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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February 10, 2020

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Applicant v. RSA Insurance (19-000560)

The claimant sought a determination that he suffered a catastrophic impairment based on the impairment under the American Spinal Injury Associate (ASIA) Impairment Scale. The claimant's injuries met the required level of impairment, but the insurer argued that the injury was not yet permanent, which is a requirement under section 3.1(1)1(ii)B of the SABS, because...

February 7, 2020

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P.K. vs. Aviva Insurance Canada (18-011533)

The claimant disputed entitlement to a partially approved OCF-18 for psychological services in the amount of $3,591.87. The insurer paid $2,444.15 of the OCF-18 based upon the Professional Services Guideline for psychological services. Adjudicator Norris noted that the insurer was correct in its payment of the services within the PSG. He commented that the $224.42...

February 6, 2020

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Applicant v Economical Insurance Company (18-008443)

The insurer brought a preliminary issue hearing on the grounds that the claimant was barred from proceeding with her application for catastrophic determination and post-104 IRBs for failure to attend section 44 IEs. Adjudicator Boyce agreed with the insurer, and found that the claimant was barred from proceeding with her application. The insurer had a...

February 6, 2020

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W.F. v. Aviva Insurance Company (18-007724)

The insurer filed a request for reconsideration following a decision in which the Tribunal found that the insurer's section 33 request was reasonably necessary and upheld its suspension of NEBs. The insurer claimed that the suspension should have lasted for a longer period of time. The Tribunal found that the insurer's initial notice of suspension...

February 6, 2020

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J.C. v. Western Assurance Company (18-009726)

The claimant requested reconsideration of the Tribunal's previous decision which precluded her from proceeding to a hearing on IRBs for failure to attend IEs. IRBs were terminated based on orthopaedic and occupational therapy IE reports. The claimant provided the insurer with further medical documentation, and in turn, the insurer arranged for further IE reports to...

February 5, 2020

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R.C. v. Intact Insurance Company (18-010864)

The insurer brought a preliminary issue hearing on the grounds that the claimant was statute-barred from proceeding with his claim for IRBs for failure to commence the application within the two year limitation period. Adjudicator Victor agreed with the insurer, and held that the application was statute-barred. The insurer's letter denying the claimant's entitlement to...

February 5, 2020

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E.M. v. The Guarantee Company of North America (18-000674)

The claimant filed a request for reconsideration following a decision in which the Tribunal concluded that he was not entitled to NEBs or various medical benefits. The claimant argued that the Tribunal erred in law by not engaging the Heath analysis and not considering evidence tendered at the hearing. Adjudicator Punyarthi dismissed the reconsideration request,...

February 5, 2020

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E.M. v. The Guarantee Company of North America (18-000674)

The claimant filed a request for reconsideration following a decision in which the Tribunal concluded that he was not entitled to NEBs or various medical benefits. The claimant argued that the Tribunal erred in law by not engaging the Heath analysis and not considering evidence tendered at the hearing. Adjudicator Punyarthi dismissed the reconsideration request,...

February 4, 2020

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P.B. v. Aviva General Insurance Company(19-009287)

The claimant filed a request for reconsideration following a decision in which the Tribunal concluded that he was not entitled to NEBs. Adjudicator Watt noted that the claimant was trying to re-argue its case, and that a reconsideration is not an opportunity to reargue arguments that previously failed. As such, he dismissed the reconsideration request.

February 3, 2020

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L.V. v. Aviva Insurance Company of Canada (18-012245)

The claimant disputed his entitlement to NEBs. The claimant argued that he suffered from a complete inability to work and live his normal life because he had a psychological impairment and widespread pain as a result of his accident-related injuries. The insurer submits that the claimant failed to discharge his onus of proving he has...

February 3, 2020

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S.M. v. Aviva Insurance Canada (18-009096)

The insurer brought a preliminary issue hearing on the grounds that the claimant was barred from disputing his entitlement to NEBs for failure to submit a completed disability certificate certifying that she meets the criterion for NEBs. Although the claimant submitted an OCF-3 within 20 weeks of the accident, it indicated that the claimant did...

