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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November 27, 2019

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C.M. v. Wawanesa Mutual Insurance Company (18-008199)

The claimant sought entitlement to attendant care benefits and a number of treatment plans for occupational therapy and physiotherapy services. Adjudicator Boyce concluded that the claimant was not entitled to attendant care as she had not demonstrated that the services were "incurred" pursuant to section 3(7)(e) of the SABS. The claimant did not provide evidence...

November 26, 2019

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R.S. v. Aviva Canada Inc. (18-003440)

The claimant sought entitlement to a chronic pain treatment program. Adjudicator Moten concluded that the claimant was entitled to the denied treatment plan, preferring the claimant's expert report over the insurer's IE reports. Notably, none of the IE assessors were pain medicine specialists and none of the IE reports specifically addressed the issue of chronic...

November 26, 2019

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A.L. v. Aviva Insurance Canada (18-008991)

The claimant sought entitlement to two treatment plans, one for occupational therapy services and one for physiotherapy services. Adjudicator Manigat concluded that the denied treatment plans were not reasonable and necessary. With respect to the occupational therapy treatment plan, Adjudicator Manigat accepted that the claimant had to make certain adjustments to cope with some pain...

November 26, 2019

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N.S. v. Scottish & York (17-007962)

The insurer sought reconsideration of the Tribunal's decision that it had to fund a catastrophic impairment assessment over and above the $50,000 medical/rehabilitation limit for those with non-catastrophic injuries. Vice-Chair Flude confirmed the Tribunal's decision, finding that the Tribunal did not make any significant error of law. Section 18(5) of the SABS provides that assessments...

November 26, 2019

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N.S. v. Scottish & York (17-007962)

The insurer sought reconsideration of the Tribunal's decision that it had to fund a catastrophic impairment assessment over and above the $50,000 medical/rehabilitation limit for those with non-catastrophic injuries. Vice-Chair Flude confirmed the Tribunal's decision, finding that the Tribunal did not make any significant error of law. Section 18(5) of the SABS provides that assessments...

November 25, 2019

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E.D. v. Aviva General Insurance (18-004361)

The claimant sought entitlement to one treatment plan for chiropractic services. Adjudicator Grant found that the proposed treatment was not reasonable and necessary. He noted that a treating physician’s mention of a chronic pain condition, be it ‘syndrome’ or specific use of the term ‘chronic pain,’ is not enough to establish the necessity of a...

November 25, 2019

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A.G. v. Aviva General Insurance (18-012669)

The claimant sought entitlement to one treatment plan for physiotherapy services. Adjudicator Grant found that the proposed physiotherapy was not reasonable and necessary. He found that the claimant had previously undergone physiotherapy, there was a lack of evidence of benefit from the previous treatment, and that none of the medical evidence established the benefit of...

November 25, 2019

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D.K. v. The Guarantee Company of North America (18-007722)

The claimant sought entitlement to attendant care benefits in the amount of $3,022.33 per month, physical treatment proposed in three treatment plans, and the cost of various expenses related to food, prescriptions, assistive devices, and other goods. Vice Chair Lester found that the claimant was entitled to the physical treatment plans and the cost of...

November 25, 2019

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J.T. v. Aviva General Insurance (18-003238)

The claimant sought entitlement to 8 treatment plans, the cost of completion of two OCF-3s, and a special award. Adjudicator Lake found that the claimant was entitled to the majority of the treatment plans in dispute. She was not entitled to the cost of the two OCF-3s that were not requested by the insurer. She...

November 25, 2019

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M.H. v. Aviva General Insurance (17-006910)

The claimant's son was struck by a car and passed away several months later. The claimant sought death benefits from the insurer. The insurer argued that the son was not a dependent of the claimant, and therefore no death benefit was payable. Adjudicator Mazerolle agreed with the insurer and held that the son was not...

November 21, 2019

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C.S. v. Wawanesa Mutual Insurance Company (18-004665)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to treatment plans for psychological services and chiropractic treatment. Adjudicator Grant found that the claimant suffered from chronic pain, which removed him from the MIG. He was not entitled to the two treatment plans in dispute, which were found to...

November 21, 2019

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R.R. v. Aviva Insurance Company of Canada (17-006460)

The insurer sought reconsideration in relation to a chronic pain treatment program, which had been awarded by the Tribunal. Adjudicator Gosio allowed the reconsideration on a portion of the treatment plan for 27 sessions of psychotherapy. He held that 15 of the 27 sessions were not reasonable and necessary.

November 21, 2019

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S.B. v. Aviva General Insurance Company (17-001414)

The claimant sought reconsideration of seven medical benefits following a determination that the MIG was improperly included as an issue in dispute (the claimant had been removed by the insurer, but the adjudicator held that the MIG applied). Adjudicator Watt considered each of the disputed medical benefits. He held that none of the disputed medical...

November 20, 2019

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K.H.N. v. The Guarantee Company of North America (19-000081)

A Tribunal hearing began regarding the claimant's entitlement to NEBs and the cost of assessments. Shortly after the start of the hearing, Adjudicator Paluch determined that he was involved in a similar hearing involving the relationship between counsel and the clinics the claimant attended. He ordered himself recused from the matter on the basis that...

November 20, 2019

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B.S. v. The Co-operators General Insurance Company (18-003423)

The claimant sought entitlement to four treatment plans for physical therapy and seven proposed assessments. Adjudicator Norris rejected all of the claims. He held that the evidence the claimant relied upon (an OT paper file review) was biased and not limited to the appropriate scope of an occupational therapist.

November 18, 2019

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T.S.W. v. The Dominion of Canada General Insurance Company (18-010342)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to NEBs, the cost of prescription medication, and one treatment plan. Adjudicator Driesel found that the claimant was within the MIG and was not entitled to the disputed benefits.

November 15, 2019

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Wawanesa Mutual Insurance Company v. S.P. (19-000982)

The insurer sought repayment of income replacement benefits that were paid as a result of misrepresentation. Adjudicator Manigat found that the claimant made a wilful misrepresentation of her employment status, the insurer had given proper notice under s. 53 of the SABS, and the insurer was entitled to repayment of IRBs plus interest. The claimant...

November 15, 2019

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G.W. v. Coachman Insurance Company (16-003306)

The insurer sought reconsideration of the adjudicator's decision regarding entitlement to ACBs, interest, and a special award. The claimant sought reconsideration of the adjudicator's finding of an end date for IRBs and ACBs, and the formula used to calculate the quantum of the special award. Vice-Chair Marzinotto partially granted both the insurer's and the claimant's...

November 15, 2019

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K.B. v. Intact Insurance Company (19-005399)

The claimant's counsel sought reconsideration of the Tribunal's decision to allow the adjuster to represent himself, and an order putting the claimant on notice that failure to participate in the next Case Conference would result in a dismissal of the claim. Associate Chair Batty dismissed the reconsideration because it was not in relation to a...

November 15, 2019

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B.H. v. Aviva Insurance Canada (18-000751, 18-001161, 18-000345)

The claimant sought entitlement to NEBs and various medical benefits. The insurer argued that the claimant failed to attend IEs and was barred from proceeding with the claim. Adjudicator Johal agreed with the insurer, holding that the request for IEs was reasonable and that the notices complied with section 44 of the SABS.

November 15, 2019

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K.N. v. Aviva Insurance Company (19-003193)

The claimant sought reconsideration of the Tribunal's decision to adjourn a preliminary motion to be heard by the hearing adjudicator. Associate Chair Batty held that the adjournment decision was not a final order and dismissed the reconsideration request.

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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