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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May 17, 2018

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Applicant v. Northbridge Insurance Company (17-005435)

The claimant sought entitlement to NEBs. Adjudicator Mather was satisfied that the claimant suffered an aggravation of pre-existing neck and back pain, but concluded that the claimant had not proven that she met the complete inability test. The claimant remained independent in all aspects of personal care. She continued to provide childcare to her granddaughter....

May 17, 2018

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L.Y.T. v. RBC Insurance Company (17-007019)

The claimant sought entitlement to attendant care benefits and a special award. The claimant claimed that her son resigned from his employment to provide her with attendant care. Adjudicator Sewrattan found that the claimant was not entitled to payment for attendant care as she had not proven that she received attendant care services from her...

May 16, 2018

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Applicant v. Coachman Insurance Company (16-003306)

The claimant sought entitlement to removal from the MIG, IRBs, ACBs, medical benefits, and special award. He argued that he sustained a fractured sternum, a concussion, and major depressive disorder as a result of the accident. Despite an IE assessor concluding that the fractured sternum was related to the accident, the insurer concluded otherwise based...

May 15, 2018

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Applicant v. Pembridge (17-005544)

The claimant sought removal from the MIG and entitlement to four medical benefits. Adjudicator Purdy concluded that the claimant did not suffer chronic pain or psychological impairments as a result of the accident, and that such injuries arose from an unrelated workplace incident.

May 15, 2018

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Applicant v. Aviva Insurance Canada (17-004001)

The claimant sought entitlement to one treatment plan for chiropractic services. The claimant was being treated outside of the MIG as a result of a psychological impairment. Adjudicator Fircot found that the claimant had not proven on a balance of probabilities that the proposed treatment was reasonable and necessary. The claimant's claim was denied.

May 14, 2018

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

The Tribunal was asked to determine, as a preliminary issue, whether assessments to determine catastrophic impairment were to be funded within the $50,000 limit for medical rehabilitation benefits prescribed by section 18(3) in the SABS. The insurer argued that section 18(5) of the SABS included the costs of CAT assessments in the $50,000 limit. Adjudicator...

May 11, 2018

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Applicant v. Aviva Insurance Canada (17-006480)

The claimant sought entitlement to an OCF-18 proposing psychological treatment. Adjudicator Boyce found the proposed psychological treatment to be reasonable and necessary because he found the the claimant's self-reporting of cycling-specific fear to be consistent and compelling, and he preferred the s. 25 psychology report to the s. 44 psychology report. Adjudicator Boyce rejected the...

May 9, 2018

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M.A. v. Aviva Insurance Canada (17-0038892)

The claimant sought entitlement to IRBs for the period of June 23, 2015, to December 1, 2016. The insurer sought repayment of IRBs in the amount of $1,600.00. The parties agree that the claimant was self-employed as the owner/operator of a gas station and convenience store for 26 out of the 52 weeks prior to...

May 9, 2018

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A.S. v. Pafco Insurance (16-003683)

The claimant sought reconsideration of the Tribunal's decision to deny the claim for ongoing IRBs. The claimant requested reconsideration on the basis that the Tribunal denied him natural justice and procedural fairness. Associate Chair Batty agreed with the claimant that the Tribunal had overlooked or mischaracterized parts of the claimant's evidence at the LAT hearing....

May 9, 2018

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S.M. v. Aviva Insurance Canada (17-003731)

The claimant sought entitlement to NEBs and medical benefits. Adjudicator Grant denied all of the claims. He concluded that the claimant's evidence lacked specificity, and that her medical assessor's opinions were not credible. He preferred the conclusions of the IE assessors, including the claimant's self-reporting to the IE assessors that she was improving and returned...

May 8, 2018

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Helmer v. Belair Direct Insurance Company (2018 ONSC 2888)

The insurer sought judicial review of the Tribunal's decision that a PSW who was not working before the accident, met the requirements of the professional service provider branch of the "incurred expense" definition. The Court held that the Tribunal's decision was both reasonable and correct. The Court held that the critical question was whether the...

