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 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...

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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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 2, 2020

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Amitofski v. Traders General Insurance Company (19-008148)

The claimant sought entitlement to NEBs and further physiotherapy treatment. Adjudicator Johal dismissed both claims. He held that the claimant failed to provide evidence of her pre-accident and post-accident activities, so the Tribunal could not consider what change was caused by the accident. He also noted that the claimant was on ODSP for 20 years...

October 1, 2020

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E.Z. v. Co-operators General Insurance Company (19-006441)

The claimant applied to the LAT disputing entitlement to IRBs. The insurer paid IRBs prior to the hearing. The claimant requested a special award. Adjudicator Maleki-Yazdi granted a special award of 15 percent on the late payment of IRBs. She held that the insurer's decision to not pay IRBs until after an EUO almost 12...

October 1, 2020

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TD General Insurance Company v. Altaweel (19-010100)

The insurer sought repayment of $1,114.60 that had been paid to the claimant rather than to a court reporter for the cost of an EUO. The claimant never responded to the insurer's requests for repayment, nor did he participate in the LAT dispute. Adjudicator Boyce awarded the insurer repayment. He held that the funds had...

September 30, 2020

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K.L. v. Aviva Insurance Company (19-004368)

The sole issue in dispute was whether the claimant was entitled to a special award under Ontario Regulation 664. The insurer initially denied a treatment plan, and referred the claimant to an IE to determine whether the plan was reasonable and necessary. Upon receipt of the IE reports, the insurer wrote to the claimant confirming...

September 29, 2020

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Staszewski v. Intact Insurance Company (19-012409)

The claimant applied to the LAT seeking entitlement to pre- and post-104 IRBs. Three medicolegal reports noted the claimant had returned to work in some capacity since the accident. The insurer suspended the claimant's entitlement to IRBs pursuant to section 33 of the SABS for failure to provide documentation regarding post-accident employment and income. The...

September 28, 2020

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B.M. v. Unica Insurance Inc. (19-009381)

The claimant sought entitlement to two medical benefits for physiotherapy and occupational therapy services. The claimant had a significant pre-accident medical history that included a workplace accident, two separate motor vehicle accidents in 2013, chronic lumbar radiculopathy, and chronic lower back pain. He was also involved in a subsequent motor vehicle accident in 2016 after...

September 28, 2020

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P.S. v. Allstate Insurance (18-012633)

The claimant was seriously injured in a 2013 accident and sought a determination that he suffered a catastrophic impairment due to a combined WPI of 55 percent. He also sought entitlement to three treatment plans for further physiotherapy and psychotherapy. The claimant suffered from chronic pain and abused opioids as a result of his injuries....

September 24, 2020

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A.J. v. Aviva General Insurance (19-010794)

The claimant disputed entitled to two treatment plans for physiotherapy and chiropractic services. The insurer disputed the claimant's entitlement based upon IE reports, and argued that new evidence was submitted in the claimant's reply submissions were prejudicial. The insurer, by way of motion, requested that the new evidence was improperly submitted and requested it be...

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Contact Us

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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