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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August 14, 2020

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N.Z. v. Economical Insurance (18-009611)

The self-employed claimant disputed entitlement to IRBs, which the insurer was not paying because it had requested further income documentation which the claimant failed to provide. The insurer had suspended IRBs under section 33 until the claimant complied with the requests. As a preliminary matter, Adjudicator Mazerolle allowed the insurer to submit late surveillance reports...

August 14, 2020

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A.Q. v. Wawanesa Mutual Insurance Company (19-006903)

The claimant sought entitlement to ACBs and various medical benefits. The insurer argued that the limitation period barred the ACBs claim and that the claimant failed to attend IEs related to the medical benefits claimed and was unable to dispute entitlement until attending the IEs. Adjudicator Boyce held that the insurer's denial of ACBs in...

August 14, 2020

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A.D.W. v. Aviva Insurance Company (18-012150)

The claimant sought entitlement to NEBs and one treatment plan for physiotherapy. Adjudicator Watt dismissed both claims. The claimant did not provide evidence of the comparison of his pre-accident and post-accident life. Further, the claimant admitted to doctors that he was independent with personal care, gardening, cooking, and yard work. With regard to physical treatment,...

August 13, 2020

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A.M. v. Aviva General Insurance Company (19-004182)

The claimant sought entitlement to IRBs. The insurer argued that the limitation period applied. Adjudicator Grant agreed with the insurer and dismissed the claim. He found that the insurer clearly and unequivocally denied IRBs in January 2017 when she returned to work. The LAT application was filed in April 2019. Adjudicator Grant did not extend...

August 13, 2020

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C.G. v. The Guarantee Company of North America (17-007300)

The claimant had a number of pre-accident injuries and impairments. She suffered an exacerbation of her conditions in the accident. She sought entitlement to NEBs, removal from the MIG, and two assessment costs. The insurer argued that the claimant's impairments were not caused by the accident. Adjudicator Johal accepted that the accident did cause an...

August 13, 2020

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M.R. v. Aviva General Insurance Company (18-006946)

The claimant sought payment of treatment plans seeking chiropractic treatment and a chronic pain program. The claimant argued that some of the denials were non-compliant with section 38 of the SABS. The insurer argued that some of the treatment plans were denied more than two years after the denial and were time barred. Adjudicator Norris...

August 12, 2020

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S.S.L. v. Certas Direct Insurance Company (19-004473)

The claimant sought removal from the MIG and entitlement to IRBs, two treatment plans for chiropractic services, and cost of examination. Prior to the hearing, the claimant withdrew her claims for the medical benefits and the costs of examinations. Adjudicator Norris held that the claimant could not dispute the MIG if no medical or rehabilitation...

August 12, 2020

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K.H. v. Gore Mutual Insurance (18-009689)

The claimant filed a Request for Reconsideration arising out of a decision in which the Tribunal found the claimant entitled to medical benefits proposed in a treatment plan, but not entitled to a special award. The claimant argued that Adjudicator Norris erred in law or fact when considering her entitlement to a special award. Adjudicator...

August 12, 2020

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A.S. v. Certas Home and Auto Insurance Company (19-004994)

The claimant was involved in a 2009 accident. She sought entitlement to three assessments and a series of CAT assessments. An initial issue was raised as to whether section 25 of the post-2010 SABS applied, or if section 24 of the earlier SABS applied. The adjudicator held that section 25 of the 2010 SABS applied,...

August 11, 2020

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A.M. v. Certas Home and Auto Insurance (19-002869)

The claimant disputed entitlement to numerous treatments plans and ACBs in the amount of $6,142.59 per month from November 29, 2018 and ongoing. The claimant was diagnosed with Parkinson's Disease and Dementia pre-accident, as well as headaches and ear pain. The insurer argued that the benefits claimed were for the claimant's pre-existing conditions, and that...