May 7, 2018

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R.P. v Aviva Insurance Canada (17-003500)

The claimant appealed Aviva's MIG determination and sought medical benefits for chiropractic services, the completion of numerous OCF-3s, a social work assessment, and an orthopaedic assessment. The claimant also sought IRBs. Aviva opposed the claimant's request to have a treating chiropractor qualified as an expert. Adjudicator Hines held that the claimant's injuries were within the...

May 7, 2018

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Applicant v. Unifund Claims Inc. (17-005698)

The claimant sought removal from the MIG, entitlement to ACBs, and entitlement to various medical benefits. Adjudicator Watt concluded that the claimant's injuries fell within the MIG. He noted that the claimant had essentially returned to his pre-accident life shortly after the accident. He also held that the claimant's self-reporting contradicted the statements in the...

May 7, 2018

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M.C. v. Aviva Insurance Company of Canada (17-002614)

The claimant sought entitlement to treatment outside of the MIG, attendant care benefits, six treatment plans, and a special award. Adjudicator Truong found that the claimant was entitled to treatment outside of the MIG, the cost of an attendant care assessment and assistive devices, interest, and a special award. Adjudicator Truong found that the claimant...

May 4, 2018

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E.A. v. Aviva Insurance Company of Canada (17-005601)

The claimant sought entitlement to various medical benefits. The insurer argued that the claimant had applied more than two years after the relevant denials. The claimant conceded that two years had passed, but relied upon section 7 of the LAT Act arguing that the insurer had delayed providing copies of the denials to the new...

May 4, 2018

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Aviva Insurance Canada v. W.D.W. (17-005894)

The claimant and the insurer disputed the proper calculation of IRBs. The claimant was self-employed at the time of the accident. He argued that his IRB entitlement was to be calculated based solely on his farming income, without regard to losses attributed to his separate numbered corporation. Aviva argued that the losses of the numbered...

May 3, 2018

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S.W. v. Aviva Insurance Company of Canada (17-005302)

At the beginning of the hearing, the insurer conceded that the impairments suffered by the claimant were sufficient for her to meet the test for IRBs, so the issue before Adjudicator Flude was what amounts the insurer could deduct from the $400 per week IRB quantum regarding the claimant's EI maternity benefits and employer top...

May 2, 2018

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D.C. v. Aviva Insurance Company (17-002921)

The claimant sought entitlement to NEBs, medical benefits, and the cost of various examinations. The insurer raised s. 55 and s. 33 defences. Pursuant to s. 55, Adjudicator Ferguson held that the claimant was barred from commencing part of the application as a result of his failure to attend IE assessments. He was only barred...

May 1, 2018

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Applicant v. Aviva Insurance Company (17-002973)

The claimant sought entitlement to IRBs, ACBs, and medical benefits. The insurer argued that the claimant failed to attend an IE assessment contrary to the SABS. Adjudicator Maedel agreed with the insurer in regard to most of the claimed benefits, and held that the IEs were not requested inappropriately. In terms of the MIG and...

April 28, 2018

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Applicant v. Certas Direct (17-002792)

The claimant sought entitlement to IRBs, one treatment plan, and interest. Adjudicator Msosa held that the medical evidence did not indicate the claimant had suffered a substantial inability to perform his employment as a security guard and was therefore not entitled to IRBs. The claimant argued that the treatment plan was payable as the insurer...

April 26, 2018

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V.S. v. Travelers Insurance Company of Canada (17-001670)

The claimant sought reconsideration that he was not entitled to treatment outside of the MIG. With the insurer having approved both treatment plans in dispute and removing the claimant from the MIG in advance of the reconsideration hearing, the single issue to be decided was whether the claimant was entitled to interest on the insurer's...

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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