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 3, 2020

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Y.R. v. Coachman Insurance Company (19-006234)

The claimant disputed a determination of catastrophic impairment and entitlement to attendant care benefits. The insurer argued that the claimant failed to attend an IE and was barred from proceeding with the hearing. Adjudicator Chakravarti permitted the claimant to proceed. The request for the IE to address attendant care benefits was not made in accordance...

July 3, 2020

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Z.A. v. Certas Home and Auto Insurance Company (19-001119)

The claimant sought entitlement to transportation expenses and a special award. Adjudicator Boyce dismissed both claims. The claimant failed to provide evidence regarding the transportation expenses, her home address, the address of the clinic, or an invoice for the transportation. Looking to the OCF-18, the longest one-way route between the addresses listed was well under...

July 3, 2020

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A.A.J. v. Echelon General Insurance Company (19-000961)

The claimant sought entitlement to IRBs for a one month period when he was in non-compliance with IE requests, and a treatment plan for chiropractic services. Adjudicator Boyce rejected all of the excuses provided by the claimant for his non-attendance as being unreasonable or not believable. The insurer rescheduled the IEs on multiple occasions and...

July 3, 2020

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H.A. v. Aviva General Insurance Company (18-012325)

The claimant sought entitlement to the cost of an EMG study. Adjudicator Hines concluded that the insurer's section 38 notice was non-compliant because it was too vague. However, the EMG study had been incurred 10 days (rather than 10 business days) after submission of the OCF-18. Because it was incurred too soon after submission of...

July 2, 2020

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D.L. v. Aviva Insurance Company (17-006056)

The claimant initially disputed entitlement to various assessments which were denied based on the MIG. The insurer later approved the assessments following an IE which concluded that the claimant suffered a psychological impairment as a result of the accident. The claimant requested a special award based on the earlier denials. Adjudicator Goela granted a special...

June 30, 2020

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B.M. v. Aviva Insurance (18-009182)

The Tribunal had awarded two of three treatment plans for chiropractic services, and denied the third as being duplicative. The claimant sought reconsideration on the denied treatment plan; the insurer sought reconsideration of the two approved treatment plans. Adjudicator Johal dismissed the claimant's reconsideration request and attempt to introduce new evidence. Adjudicator Johal granted the...

June 30, 2020

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S.B.S. v. Wawanesa Mutual Insurance Company (17-006935)

The claimant sought entitlement to ongoing IRBs and two medical benefits. The insurer argued that the claimant was not credible, and that her impairments were caused by other health issues and second motor vehicle accident. Adjudicator Neilson found the claimant to be a poor historian who consistently exaggerated her complaints. She concluded that the claimant...

June 30, 2020

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J.Z. v. Certas Home and Auto Insurance (19-005337)

The minor claimant suffered a broken arm in an accident. He received attendant care for over one year, but ACBs were terminated thereafter. He sought entitlement to further ACBs and one medical benefit for physiotherapy. Adjudicator Boyce denied both claims. The medical evidence suggested that the minor claimant had largely healed from his physical injuries...

June 30, 2020

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M.Z. v. Certas Home and Auto Insurance (19-005344)

The minor claimant suffered serious injuries in an accident. He received attendant care for over one year, but ACBs were terminated thereafter. He sought entitlement to further ACBs and one medical benefit for physiotherapy. Adjudicator Boyce denied the claim for further ACBs, but partially approved the claim for physiotherapy. The medical evidence suggested that the...

June 30, 2020

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P.H. v. Aviva Insurance Company of Canada (18-010205)

A vehicle struck the claimant's back patio, which caused it to detach from the house. The claimant heard the crash and opened her back door and stepped onto the patio, not knowing that it had detached. She fell through a gap to the ground. The insurer argued that the claimant was not injured in an...

