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 8, 2020

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B.E. v. The Personal Insurance Company (18-012331)

The insurer had initially treated the claimant with the MIG, but removed her from the MIG following receipt of medical records. Despite being removed from the MIG, the claimant sought an order that the MIG was unconstitutional. Adjudicator Boyce held that the Tribunal did not have jurisdiction to address the Charter challenge because the dispute...

June 5, 2020

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O.S. v. Certas Home and Auto Insurance Company (18-006633)

The claimant disputed entitlement to three treatment plans for chiropractic services, an orthopaedic assessment, and a neuropsychological assessment, as well as multi-disciplinary CAT assessments. Adjudicator Pinto ruled that all disputed plans were not reasonable or necessary based upon the evidence provided. In her decision, she noted that the disputed treatment plans did not provide medical...

June 3, 2020

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F.P. v. The Personal Insurance Company (19-001886)

The insurer denied payment of IRBs and NEBs on March 30, 2017. The claimant argued that he mistakenly claimed IRBs instead of NEBs and requested to correct the Application at a Case Conference on September 26, 2019. He further claimed that the denials by the insurer were not clear and unequivocal, but confusing, ambiguous and...

June 3, 2020

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J.V.D.A. v. Aviva General Insurance(19-002631)

The claimant sought payment of HST on attendant care services outside of the ACB limit. Aviva had paid a total of $1,829.62 in HST as charged by the AC service provider, but paid it from the ACB limits. The claimant argued that the payable HST was not subject to the ACB limit as set out...

June 3, 2020

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C.W. v. Aviva Insurance Company (19-002426)

The claimant sought removal from the MIG and entitlement to various medical benefits. Adjudicator Farlam found that the claimant sustained minor injuries in the accident. While the disability certificate noted COPD, mild stroke, right sciatica, low back pain, they appeared to be self-reported by the claimant, and there was no pre-accident medical records documenting the...

June 2, 2020

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N.I.F. v. Certas Home and Auto Insurance Company (19-004334)

The claimant's adult son was involved in a motorcycle accident and died as a result of the accident. A preliminary issue hearing was held to determine: (1) if the claimant was an "insured person" under the SABS at the time of the accident, and (2) whether the claimant was statute-barred from claiming benefits sought as...

June 1, 2020

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A.B. v. Aviva General Insurance (19-005231)

The claimant sought ongoing IRBs in the amount of $385. The adjudicator found that the claimant was not entitled to IRBs because the claimant failed to provide evidence from the employer or himself regarding his employment (other than differing self-reports to various assessors), and failed to provide sufficient medical evidence that he suffered a substantial...

June 1, 2020

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Q.N.N. v. Aviva Insurance Canada (19-003381)

The claimant sought IRBs in the amount of $400 per week and the cost of prescriptions. Adjudicator Farlam found that the claimant was not entitled to payment of IRBs because he had only submitted his 2016 T4 and failed to report his 2016 income to the CRA. The adjudicator held that it was unnecessary to...

June 1, 2020

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S.V. v. Aviva Insurance Canada (18-011347)

The claimant sought entitlement to ongoing NEBs, and medical benefits for physical therapy. With regard to NEBs, the claimant argued that the insurer failed to respond to the application within the timelines set out in section 36. Adjudicator Flude found that the insurer did not comply with its obligations under section 36(4)(b) of the SABS...

May 29, 2020

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L.C. v. Aviva Insurance Canada (18-008289)

The claimant attended IEs addressing her determination of a catastrophic impairment, but refused to allow the IE facility to release the assessment reports, arguing that the insurer's use of a third party to conduct the assessments violated her privacy rights and Charter rights. Adjudicator Norris held that the claimant's refusal to allow the IE facility...

May 28, 2020

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G.S. v. The Personal Insurance Company (19-001049)

The claimant sought various accident benefits. The insurer argued that the claimant was not involved in an accident, and alleged that he had made material misrepresentations. The insurer sought repayment of all accident benefits paid. Regarding the burden of proof, Adjudicator Hines held that the claimant had to prove that he was involved in an...

