant sought entitlement to NEBs. The insurer argued that the dispute was time barred. Adjudicator Farlam held that the denial of NEBs was clear an unequivocal, and that it was delivered to both the claimant and the claimant's legal representative. The LAT application was made more than three months after the expiry of the...

October 9, 2020

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Moore v. Certas Direct Insurance Company (19-008177)

The self-employed claimant was injured when a garage door fell on his head during the delivery of a parcel. He applied for accident benefits, which the insurer denied. Adjudicator Norris held that the incident was not an accident for SABS purposes. The parties agreed that the purpose test was met, as the delivery of a...

October 9, 2020

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C.S. v. Echelon General Insurance Company (19-012146)

The claimant sought $12,763 for lost educational expenses. The insurer had approved $2,596 for lost tuition. The remainder of the claim was for lost grants and loans, which the insurer had denied. The claimant argued that those amounts were intended to help pay for tuition, supplies, and housing. The insurer argued that those claims do...

October 9, 2020

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Landa v. The Dominion of Canada General Insurance Company (19-011699)

The claimant sought entitlement to IRBs, housekeeping expenses, and various medical benefits. The insurer argued that the application was barred by the limitation period. Vice Chair McGee held that the insurer's denials were clear and unequivocal, regardless of whether they were correct to deny the benefits. With regard to section 7 of the LAT Act,...

October 8, 2020

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V.G. v. Western Assurance Company (18-005817)

The 20 year old claimant was involved in an accident in 2014, suffering various orthopaedic injuries and a head injury. He entered a full and final settlement in April 2016. In June 2016, he underwent a capacity assessment, and the assessor concluded that the claimant lacked capacity. Based on the assessment, the claimant through counsel...

October 7, 2020

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J.O. v. Aviva Insurance Canada (19-007565)

The claimant disputed his entitlement to various treatment plans. The insurer argued that the claimant and his treatment provider failed to comply with section 38(2), 49.1, and 64 of the SABS, and that none of the treatment plans were payable. Adjudicator Grant held that each of the noted provisions were mandatory and the claimant's failure...

October 7, 2020

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Polidori v. Motor Vehicle Accident Claims Fund (19-009160)

The claimant sought entitlement to an in-home assessment and a special award. The insurer had an occupational therapy IE to address the proposed assessment. The questions posed to the occupational therapist were suggestive of the answers the Fund wished to receive. The occupational therapist assessed the claimant's abilities, but was unable to diagnose the cause...

October 7, 2020

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J.J. v. Jevco Insurance (18-012155)

The insurer sought reconsideration of the Tribunal's decision that the claimant's newly purchased motorcycle was insured under the policy as a "newly acquired automobile". The insurer's arguments were primarily based on failure to follow two Superior Court decisions. Vice Chair Flude rejected the reconsideration, holding that he did not make an error that would change...

October 7, 2020

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J.J. v. Jevco Insurance (18-012155)

The insurer sought reconsideration of the Tribunal's decision that the claimant's newly purchased motorcycle was insured under the policy as a "newly acquired automobile". The insurer's arguments were primarily based on failure to follow two Superior Court decisions. Vice Chair Flude rejected the reconsideration, holding that he did not make an error that would change...

October 6, 2020

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Heartland Farm Mutual Inc. v. Desjardins (19-008574)

The insurer sought repayment of $9,197.65 in IRBs it had paid to the claimant. The claimant's initial application stated that he had been working at the time of the accident, and an OCF2 was submitted with income information supporting $303.65 per week in payments. The insurer was eventually provided with two Records of Employment that...

October 5, 2020

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R.M. v. Certas Home and Auto Insurance Company (18-007521)

The claimant requested reconsideration of the Tribunal's decision that her claim for NEBs and medical benefits was barred by the limitation period. She argued that the Tribunal should have applied Tomec v. Economical to conclude that the claimant could not have discovered her claim until receiving an MRI result. Adjudicator Johal dismissed the reconsideration. He...

October 5, 2020

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K.A.J. v. Aviva General Insurance (19-007068)

The claimant sought entitlement to a chronic pain assessment. Adjudicator Goela held that the assessment was not reasonable and necessary, and not payable. Additionally, she held that the treatment plan did not comply with section 38(3) as it was not signed by the claimant or the proposed assessor, nor did assessor provide information or opinion...

October 5, 2020

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R.M. v. Certas Home and Auto Insurance Company (18-007521)

The claimant requested reconsideration of the Tribunal's decision that her claim for NEBs and medical benefits was barred by the limitation period. She argued that the Tribunal should have applied Tomec v. Economical to conclude that the claimant could not have discovered her claim until receiving an MRI result. Adjudicator Johal dismissed the reconsideration. He...

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Contact Us

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

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

416.507.1850

eodonnell@tgplawyers.com