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.

February 22, 2023

/

tgp-admin

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

/

tgp-admin

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

/

tgp-admin

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

/

tgp-admin

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

/

tgp-admin

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

/

tgp-admin

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

/

tgp-admin

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

/

tgp-admin

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

/

tgp-admin

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...

February 8, 2023

/

tgp-admin

Sagastume v. Allstate Insurance Company of Canada (20-014755)

The claimant disputed entitlement to ACBs and medical benefits that were denied because the claimant was within the MIG. The Tribunal found that the claimant failed to demonstrate that his injuries warranted removal from the MIG. The Tribunal rejected the argument that an insurer is required to re-schedule an IE within 10 days of an...

February 7, 2023

/

tgp-admin

Ciyayi v. Economical Insurance Company (19-005222)

The claimant suffered from a non-catastrophic impairment and applied to the LAT for attendant care and medical benefits. The claimant sought repayment for both non-professional and professional attendant care services. To establish that expenses for non-professional attendant care were “incurred” under s. 3(7)(e) of the SABS, a claimant must prove that a non-professional service provider...

February 7, 2023

/

tgp-admin

Nichols v. Gore Mutual Insurance Company (21-008322)

The claimant sought reconsideration of the Tribunal's decision that the late OCF-1 barred the application. The Tribunal found that the insurer had not provided the application package, yet found that section 32 applied. Adjudicator Kaur granted the reconsideration, holding that the 30 day deadline to submit the OCF-1 did not start running because the claimant...

February 6, 2023

/

tgp-admin

Varriano v. Allstate Insurance Company of Canada (2023 ONCA 78)

The insurer appealed the Divisional Court's decision that the limitation period on IRBs did not commence because the denial did not provide any medical reasons. The insurer argued that the only basis for denial was the claimant's return to work (i.e. an "other" reason), and that it was not required to state a medical reason...

February 6, 2023

/

tgp-admin

Aized v. The Co-operators (20-012300)

The claimant applied to the LAT for post-104 week IRBs and medical benefits, including physiotherapy services and an attendant care assessment. Prior to the accident, the claimant was employed as a student placement coordinator, which required concentration, critical thinking skills and sitting in front of a computer screen for prolonged periods of time. Despite returning...

February 6, 2023

/

tgp-admin

Al Dhoun v Aviva Insurance Company (20-009309)

The claimant disputed entitlement to non-earner benefits, medical assessments, and psychological services. The Tribunal found that the claimant did not meet the requirements for NEBs, as he failed to demonstrate a complete inability to carry on a normal life due to the accident. Despite medical evidence of ongoing impairments, the claimant did not establish the...

February 6, 2023

/

tgp-admin

Sexsmith v Certas Home and Auto Insurance Company (21-000943)

The claimant disputed the insurers decision that he was precluded from receiving specified benefits pursuant to s. 31 of the SABS. The claimant's uninsured motorcycle, which was involved in the accident, was not listed on any policy despite the claimant owning multiple vehicles and holding separate policies. The Tribunal found that the claimant failed to...

February 6, 2023

/

tgp-admin

Hassan v. Aviva Insurance Company of Canada (21-000811)

The claimant disputed entitlement to NEBs, ACBs, and a special award. As a preliminary motion, the insurer sought to exclude the claimant's CAT reports because they were not disclosed in accordance with the LAT order timelines. Adjudicator Prowse excluded the CAT reports because the documents were not exchanged in accordance with the order, and because...

February 3, 2023

/

tgp-admin

Khan v. Allstate Insurance Company of Canada (20-000806)

The claimant sought reconsideration of the Tribunal's decision that he did not suffer a catastrophic impairment. The claimant argued that the hearing was procedurally unfair and that the Tribunal applied the wrong test for causation. Adjudicator Neilson dismissed the reconsideration. She found that the claimant was aware of the insurer's position regarding causation, and as...

February 3, 2023

/

tgp-admin

Nouracham v. Aviva General Insurance Company (21-000224)

The claimant applied to the LAT for entitlement to IRBs. Prior to the accident, the claimant, who worked as an employee on an “on call” basis, had not been called upon to work for a period of six weeks. The insurer denied IRBs on the basis that the claimant was not eligible for IRBs because...

February 3, 2023

/

tgp-admin

Gagnon v Belairdirect (20-010307)

The claimant filed a LAT Application seeking a determination of catastrophic impairment under Criteria 8. At the outset of the hearing, the claimant raised a motion to have the insurer's psychology report excluded because the psychologist had passed away and could not be cross-examined. Adjudicator Norris allowed the insurer to rely on the report but...

February 3, 2023

/

tgp-admin

Stewart v Travelers Canada (21-008891)

This is a preliminary issues decision addressing whether the claimant was barred from applying to the LAT for attendant care benefits under s. 55(3) of the SABS for failure to comply with s. 46.2(1) of the SABS (i.e., the duty of a provider to provide information). The insurer argued that there was non-compliance with s....

Contact Us

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

416.507.1850

eodonnell@tgplawyers.com

© 2020 Thomas Gold Pettingill LLP Disclaimer | Privacy Policy | Statement of Principles

Powered by Crow & Pitcher

Subscribe to get TGP’s case summaries straight to your inbox

Subscribe to get TGP’s case summaries straight to your inbox

Contact Us

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

416.507.1850

eodonnell@tgplawyers.com

© 2020 Thomas Gold Pettingill LLP