May 27, 2020

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K.P. v. CUMIS General Insurance (18-001556)

The claimant applied to the LAT seeking entitlement to pre- and post-104 IRBs, psychological treatment, and physical treatment. Adjudicator Letourneau found that, due chiefly to the pain management needs of the claimant and the diagnoses presented by treating practitioners, the claimant was entitled to the medical benefits in dispute. The claimant was not entitled to...

May 27, 2020

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M.A. v. Unifund Assurance Company (19-000209)

The claimant applied to the LAT seeking entitlement to pre- and post-104 IRBs, psychological treatment, and physiotherapy treatment. Adjudicator Go found that the claimant was entitled to pre-104 IRBs only. Adjudicator Go noted that although the claimant was taking anti-depression medication, she had failed to complete all her sessions with a social worker, she had...

May 27, 2020

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C.P. v. Aviva General Insurance (19-002331)

The claimant applied to the LAT seeking entitlement to a chronic pain assessment and physiotherapy treatment. The insurer sought a determination that the claimant was barred from proceeding to the LAT on the basis that she failed to attend s. 44 assessments. Adjudicator Grant found that the claimant failed to attend s. 44 assessments on...

May 27, 2020

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G.S. v. Western Assurance Company (19-003626)

The claimant applied to the LAT seeking entitlement to occupational therapy services proposed in one treatment plan. Causation was an issue at the hearing. The insurer submitted that the claimant's concussion symptoms were caused by documented pre- and/or post-accident incidents, and not caused by the subject accident. The claimant submitted that the pre-accident incident, the...

May 27, 2020

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D.M. v. Aviva Insurance Company (17-006525)

This is a re-hearing decision heard in writing after the insurer made a request for reconsideration on the basis that the LAT made significant errors of fact and law in the initial hearing decision. The issue was whether post-accident money received by the claimant was a gift or income that was deductible from IRB payments....

May 27, 2020

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J.R. v. Aviva General Insurance Company (19-007539)

The insurer filed a request for reconsideration of a motion decision extending the time for exchange of documents and the production of log notes. Pursuant to the amended rule 18.1 of the Common Rules of Practice and Procedure, Associate Chair Jovanovic dismissed the request for reconsideration as it was in regard to a decision that...

May 27, 2020

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T.B. v. Echelon General Insurance Company (19-001347)

The claimant sought a determination that she suffered a catastrophic impairment due to a Class 4 Marked Impairment in either concentration, persistence, and pace, or adaptation. Adjudicator Ferguson held that the claimant did not satisfy the criteria to meet a Class 4 marked impairment in either category. While the claimant did suffer mental impairments as...

May 27, 2020

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A.W.A. v. Certas Home and Auto Insurance (18-007207)

The claimant sought entitlement to IRBs, a series of catastrophic impairment assessments, and further physiotherapy. Adjudicator Gosio awarded IRBs up to the 104 week mark, but denied the remainder of the claims. The claimant worked as a machine operator, and his chronic neck pain inhibited his work. The claimant did not submit any evidence that...

May 27, 2020

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K.H. v. The Personal Insurance Company (18-009077)

The claimant sought entitlement to $26,000 in catastrophic impairment assessments. Adjudicator Ferguson concluded that none of the proposed assessments were reasonable. The claimant had very few visits to his family physician, and very little treatment; he did not use any prescription medications; there were no neurological impairments; he attended the gym; his mood was "okay";...

May 26, 2020

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C.B. v. Intact Insurance Company (18-011003)

The claimant was involved in an incident when she was shovelling her parking spot, which led to physical injuries. She applied to the insurer for accident benefits. The insurer denied payment of benefits on the basis that the incident did not fall under the definition of "accident" in the SABS. The incident was described as...

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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