August 11, 2020

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E.C. v. Northbridge Commercial Insurance Corporation (18-006384)

The claimant was involved in an accident on February 9, 2006 and disputed entitlement to a treatment plan for $25,659.25 proposing catastrophic assessments. The insurer argued that the claimant had sustained only minor, soft tissue injuries as a result of the subject accident and had not established that catastrophic assessments were either reasonable or necessary...

August 11, 2020

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V.O. v. Aviva General Insurance (19-002218)

The claimant sought entitlement to the cost of a psychological assessment. The insurer argued that the limitation period barred the claim. Adjudicator Driesel agreed that the proposed assessment was denied more than two years before the LAT application. The denial was mailed to the claimant, which is a permitted method under the SABS. While no...

August 11, 2020

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T.L.D. v. Aviva General Insurance Company (19-009050)

The claimant sought IRB, removal from the MIG, and various medical benefits. Adjudicator Grant held that the claimant failed to prove that the accident results in injuries preventing him from returning to his pre-accident employment in food delivery. He also concluded that the claimant's injuries fell within the MIG. With regard to a hospital expense,...

August 10, 2020

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K.V. v. Aviva General Insurance Company (19-006030)

The claimant sought entitlement to one treatment plan for chiropractic services. Adjudicator Cavdar concluded that the claimant had not adduced sufficient evidence to demonstrate that the proposed treatment plan was both reasonable and necessary. The decision was based on the fact that the treatment plans did not shed light on how the proposed chiropractic services...

August 10, 2020

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N.P. v. Western Assurance Company (19-012841)

The claimant sustained a significant impairment as a result of an accident on November 24, 2013. The insurer accepted that the claimant was catastrophically impaired on February 24, 2014. The insurer denied ACBs and HK expenses on May 23, 2014. The claimant disputed entitlement in a FSCO arbitration, and the benefits were settled via a...

August 6, 2020

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I.D.F. v. Aviva General Insurance Company (19-008993)

The claimant sought entitlement to four treatment plans for physiotherapy and other goods and services. The claimant submitted that he suffered from chronic back pain and required constant treatment. He argued that without treatment and medication, his condition would regress and his daily activities and function were reduced. Adjudicator Boyce found that the claimant's reports...

August 6, 2020

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R.M. v. Certas Home and Auto Insurance Company (18-007521)

The claimant disputed entitlement to the cost of CAT assessments in the amount of $22,400. The claimant argued that the proposed assessments were reasonable and necessary to determine whether or not she sustained a catastrophic impairment because "it is possible [she] may be catastrophically impaired, either under s. 3.1 of the Schedule, criteria 7 (whole...

August 6, 2020

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L.L. v Aviva Insurance Canada (18-001329)

Requests for reconsideration were filed by the claimant and the insurer in relation to a special award of $550 on a $2,200 assessment. The claimant sought an increase in the quantum awarded; the insurer argued that no special award ought to have been granted. Adjudicator Kepman dismissed both reconsideration requests, writing that the insurer had...

August 5, 2020

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M.Y. v. Wawanesa Mutual Insurance Company (19-003973)

The claimant sought reconsideration of the Tribunal's decision that she was barred from litigating her claim due to failure to attend two IEs. The insurer argued that the claimant's request for reconsideration was filed beyond the 21 as required in the Rules. Vice Chair Farlam noted that the request was only a single business days...

August 5, 2020

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S.D-T. v. Wawanesa Mutual Insurance Company (19-009280)

The claimant sought entitlement to IRBs and psychological treatment. A preliminary hearing was held to determine whether the claimant was statute barred from proceeding with her claim for failure to dispute the following issues within the two year limitation period. Vice Chair Farlam found the claimant's application was statute-barred and dismissed the claims. She found...

August 4, 2020

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H.M. v. Wawanesa Mutual Insurance Company (18-011655)

The claimant sought entitlement to pre-104 and post-104 weeks IRBs. The claimant was self-employed as a steel worker at the time of the accident and he owned 75 percent of a small steel fabrication business. Adjudicator Hans determined that the claimant established that he was substantially unable to perform the essential tasks of his pre-accident...

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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