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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October 4, 2018

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R.K. v. Aviva Insurance Company (16-003997)

The insurer sought reconsideration of the Tribunal's award of medical benefits, arguing that the claimant had not provided invoices evidencing that services were incurred. Associate Chair Jovanovic denied the reconsideration. He held that the adjudicator had considered and weighed the evidence and accepted that the medical treatment in dispute was reasonable, and that it was...

October 4, 2018

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X.L. v. Unifund Assurance Company (17-008769)

The insurer sought the production of records from all post-accident physicians identified on the OHIP summary. The claimant did not dispute the relevance, but argued that the production of all records would be disproportionate. The Case Conference adjudicator did not make an order for such records, and the insurer sought reconsideration. Associate Chair Jovanovic ordered...

October 3, 2018

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A.H. v. Aviva Insurance Canada (17-006373)

The claimant sought a determination that her impairments were outside of the MIG and entitlement to benefits proposed in one treatment plan. The respondent submitted that the claimant failed to provide any evidence to support her allegations of chronic pain and failed to comply with a case conference order to produce medical documents. The claimant...

October 3, 2018

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Applicant v. Aviva Insurance Canada (17-008086)

The claimant sought entitlement to non-earner benefits. Adjudicator Ferguson found that the claimant was not entitled to NEBs based largely on multidisciplinary IE assessments. Adjudicator Ferguson noted that the claimant's failure to produce ODSP records raised insurmountable doubts as to what her pre-accident level of housekeeping activity actually was. He found that without evidence of...

October 2, 2018

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Applicant v. Certas Home and Auto Insurance Company (17-000513)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to benefits proposed in two treatment plans. Adjudicator Punyarthi found that the claimant's injuries fell within the MIG and that the treatment plans in dispute were not payable as the MIG limits had been exhausted. Adjudicator Punyarthi decided not to...

October 2, 2018

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Applicant v. Certas Home and Auto Insurance Company (17-006892)

The claimant sought a determination that her impairments were outside of the MIG and entitlement to benefits proposed in one treatment plan. Adjudicator Mazerolle found that the claimant's injuries fell within the MIG and that the treatment plan in dispute was not payable as the MIG limits had been exhausted.

October 2, 2018

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S.C. v. Pembridge Insurance Company (17-007017)

The claimant sought entitlement to income replacement benefits for a period of 3 weeks and 4 days (from stoppage to return to work). Adjudicator Hans found that the claimant failed to establish that she was substantially unable to complete the essential tasks of her pre-accident employment, and the claimed benefits were not payable.

October 2, 2018

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Tomec v. Economical Mutual Insurance Company (2018 ONSC 5664)

The claimant was declared catastrophically impaired seven years after the accident. The insurer had denied entitlement to further attendant care benefits and housekeeping expenses at the 104 week anniversary. The claimant sought entitlement to ACBs and HK expenses from the 104 week anniversary onwards following the catastrophic impairment designation. The insurer argued that the claims...

October 2, 2018

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Lefebvre v. Aviva Insurance Company of Canada (2018 ONSC 5676)

The claimant sought judicial review of the Tribunal's decision that she could not pursue specified benefits because she had not completed and returned an election prior to applying to the LAT. The Court dismissed the review. The Court held that the claimant's failure to submit the election, contrary to section 35 of the SABS, meant...

September 28, 2018

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T.B. v Aviva Insurance Canada (17-006162)

The claimant sought various medical benefits, the cost of a chronic pain assessment, and a special award. Adjudicator Johal held that the claimant was not entitled to any of the benefits in dispute. The claimant relied solely on her self-reporting of her injuries to IE assessors to argue that the treatment plans in dispute were...

September 28, 2018

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Applicant v. Aviva General Insurance Company (17-006163)

The claimant sought removal from the MIG and entitlement to four treatment plans. Adjudicator Johal concluded that the claimant sustained a predominantly minor injury, and that the claimant did not provide sufficient evidence of a pre-existing condition that would prevent maximal recovery under the MIG.

September 28, 2018

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T.B. v. Aviva Insurance Canada (17-006162)

The claimant sought entitlement to various medical benefits for physical treatment and assistive devices. Adjudicator Johal concluded that the claims were not reasonable and necessary and dismissed the claims. She held that self-reports of pain were not sufficient to prove treatment was reasonable and necessary, and wrote that some form of medical documentation corroborating the...

September 27, 2018

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F.S. v. Travelers (18-000582)

The insurer argued that the claimant was barred from proceeding with the LAT dispute in accordance with section 55. Adjudicator Ferguson disagreed. He held that the claimant had notified the insurer of the accident within a few days and of his intention to claim benefits. An OCF-1 was filed within 30 days of the accident....

September 27, 2018

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Zheng v. Aviva Insurance Company of Canada (2018 ONSC 5707)

The insurer applied for judicial review of the Tribunal's decision that a denial of medical benefits that did not comply with section 38 resulted in the treatment plan being payable and barring the insurer from relying on the MIG. The court found the Tribunal's decision to be reasonable and concluded that the treatment plans were...

September 25, 2018

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Charbonneau v. Intact Insurance Company (2018 ONSC 5660)

The insurer sought judicial review of the Tribunal's decision that the claimant was involved in an accident. The claimant had been "car surfing," and was injured after falling from a moving vehicle when it made a sharp turn. The insurer argued that although the causation test was met, the purpose test was not. The Court...

September 24, 2018

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Applicant v. Travelers (17-001522)

The claimant sought removal from the MIG and entitlement to three medical benefits. Adjudicator Ferguson held that the claimant's injuries fell within the MIG. He was critical of the claimant's asserted accident-related injuries, which contradicted evidence in the WSIB file which showed pre-existing complaints of the same nature. Adjudicator Ferguson also held that the insurer's...

September 24, 2018

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Applicant v. Unifund Assurance Company (17-006328)

The claimant sought removal from the MIG and two medical benefits. Adjudicator Ferguson held that the claimant suffered from a chronic pain condition which removed him from the MIG. He relied upon the claimant's ongoing functional impairments, and the claimant's ongoing pain complaints. He also awarded the claim for further physical therapy, but denied the...

September 20, 2018

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Applicant v. Certas Direct Insurance Company (17-009179)

The claimant sought entitlement to a chronic pain treatment program. Adjudicator Ferguson found the treatment plan payable. He concluded that the claimant suffered from ongoing pain and was significantly impaired in terms of pre-accident activities. He also noted that the IE assessor found the claimant to be "approaching" maximum medical recovery, which left room for...

September 20, 2018

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Applicant v. Allstate Insurance Company of Canada (17-005138)

The claimant sought removal from the MIG and five medical benefits. Adjudicator Parish concluded that the claimant suffered minor injuries and did not suffer psychological injuries or chronic pain as a result of the accident. She did not accept the opinions of the claimant's experts. Adjudicator Parish did not permit the claimant to rely upon...

September 19, 2018

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S.S. v. Aviva Insurance Canada (17-007853)

The claimant sought entitlement to three medical benefits for physical therapy. Adjudicator Helt concluded that the proposed treatment was not reasonable and necessary. She concluded that the claimant's physical complaints pre-dated the accident, and that the evidence did not support the need for treatment in relation to the accident. The medical evidence also failed to...

September 19, 2018

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P.F. v. Jevco Insurance (18-000533)

The claimant failed to attend an examination under oath. The insurer argued that the claimant's entitlement to accident benefits was suspended. The claimant argued that the examination under oath was not properly scheduled. Adjudicator Norris held that the examination under oath was properly scheduled. He reasoned that an examination under oath can be requested after...

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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