June 29, 2020

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M.H. and T.H. v. Economical Insurance Company (19-004735)

The claimants were the mother and father of a child who died in a motor vehicle accident. They sought, and were paid, death and funeral benefits by the insurer. They disputed entitlement to interest and a special award. Vice Chair Farlam concluded that the claimants were not entitled to interest. The insurer requested a completed...

June 29, 2020

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N.L. v. Aviva Insurance Canada (18-011431)

The claimant sought reconsideration of the Tribunal's order that her non-attendance at an IE barred her from disputing entitlement to a psychological assessment. She argued that the Tribunal erred by not permitting the dispute to proceed. Adjudicator Maleki-Yazdi dismissed the reconsideration. She held that the Tribunal did not make any reversible errors. The claimant did...

June 26, 2020

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R.F. v. Pafco Insurance (17-008708)

On the eve of the hearing, the claimant brought various motions to add the insurer's counsel as a witness, for production of records from the IE facilities, to hold the insurer's counsel in contempt, and to adjourn the hearing. The motions all related to the claimant's counsel's position that the IE assessors had violated PIPEDA...

June 26, 2020

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R.K. v. Allstate Insurance (19-000502)

The claimant sought entitlement to monthly ACBs and one treatment plan for physiotherapy. Vice Chair Flude concluded that the claimant's impairments all preceded the accident, and that she did not require attendant care nor further physiotherapy. The claimant's self-reporting to her experts was contradicted by the medical records and the surveillance.

June 26, 2020

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D.S. v. Aviva Insurance Company of Canada (18-006592)

The insurer sought reconsideration of the Tribunal's award of medical benefits based on section 38 deficient denials, on the basis that the Tribunal failed to consider whether the benefits were incurred. Adjudicator Grant dismissed the reconsideration request. While he agreed with the insurer that the benefits were not deemed incurred under section 3(8), he also...

June 25, 2020

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S.M. v. Unica Insurance Inc. (18-010164)

The Tribunal had found the claimant entitled to (among other things) $6,000 per month in ACBs and granted a 25 percent special award. The insurer sought reconsideration. Adjudicator Boyce granted the reconsideration and reduced the payable ACBs and concluded that no special award was payable on ACBs or an awarded home modification. With regard to...

June 25, 2020

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S.M. v. Unica Insurance Inc. (18-010164)

The Tribunal had found the claimant entitled to (among other things) $6,000 per month in ACBs and granted a 25 percent special award. The insurer sought reconsideration. Adjudicator Boyce granted the reconsideration and reduced the payable ACBs and concluded that no special award was payable on ACBs or an awarded home modification. With regard to...

June 24, 2020

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A.A. v. Aviva Insurance Company (18-011152)

The claimant sought entitlement to attendant care benefits of $2,442.67 per month for a seven month period. Adjudicator Boyce concluded that the services identified on the claimant's Form 1 could not reasonable be associated with the claimant's accident-related impairments when he continued to work in his pre-accident employment, had not seen his family physician, and...

June 23, 2020

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S.S. v. RSA Insurance (19-005229)

The claimant sought removal from the MIG and entitlement to two medical benefits. The claimant refused to attend IEs and applied to the LAT more than two years after the denials. Adjudicator Boyce held that the limitation period applied and that he would not exercise discretion under section 7 of the LAT Act. The claimant...

June 22, 2020

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M.M.R. v. Travelers Insurance Company of Canada (18-009122)

The claimant sought entitlement to ongoing IRBs. The insurer approved IRBs prior to the hearing. The claimant argued that she was entitled to a special award. Adjudicator Chakravarti held that a special award was not payable. The insurer had notified the claimant that an OCF-2 was required in order to determine the quantum of IRBs...

June 19, 2020

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S.K. v. Technology Insurance Company Inc. (19-003749)

The claimant sought entitlement to social work services, HST on treatment plans, and the cost of CAT assessments. Adjudicator Chakravarti held that the limitation period applied to the social work services because the denial of the proposed rate was clear and unequivocal. Section 7 of the LAT Act did not apply because the claimant did...

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com