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.

July 25, 2023

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C. B., T.G.B. and B.G.B v Belair Direct Insurance Company (22-002265)

The issue revolved around the family of the accident victim, JG, who was deemed psychologically catastrophically impaired as a result of witnessing her friend being struck and killed by a vehicle. JG's spouse and children applied for accident benefits claiming they had suffered psychological injury as a result of JG's psychological impairments. The claimants applied...

July 25, 2023

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Abdi v. TD General Insurance Company (2023 ONSC 3536)

The claimant appealed the Tribunal's decision that he did not suffer a catastrophic impairment, as he did not meet the Extended Glasgow Outcome Scale ("GOS-E"). In particular, the adjudicator preferred the assessments of the insurer which took place almost 24 months after the accident, rather than the assessments of the claimant which took place around...

July 18, 2023

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D.I. v. TD General Insurance Company (19-013437)

The claimant was a minor whose father was involved in an motor vehicle accident. The claimant was autistic and was largely cared for by his mother. The father and mother separated years prior to the accident. The father was a listed driver on his mother-in-law's insurance policy with TD. The claimant applied for accident benefits...

July 14, 2023

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Rawal v. Economical Insurance (21-007975)

The claimant sought entitlement to IRBs, medical/rehabilitation benefits, a psychological assessment, and the cost of an accountant's report. The respondent denied the claims for medical and rehabilitation benefits because it determined that the claimant's injuries fell within the MIG. Adjudicator Neilson accepted that the claimant sustained a psychological impairment as a result of the accident...

July 11, 2023

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Bashiruddin v. TD General Insurance Company (21-008274)

The claimant sought entitlement to a special award and interest on an approved OCF-18 for a psychological assessment. The claimant was involved in an automobile accident in September 2018. In March 2020, the respondent contacted the claimant about scheduling section 44 IE assessments to determine her eligibility to receive benefits. These assessments were rescheduled several...

July 4, 2023

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Rathbone v. Co-operators General Insurance Company (22-009104)

The claimant was stopped at a drive-thru window at Tim Hortons. His vehicle was in drive mode. As he transferred the coffee cup, the lid came off and the upper brim of the cup collapsed inwards, spilling coffee over the sides of the cup and onto his lap. The respondent raised a preliminary issue, taking...

June 30, 2023

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Luluquisin v. Aviva Insurance Company of Canada (2023 ONSC 3912)

The claimant sought judicial review of the Tribunal's decision regarding the quantum of ACBs awarded, and entitlement to various medical benefits. The insurer argued that the decision should have been appealed, rather than the subject of judicial review. The Court agreed with the insurer, holding that judicial review was not warranted and that the Court...

June 29, 2023

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Shaver v. Onlia Insurance Company

The claimant applied to the LAT seeking entitlement to accident benefits. He was involved in a motor vehicle accident as a pedestrian. The main issue was whether the claimant was barred from proceeding to a hearing as he failed to notify the insurer of the circumstances giving rise to a claim for benefits no later...

June 27, 2023

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L.D. v. Gore Mutual Insurance Company (18-011978)

The claimant sought entitlement to IRBs and a special award relating to a three year prior where she did not attend IEs. The Tribunal dismissed the claim, holding that the insurer had given proper IE notices, and that the claimant did not have a reasonable explanation for failing to attend the IEs. The claimant raised...

June 23, 2023

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[K.M.] v. Aviva Insurance Canada (22-000554)

The claimant sought benefits, including increased monthly rental costs, home renovations and a wheelchair accessible vehicle, after sustaining a catastrophic impairment. Prior to the hearing, the insurer approved all treatment plans at issue, leaving only a special award in dispute. The claimant argued that they were entitled to a special award as the insurers adjusting...

June 23, 2023

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Doran v Gore Mutual Insurance Company (20-013924)

The claimant sustained a CAT impairment and sought ACBs from the insurer. The insurer initially provided ACBs at $6,000 per month, but benefits were reduced to $4,339.71 and later cut to $1,040.10, based on the determination that she no longer required basic supervisory care and mobility assistance. The claimant disputed these reductions. The LAT ruled...

