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.

August 10, 2020

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N.P. v. Western Assurance Company (19-012841)

The claimant sustained a significant impairment as a result of an accident on November 24, 2013. The insurer accepted that the claimant was catastrophically impaired on February 24, 2014. The insurer denied ACBs and HK expenses on May 23, 2014. The claimant disputed entitlement in a FSCO arbitration, and the benefits were settled via a...

August 6, 2020

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I.D.F. v. Aviva General Insurance Company (19-008993)

The claimant sought entitlement to four treatment plans for physiotherapy and other goods and services. The claimant submitted that he suffered from chronic back pain and required constant treatment. He argued that without treatment and medication, his condition would regress and his daily activities and function were reduced. Adjudicator Boyce found that the claimant's reports...

August 6, 2020

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

The claimant disputed entitlement to the cost of CAT assessments in the amount of $22,400. The claimant argued that the proposed assessments were reasonable and necessary to determine whether or not she sustained a catastrophic impairment because "it is possible [she] may be catastrophically impaired, either under s. 3.1 of the Schedule, criteria 7 (whole...

August 6, 2020

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L.L. v Aviva Insurance Canada (18-001329)

Requests for reconsideration were filed by the claimant and the insurer in relation to a special award of $550 on a $2,200 assessment. The claimant sought an increase in the quantum awarded; the insurer argued that no special award ought to have been granted. Adjudicator Kepman dismissed both reconsideration requests, writing that the insurer had...

August 5, 2020

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M.Y. v. Wawanesa Mutual Insurance Company (19-003973)

The claimant sought reconsideration of the Tribunal's decision that she was barred from litigating her claim due to failure to attend two IEs. The insurer argued that the claimant's request for reconsideration was filed beyond the 21 as required in the Rules. Vice Chair Farlam noted that the request was only a single business days...

August 5, 2020

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S.D-T. v. Wawanesa Mutual Insurance Company (19-009280)

The claimant sought entitlement to IRBs and psychological treatment. A preliminary hearing was held to determine whether the claimant was statute barred from proceeding with her claim for failure to dispute the following issues within the two year limitation period. Vice Chair Farlam found the claimant's application was statute-barred and dismissed the claims. She found...

August 4, 2020

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H.M. v. Wawanesa Mutual Insurance Company (18-011655)

The claimant sought entitlement to pre-104 and post-104 weeks IRBs. The claimant was self-employed as a steel worker at the time of the accident and he owned 75 percent of a small steel fabrication business. Adjudicator Hans determined that the claimant established that he was substantially unable to perform the essential tasks of his pre-accident...

July 31, 2020

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M.L. v. Primmum Insurance Company (17-002915)

The claimant sought a determination that she suffered a catastrophic impairment due to a Class 4 marked impairment due to somatic symptom disorder. The insurer argued that the claimant had made functional improvement and that the impairments described by her assessors were brought on by the stressful nature of assessments. Adjudicator Mazerolle concluded that the...

July 31, 2020

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C.B. v. Allstate Canada (18-009967)

The claimant sought an order for the particulars of redaction in the adjuster log notes, the complete files from IE assessors, further log notes after the date of the LAT application related to section 33 requests and further IE requests, an updated payment summary, the particulars of whether the cost claimant's catastrophic impairment assessments were...

July 31, 2020

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Z.R. v. Certas Direct Insurance Company (18-001468)

The minor claimant sought a determination that he suffered a catastrophic impairment as a result of the accident due to traumatic brain injury under the post-2016 definitions. Section 3.1(1)5.i. of the SABS required that a person under 18 years of age be accepted for admission on an in-patient basis to a public hospital with positive...

July 31, 2020

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B.H.X. v. Aviva General Insurance (19-002556)

The claimant sought entitlement to NEBs, a psychological assessment, and the cost of a plastic surgery consult. Adjudicator Norris dismissed the claims for NEBs and plastic surgery consult, but awarded the psychological assessment. The claimant failed to provide evidence supporting NEB entitlement, and his self-reporting suggested he was in fact more active after the accident,...

