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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December 4, 2018

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R.M. v. Unica Insurance Inc. (17-007500)

The claimant exhausted his medical benefits coverage and sought payment of catastrophic impairment assessment outside of the medical benefits limits. He sought a total of $9,718. The insurer argued that it was not required to pay for assessments outside of the medical limits, and in the alternative, that one of the proposed assessments was not...

December 4, 2018

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P.J. v. Aviva Insurance Company (18-001418)

The insurer sought reconsideration of the order that it produce unredacted log notes and that the claimant was not required to provide the particular of the special award claim until after receipt of the log notes. Vice Chair Trojek held that the insurer was to provide the log notes up to the date the LAT...

December 3, 2018

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S.M. v. Certas Home and Auto Insurance Company

The claimant sought entitlement to medical benefits and removal from the MIG. The insurer argued that one of the treatment plans was barred by the limitation period, and should be dismissed. Adjudicator Norris agreed that one of the treatment plans could not be disputed because it was dispute more than two years after the denial....

November 30, 2018

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D.T. v. Aviva General Insurance (17-004698)

The claimant sought entitlement to two treatment plans for physical therapy. Adjudicator Norris awarded the treatment plan for chiropractic services but denied the treatment plan for physiotherapy services. He held that the chiropractic services made the claimant more functional. The claimant failed to provide evidence that physiotherapy was needed.

November 28, 2018

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Applicant v. The Dominion of Canada General Insurance Company (17-006860)

The claimant sought entitlement to NEBs and various medical benefits. Adjudicator Kepman denied all claims. She held that the claimant's post-accident presentation was largely the same as the pre-accident presentation, and that he was receiving disability support payments prior to the accident due to significant impairments and disabilities. The claimant's wife assisted with most activities...

November 27, 2018

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A. AH. v. Royal Sun Alliance Insurance (17-006850)

The claimant sought entitlement to the cost of various prescription medications. Adjudicator Letourneau found that some of the prescriptions in dispute were reasonable and necessary as a result of the accident.

November 27, 2018

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K.B. v. Echelon General Insurance Company (18-000655)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to benefits proposed in two treatment plans. Adjudicator Sewrattan found that the claimant's injuries fell outside of the MIG due to a diagnosis of accident-related concussion and post-concussion symptoms. The claimant was found entitled to the in-dispute driving rehabilitation and...

November 20, 2018

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K.H. v. Unifund Insurance Company (17-007586)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to benefits proposed in three treatment plans. Adjudicator Ferguson found that the claimant's injuries fell within the MIG and that the treatment plans in dispute were not payable as the MIG limits had been exhausted.

November 16, 2018

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H.S. v. Allstate Insurance Company (17-007264)

The claimant was in an accident in August 2016. She argued that the pre-June 1, 2016 definition of catastrophic impairment should apply to her claim because her policy had not renewed. Adjudicator Neilson disagreed with the claimant and held that section 2 of the SABS unambiguously stated that the new catastrophic impairment definition applied to...

November 16, 2018

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H.C. v. Allstate Insurance Company (17-007262)

The claimant was in an accident in August 2016. He argued that the pre-June 1, 2016 definition of catastrophic impairment should apply to his claim because his policy had not renewed. Adjudicator Neilson disagreed with the claimant and held that section 2 of the SABS unambiguously stated that the new catastrophic impairment definition applied to...

November 13, 2018

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Applicant v. Aviva Insurance Canada (17-003957)

The claimant sought entitlement to medical benefits for physical and psychological therapy. Adjudicator Goela awarded all of the claimed benefits. She held that the claimant suffered from chronic pain and psychological injuries. She relied upon the records of the family physician which supported the need for ongoing treatment.

November 8, 2018

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L.J. v. The Personal Insurance Company (17-004701)

The claimant sought an order removing the insurer's counsel because the same counsel had acted for the insurer in the priority dispute. The claimant also sought to exclude the transcripts from the priority examination under oath. Vice Chair Trojek granted reconsideration and barred counsel from representing the insurer in the LAT dispute. She also barred...

November 8, 2018

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P.Y.J. v. The Personal Insurance Company (17-004636)

The claimant sought an order removing the insurer's counsel because the same counsel had acted for the insurer in the priority dispute. The claimant also sought to exclude the transcripts from the priority examination under oath. Vice Chair Trojek granted reconsideration and barred counsel from representing the insurer in the LAT dispute. She also barred...

November 7, 2018

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J.M. v. Certas Home and Auto Insurance Company (18-001406)

The claimant was involved in an accident in 1997. She applied for a catastrophic impairment determination in 2007, which found that she did not meet the definition. She did not dispute the determination. In 2016 she submitted a new OCF-19 seeking a catastrophic impairment determination and sought payment for assessments in that regard. The insurer...

October 31, 2018

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H.M. v. Aviva Insurance Canada (17-005588)

The claimant sought entitlement to IRBs. The only issue in dispute was the quantum of IRBs payable. The claimant submitted that she earned $1,500 gross income in the 4 weeks pre-accident whereas the insurer submitted that based on the evidence, the claimant earned $700 gross income in the 4 weeks pre-accident. Adjudicator Neilson found that...

October 31, 2018

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P.F. v. Aviva Insurance (18-002458)

The claimant sought entitlement to NEBs. Adjudicator Boyce held that the claimant did not demonstrate a complete inability to live a normal life. Adjudicator Boyce held that while the claimant's pain affected her activities of daily living, it did not prevent her from independent self-care or complete engagement in her daily activities. Adjudicator Boyce noted...

October 31, 2018

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Intact Insurance Company v. Lanziner-Brackett (2018 ONSC 6546)

The insurer sought judicial review of the Tribunal's decision that the claimant was involved in an accident, and also sought judicial review of the Case Conference adjudicator's framing of the dispute. The claimant had been struck by the door of a vehicle twice, and then physically assaulted by the driver of the vehicle. The insurer...

October 30, 2018

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N.B. v. Aviva Insurance Canada (17-006736)

The claimant sought entitlement to NEBs and various medical/rehabilitation benefits. The hearing proceeded in-person and by writing. Adjudicator Boyce concluded that the claimant did not suffer a complete inability to carry on a normal life. Adjudicator Boyce noted that while the claimant's injuries prevented her from returning to some of her pre-accident activities of daily...

October 30, 2018

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M.G. v. RBC Insurance Company (17-007098)

The claimant disputed his entitlement to NEBs and various medical/rehabilitation benefits. The dispute proceeded by way of a written hearing. Adjudicator Boyce held that while the claimant suffered from pain, the claimant managed his pain and it did not prevent the claimant from engaging in self-care and in his daily activities. Adjudicator Boyce noted that...

October 29, 2018

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P.P. v Portage La Prairie Mutual Insurance Company (17-008689)

The claimant disputed her entitlement to eight treatment and assessment plans and post-104 week IRBs. Adjudicator Kershaw awarded all of the medical benefits in dispute, save for a portion of a treatment plan that sought funding for a weighted vest. With respect to the weighted vest, Adjudicator Kershaw agreed with the IE neurologist's opinion that...

October 29, 2018

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E.S. v Aviva Insurance Canada (18-000456)

The claimant sought entitlement to the balance of a partially approved chronic pain assessment treatment plan and interest. Adjudicator Victor awarded the balance of the treatment plan, less transportation expenses, and interest on the overdue payment of benefits. Adjudicator Victor noted that she arrived at her decision largely in part due to the claimant's credibility...

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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