June 22, 2023

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Novick v. RSA (21-008181)

The claimant was involved in an accident and sought benefits under the SABS. The insurer denied his claim, arguing that the vehicle involved—a backhoe—was not classified as an automobile, which would exempt it from SABS coverage. The claimant applied to the LAT to determine whether the backhoe qualified as an automobile. The SABS does not...

June 20, 2023

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Banga v. Certas Home and Auto Insurance Company (20-010495)

The claimant was involved in a motor vehicle accident on June 22, 2016. The policy of insurance was in place on May 18, 2016. The SABS was revised June 1, 2016. The revised SABS raised the threshold for determining catastrophic impairment pursuant to criteria F, from 1 of 4 class IV findings to 3 of...

June 20, 2023

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Khan v. Allstate Insurance Company (2023 ONSC 3652)

The claimant appealed the LAT's decision that he did not suffer a catastrophic impairment. The claimant argued that procedural fairness was denied because he did not know the insurer would argue that an intervening event was the cause of his impairments, and argued that the LAT applied the wrong causation test. The LAT dismissed the...

June 16, 2023

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Sparks v. TD General Insurance (21-015016)

The issues at the hearing were whether the respondent was entitled to a repayment for an overpayment of IRBs and whether the claimant was barred from pursuing IRBs pursuant to s. 31(1)(a)(ii) of the SABS. TD had the burden of proving that it was not liable to pay IRBs to the claimant because she was...

June 15, 2023

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J.T. v. Certas Home and Auto Insurance Company (19-001148)

The matter stemmed from a previous LAT Application in which Adjudicator Hines deemed an OCF-18 in the amount of $166,437.70 to be incurred pursuant to the SABS, and awarded the claimant an award equal to 25% of the OCF-18. Certas had issued payment for the OCF-18 on July 6, 2022, consisting of $166,437.70 for the...

June 15, 2023

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Kahissay v. Intact Insurance (2023 ONSC 3650)

Two claimants sought judicial review of the Tribunal Orders staying their applications while ordering the claimants to attend IEs prior to hearings on catastrophic impairment disputes. The Court held that the judicial review was premature and should not be heard. The cases did not raise exceptional circumstances, absent which the Court would not consider review...

June 8, 2023

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Anwar v. Travelers Insurance (21-000574)

The claimant was found not to have sustained a catastrophic impairment pursuant to criteria 4 of section 3.1 of the SABS. While it was agreed that the claimant had sustained a traumatic brain injury pursuant to a positive CT scan, the adjudicator concluded that the level of impairment caused by the brain injury was not...

June 7, 2023

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Soldatovas v. Wawanesa Mutual Insurance Company (2023 ONSC 3440)

The claimant appealed the Tribunal's denial of IRBs and a special award, arguing that the decision lacked procedural fairness, reasonableness, and did not consider key evidence. The Court dismissed the appeal, holding that the Tribunal provided the claimant with an opportunity to present his case, and holding that the Tribunal was not required to cite...

June 7, 2023

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Aviva Insurance Canada v. Harland-Bettany (2023 ONSC 3395)

The insurer appealed the Tribunal's decision that the claimant's slip and fall on ice met the definition of accident. The claimant's application included other disputes relating to accident benefits claims that were not yet decided. The Court held that the insurer's appeal was premature as the accident definition decision was interlocutory. The Court wrote that...

June 5, 2023

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Temple v. Economical Mutual Insurance Company (21-005510)

The preliminary issue in dispute was whether the claimant was barred, pursuant to s. 55(1)(3) of the SABS, from proceeding with the application as the claimant failed to provide information to the respondent in accordance with s. 46.2 and s. 46.3 of the Schedule. The respondent made multiple requests for the particulars pertaining to the...

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416.507.1850

eodonnell@tgplawyers.com

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com