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.

March 9, 2023

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Krzweski v. CUMIS General Insurance Company (20-013665)

The claimant disputed entitlement to a chronic pain assessment and a psychological assessment. The claimant argued that in denying these plans, the insurer did not specify a medical basis for the denial or request further medical documentation from the claimant. The claimant further contended that the insurer failed to provide a medical ground for maintaining...

March 6, 2023

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Amalathasan v. Certas Home and Auto Insurance Company (21-006393)

The claimant applied to the LAT for entitlement to medical benefits outside of the MIG. Adjudicator Cavdar found that the issue of whether the claimant sustained predominantly minor injuries was already determined by the LAT in a 2020 decision and was, therefore, res judicata. Accordingly, the claimant remained in the MIG and was not entitled...

March 6, 2023

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Hutchinson v. Aviva General Insurance Company (2023 ONSC 1472)

The claimant appealed the Tribunal's decision that she was not entitled to various medical benefits. The claimant argued that the Tribunal's refusal to convert the videoconference hearing to a written hearing was a breach of procedural fairness and natural justice. The claimant's counsel had argued that the claimant was unable to participate in the hearing...

February 28, 2023

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Panchadcharam v Aviva Insurance Company (20-013921)

The claimant initially applied to the LAT regarding a MIG determination and various denied OCF-18s. Prior to the LAT Case Conference, Aviva removed the claimant from the MIG and approved all disputed treatment, leaving only a special award in dispute. The claimant argued that they were entitled to a special award as Aviva had maintained...

February 28, 2023

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Chu v. Unica Insurance Inc. (20-001934)

The claimant applied to the LAT for a catastrophic impairment designation under Criteria 8. She had already exhausted her $65,000 non-CAT policy limit. The claimant bore the onus of proving on a balance of probabilities that she had a “Marked” or Class 4 impairment in at least three of the four domains set out in...

February 28, 2023

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Calderon v Allstate Canada (20-013275)

The main issue in this matter was whether the claimant was barred from pursuing accident benefits due to entitlement to WSIB benefits. The adjudicator found that the claimant was statute-barred under section 61 of the SABS, which states that insurers are not required to pay benefits to individuals entitled to workers’ compensation benefits. Despite the...

February 27, 2023

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Khalaf v The Dominion of Canada General Insurance Company (20-000264)

The claimant was involved in an accident on October 19, 2016, and applied for accident benefits. The dispute involved the insurer denying catastrophic impairment under criterion 8, based on the s. 44 psychiatry IE of Dr. Sivasubramanian, and involved a 7-day videoconference hearing. Initially, Dr. Sivasubramanian had opined that the claimant suffered 2 Class 4...

February 27, 2023

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Ali v The Co-operators General Insurance Company (20-006796)

The claimant applied to the LAT seeking entitlement to NEBs and interest. During the written hearing, the claimant sought to add a claim for a special award. The Co-operators sought to strike 2 pages of the claimant's submissions as they were over the 10 page limit ordered at the Case Conference. Furthermore, they sought to...

February 27, 2023

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Boni v CAA Insurance Company (20-007645)

The claimant applied for CAT designation for injuries arising from a 2017 accident. The insurer acknowledged that the claimant was catastrophically impaired, but argued that he had already been impaired before the accident occurred. The insurer argued that the claimant had been taking prescription medications for depression and sleep difficulties before the accident. The claimant...

February 24, 2023

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Kumar v. Aviva Insurance Company (21-002087)

The claimant applied to the LAT for entitlement to post-104 week IRBs. Prior to the accident, the claimant was employed as a manual labourer and had prior experience working as a retail salesclerk. The claimant argued that he was entitled to post-104 week IRBs based on his various accident-related physical and psychological impairments, including a...

February 24, 2023

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Thiyagarajah v Economical Insurance (21-001866)

The claimant was entitled to WSIB benefits. The issue in dispute at the LAT hearing was whether his election to claim benefits under the SABS was primarily to receive those benefits or to pursue a tort action against the at-fault driver. The insurer argued that the claimant's election was primarily for claiming benefits, as he...

February 23, 2023

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Amadiegwu v. Aviva General Insurance Company (2023 ONSC 1256)

The claimant appealed the Tribunal's decision dismissing her claim for IRBs. The Court dismissed the appeal holding that there was no extricable question of law. The Court also rejected the arguments that the Tribunal process lacked procedural fairness or that the Tribunal did not apply the correct test for causation.

February 22, 2023

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Shahin v. Intact Insurance Company (21-002418)

The claimant applied to the LAT for a determination that she was catastrophically impaired under Criterion 8. The claimant struggled with anxiety due to pre-existing health issues, for which she received treatment prior to the accident. It was thus incumbent upon the claimant to demonstrate on a balance of probabilities that, but for the accident,...

February 21, 2023

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Jin v Certas Home and Auto Insurance Company (20-011392)

The claimant was involved in an accident on July 16, 2019 and sought accident benefits. Certas had initially kept the claimant within the MIG and denied various medical benefits. The claimant filed a LAT Application in response to the MIG designation and denials. Following various s. 44 IEs, Certas removed the claimant from the MIG...

February 17, 2023

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C.S. v Travelers Insurance (20-014495)

The claimant was injured in an accident in 2014. She applied to the LAT seeking a catastrophic impairment determination under Criteria 8. Adjudicator Lake found that a failure to return to one's pre-accident employment is not on its own evidence of a Class 4 "marked" impairment in the domain of Adaptation and determined that the...

February 16, 2023

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Pec v Certas Direct Insurance (21-009610)

The claimant claimed accident benefits in relation to injuries sustained in a confrontation after an alleged road rage incident. The insurer argued that this did not constitute an "accident" under the SABS. The adjudicator, applying a two-part test, found that while the incident arose from the use of the vehicle, the injuries were not directly...

February 16, 2023

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Sookbir v. Wawanesa Insurance (20-008613)

The insurer and the claimant disputed at a preliminary issue hearing whether the claimant's IRB claim ought to be barred for a failure to submit a completed OCF-3 to the insurer. The claimant submitted an OCF-3 form which indicated that she was not working in the 26 weeks before the accident and that she did...

February 15, 2023

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Wicks v Intact Insurance Company (20-011457)

The claimant disputed entitlement to vocational/academic training services, a mattress, a massage chair, and a Stairmaster. The Tribunal found that the claimant did not meet the burden of proving that the disputed benefits were reasonable and necessary. Despite recommendations from occupational therapists and physicians, there was a lack of supporting medical evidence to justify the...

February 14, 2023

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Vaillancourt v. The Guarantee Company of North America (21-008125)

The claimant was previously deemed catastrophically impaired. He applied to the LAT to resolve a dispute concerning the quantum of certain benefits, including attendant care and home modifications. Prior to the accident, the claimant managed his own consulting company, was quite active, and regularly enjoyed doing housework. The insurer denied much of the claimant’s attendant...

February 10, 2023

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RBC General Insurance Company v Balasubramaniam (19-008701)

The claimant was involved in a motor vehicle accident in 2005. In 2010, FSCO ordered the insurer to pay the claimant IRBs. On July 22, 2019, the insurer applied to the LAT to have the LAT vary or revoke the 2010 FSCO order. Adjudicator Adamidis found that the LAT cannot vary or revoke an order...

February 8, 2023

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Gibson v. Intact Insurance Company (20-012060)

The claimant applied to the LAT for the approval of multiple treatment plans, including a treatment plan for a tractor. The insurer brought a motion to bar the claimant from disputing the entitlement to the tractor for failing to attend s. 44 IEs. The LAT added the claimant’s non-attendance at the IEs as a preliminary...

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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