February 3, 2020

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Y.L.C. v. Gore Mutual Insurance Company (18-010499)

The claimant disputed his entitlement to chiropractic treatment and income replacement benefits. The insurer denied the proposed chiropractic treatment based on a physiatry IE report which found that further facility-based treatment would not be helpful. Vice Chair Lester nevertheless determined that the disputed treatment plan was reasonable and necessary, given the records from the treating...

February 3, 2020

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A.G. v. Allstate Canada (18-004980)

The claimant filed a request for reconsideration following a decision in which the Tribunal concluded that the claimant's death was not caused by the subject accident. The claimant argued that the Tribunal failed to properly analyze the evidence and over-exaggerated his pre-accident medical history. Adjudicator Watt dismissed the reconsideration request, finding that there was no...

February 3, 2020

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K.K. v. Coseco Insurance (18-002839)

The claimant disputed his MIG determination and entitlement to various medical benefits. The respondent raised a preliminary issue, arguing that the claimant was statute-barred from proceeding with his claim in respect of two of the disputed treatment plans for failure to dispute entitlement within the two year limitation period. Adjudicator Norris agreed, noting that the...

February 3, 2020

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A.A. v. Technology Insurance Company Inc. (18-007493)

The claimant sought removal from the MIG and entitlement to chiropractic services and rebuttal assessments. Adjudicator Paluch concluded that the claimant suffered from chronic pain syndrome, which was not simply a clinically associated sequela to his minor injuries. There was also evidence of disc bulges, protrusion and canal stenosis which are not minor injuries. The...

January 31, 2020

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J.F. v. Aviva General Insurance Company (18-012511)

The insurer brought a preliminary issue hearing on the grounds that the claimant was barred from commencing a proceeding for failure to attend NEB IEs. The insurer made several attempts to schedule NEB IEs, in response to which the claimant asked for the IEs to be rescheduled. The IEs were ultimately scheduled to take place...

January 28, 2020

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M.A. v. TD General Insurance Company (18-005141)

The claimant applied to the LAT seeking entitlement to NEBs. Causation was an issue at the hearing. Adjudicator Johal held that the test to determine causation is the "but for" test. The claimant submitted that he had one episode of psychosis a couple of months prior to the accident, but a formal diagnosis of psychosis...

January 27, 2020

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J.P. v. Royal Sun Alliance (18-006654)

The insurer sought a determination that the claimant was barred from proceeding to the LAT on the basis that he failed to attend insurer's CAT assessments. The claimant took the position that he was not required to attend the assessments as the insurer failed to set out the medical and other reasons for requiring the...

January 27, 2020

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K.W. v. Aviva Insurance Company (18-006959)

The claimant applied to the LAT seeking entitlement to IRBs, the benefits proposed in two treatment plans, and a special award. The insurer conceded that the claimant qualified for IRBs during the disputed period but contested the quantum of IRBs being claimed. Adjudicator Watt held that post-accident "passive" income earned by a claimant was to...

January 27, 2020

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N.L. v. Aviva Insurance Company (18-011431)

The claimant applied to the LAT seeking entitlement to chiropractic treatment, a psychological assessment, and an orthopaedic assessment. The insurer raised the preliminary issue of whether the claimant was barred from proceeding with her claim for the psychological assessment as she failed to submit to an insurer's examination. Adjudicator Maleki-Yazdi found, pursuant to s. 55...

January 24, 2020

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J.V.M v. Aviva General Insurance Company (18-009606)

A preliminary issues hearing was held to determine whether the insurer was barred from claiming a repayment of IRBs. The claimant argued that the insurer's request was made outside of the 12 month period permitted by section 52. Adjudicator Grant held that the insurer was not barred from claiming a repayment of IRBs, as the...

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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