July 31, 2020

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F.G. v. Aviva General Insurance (19-002587)

A preliminary issue hearing was held to address whether the limitation period barred the claimant's IRB dispute. Adjudicator Norris held that the limitation period applied. The IRB denial was clear and unequivocal, and the limitation period did not "restart" when the insurer re-iterated its denial of IRBs in subsequent correspondence. Adjudicator Gosio did not extend...

July 31, 2020

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F.K. v. TD Home and Auto Insurance Company (18-008114)

The claimant sought entitlement to NEBs, ACBs, and psychological treatment. Adjudicator Gosio rejected the claims for NEBs and ACBs, and found that the psychological treatment plan was disputed more than two years after the denial. The claimant failed to lead sufficient evidence that the accident was the cause of her impairments, as she had extensive...

July 30, 2020

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R.L. (Litigation Guardian) v. Allstate Insurance Company of Canada (18-005036)

A preliminary issue was heard as to whether the claimant's NEBs appeal was barred by the limitation period. Adjudicator Johal concluded that the limitation period barred the appeal and that the case did not warrant an extension under section 7 of the LAT Act. The claimant argued that she did not have the requisite mental...

July 30, 2020

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N.F. v. Aviva Insurance Canada (18-007077)

The claimant sought entitlement to IRBs and a chronic pain assessment. In addition to denying entitlement to the claimed benefits, the insurer disputed what the weekly quantum of IRBs would be. Adjudicator Mazerolle concluded that the claimant was entitled to IRBs and the chronic pain assessment. The claimant worked as a restaurant manager and his...

July 30, 2020

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K.A. v. Aviva General Insurance Company (19-002676)

The claimant sought entitlement to IRBs. The insurer argued that the claimant had failed to attend IE, and failed to comply with section 33 requests. Adjudicator Johal held that the claimant was barred from proceeding due to the IE non-attendance, reasoning that the IEs were reasonably required for determining entitlement to post-104 week IRBs even...

July 30, 2020

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A.L. v. The Guarantee Company of North America (19-003474)

The claimant initially sought entitlement to NEBs and the cost of two assessments. The insurer argued that the dispute was time barred. Prior to the preliminary hearing regarding the limitations argument the claimant withdrew her claim; the insurer still sought costs. Adjudicator Johal rejected the claim for costs, even though the claimant had made a...

July 30, 2020

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C.G. v. Pembridge Insurance Company (19-010979)

The claimant disputed entitlement to IRBs. The insurer raised a preliminary issue that the claimant had not applied for IRBs within the first 104 weeks following the accident and therefore could not receive IRBs. Adjudicator Johal agreed with the insurer. The claimant had not submitted a Disability Certificate within the first 104 weeks after the...

July 29, 2020

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Levey v. Aviva Insurance Company (19-006014)

The claimant applied to the LAT seeking entitlement to psychological services and the balance of a partially approved OCF-18 for driving lessons. Adjudicator Parish found that the claimant was not entitled to the disputed benefits. Adjudicator Parish noted that the OCF-18 for psychological services was completed by a psychologist, but the claimant previously received and...

July 29, 2020

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S.V. v. Aviva Insurance Company (19-005032)

The insurer initially denied a treatment plan based on the MIG, but did not respond to it for three weeks. The insurer later acknowledged that the denial was late and offered to pay for all incurred treatment, but did not provide an explanation for the delay. The claimant sought interest on the incurred treatment and...

July 27, 2020

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A.S. v. Intact Insurance Company (19-000979)

The claimant was involved in a motor vehicle accident in Alberta. At the time of the accident, he had an insurance policy that was sold in Alberta and was driving a vehicle that was registered in Alberta. He received benefits pursuant to the Alberta Automobile Accident Insurance Benefits and then claimed benefits under the SABS....

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Contact Us

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

416.507.1850

eodonnell@tgplawyers.com

© 2020 Thomas Gold Pettingill LLP