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.

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...

May 26, 2023

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Pinera v. Motor Vehicle Accident Claims Fund (2023 ONSC 3155)

The claimant appealed the Tribunal's decision that he was not involved in an accident. The Court dismissed the appeal, holding that the Tribunal's reasons had no error of law, and that the claimant's appeal was largely an attempt to relitigate the factual issues that were before the adjudicator.

May 25, 2023

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Reid v. Aviva Insurance Company of Canada (20-008924)

The claimant applied to the LAT seeking entitlement to attendant care benefits during two periods: April 2018 to May 11, 2022, and May 12, 2022, to date. In October 2018, the insurer had cancelled a s. 44 in-home assessment because the claimant's counsel had advised the claimant no longer wanted to claim ACBs. In July...

May 9, 2023

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Kathirgamanathan v. Aviva Insurance Company (20-011425)

The claimant applied to the LAT seeking entitlement to IRBs, physiotherapy, and interest on overdue payments. Adjudicator John found that the insurer was not liable to pay IRBs during the period in which the claimant was non-compliant with s. 33 requests for an OCF-2 and other reasonably required employment/income-related documents. Adjudicator John also found the...

May 5, 2023

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Chaffey v. Wawanesa Mutual Insurance Company (22-001049)

The claimant sought a determination that he was catastrophically impaired after a motorcycle accident in July 2018. Under Criterion 4 there is a two-prong test which must be satisfied. The parties agreed that the first prong of the test had been met as there was sufficient diagnostic evidence of brain trauma. Looking at the second...

May 4, 2023

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Ossipova v. BelairDirect Insurance Company (21-001405)

The claimant applied to the LAT for the balance of various partially approved medical benefits. The insurer's denials were almost entirely based on the position that the claimant sought rates in excess of the rates authorized in the Professional Services Guideline. In addition, the insurer had approved 1-hour sessions for psychological therapy, rather than the...

May 3, 2023

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Al-Basheky v. Co-operators General Insurance Company (20-008231)

The claimant commenced an application after he was involved in a motor vehicle accident on November 9, 2018. He claimed entitlement to IRBs, which the insurer denied on the basis that he did not produce an OCF-3 within 104 weeks of the accident. Vice-Chair Todd found that the claimant was barred from proceeding with his...

May 3, 2023

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Coban v. Allstate Insurance (21-012430)

The claimant was catastrophically impaired in a motor vehicle accident in October 2018. At the time of the accident, the claimant was participating in a Work Transition Program through the WSIB. The Work Transition Program included attending an educational programme and working for a company through a work placement programme. During his participation in the...

May 1, 2023

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Bennett v. Allstate Insurance Company of Canada (2023 ONSC 2609)

The claimant appealed the Tribunal's denial of a special award related to IRBs which were reinstated after the post-104 week mark following further medical assessments. The Court dismissed the appeal, holding that it did not raise an issue of law. The Tribunal's determination regarding the special award were factual in nature, and the Tribunal applied...

April 28, 2023

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Nguyen v. Economical Mutual Insurance Company (2023 ONSC 2541)

The claimant appealed the LAT's decision that the limitation period barred the application. The Court allowed the appeal and remitted the matter to the Tribunal for a new hearing. The Court found the Tribunal erred in concluding that the denial letter was received on the day it was authored, as no evidence was before the...

April 28, 2023

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Sahadeo v. Pafco Insurance Company (2023 ONSC 2542)

The claimant appealed the LAT's dismissal of his catastrophic impairment dispute, arguing that the Tribunal's supplemental reasons contained in the reconsideration decision violated the principles of fairness. The Court dismissed the appeal, holding that the SPPA gave the Tribunal the power to make rules to reconsider its own decision, and that the reconsideration process gave...

April 26, 2023

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Di Giulio v. Aviva General Insurance Company (2023 ONSC 2426)

The claimant sought a stay from Divisional Court of the LAT's decision that the dispute would proceed in writing rather than orally. The Court rejected the stay, holding that there was not a serious issue, there was no irreparable harm if the stay was not granted, and the balance of convenience did not favour the...

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Contact Us

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

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Contact Us

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

416.507.1850

eodonnell@tgplawyers.com