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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January 13, 2020

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J.S. v. Aviva Insurance Canada (18-008643)

The claimant sought entitlement to an orthopedic assessment, a chiropractic treatment plan, interest on the payment of overdue benefits, and a special award. Adjudicator Norris found that the disputed orthopaedic assessment plan was not reasonable and necessary; it was a duplication of services as the claimant was previously assessed by an orthopaedic fewer than two...

January 13, 2020

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A.S. v. Aviva Insurance Canada (18-010483)

The claimant sought entitlement to medical benefits proposed in two treatment plants. The insurer raised a preliminary issue on the claimant's late production of evidence. Adjudicator Johal admitted the late disclosure, finding the respondent did not suffer any resulting prejudice. Nevertheless, the claimant was found not entitled to any medical benefits as the treatment plans...

January 13, 2020

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T.A.K. v. Aviva General Insurance Company (18-008232)

The claimant sought entitlement to IRBs, ACBs, and a special award. The claim for IRBs only concerned the weekly quantum. Adjudicator Neilson held that the insurer was entitled to deduct CPP Disability Benefits, and entitled to deduct income reported on the claimant's tax returns which the claimant could not provide documentation for. She was critical...

January 10, 2020

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L.D. v. Aviva Insurance Canada (19-000674)

The claimant sought entitlement to an orthopedic assessment and interest on the payment of overdue benefits. Adjudicator Boyce found that the disputed orthopedic assessment was reasonable and necessary at the time it was requested because the claimant continued to experience pain post-accident and treatment had plateaued. On this basis, Adjudicator Boyce found it reasonable that...

January 10, 2020

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S.M. v. Aviva General Insurance Company (18-010116)

The claimant sought entitlement to the cost of an accounting report related to IRBs. Adjudicator Boyce dismissed the dispute. He held that it was not reasonable and necessary for the claimant to procure an accounting report. The claimant had a single source of income, and was not self-employed. The existence of short-term disability payments did...

January 9, 2020

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D.O. v. Aviva Insurance Canada (18-007687)

The claimant sought entitlement to various chiropractic treatment plans, a functional cognitive assessment, and interest on the payment of overdue benefits. Adjudicator Norris found the following: since the claimant incurred the disputed chiropractic treatment plans prior to their submission and without prior approval of the insurer or meeting any of the other exceptions under section...

January 9, 2020

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A.G. v. Coseco Insurance (18-007969)

The claimant sought removal from the MIG, entitlement to a chronic pain assessment and chronic pain program, and interest on the payment of overdue benefits. Adjudicator Sharda found that the claimant should be removed from the MIG since the chronic pain she suffered in her neck and left shoulder were not predominantly minor injuries. Adjudicator...

January 9, 2020

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J.P. v. Allstate Insurance Company (18-008027)

The claimant sought entitlement to IRBs and eight medical benefits. Adjudicator Boyce rejected the claims. He held that the claimant failed to adduce sufficient objective evidence of a substantial inability to engage in his pre-accident employment. All of his evidence was self-reported. Further, the claimant did not use any prescriptions to address his soft tissue...

January 9, 2020

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S.S.R. v. Unifund Assurance Company (18-004772)

The insurer sought reconsideration of the Tribunal's award of NEBs and medical benefits, and that section 55 did not prevent the claimant from disputing entitlement to the medical benefits. Vice Chair Lester granted the reconsideration in relation to NEBs, but only in ordering that NEB entitlement began six months after the accident as opposed to...

January 8, 2020

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M.A. v. Wawanesa Mutual Insurance Company (18-006614)

The claimant sought removal from the MIG, entitlement to various medical/rehabilitation benefits (which were denied due to the insurer's position that the MIG applied to the claimant's injuries), and interest on the payment of overdue benefits. Adjudicator Kaur found that the claimant's pre-existing conditions did not remove him from the MIG and that he sustained...

January 8, 2020

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Z.K. v. Unifund Assurance Company (18-007924)

The claimant sought entitlement to four physiotherapy treatment plans and the cost of an impairment assessment, a multi-disciplinary catastrophic assessment, and a neurological assessment. Adjudicator Manigat rejected the opinion of the insurer's psychiatry assessor that there was no objective evidence of ongoing impairments and that the claimant did not have any functional limitations or physical...

January 7, 2020

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H.W.G. v. Dominion of Canada General Insurance Company (Travelers) (18-000126)

The claimant sought removal from the MIG and entitlement to a psychological assessment, chiropractic treatment, and interest on the payment of overdue benefits. Adjudicator Corapi found that the claimant established on a balance of probabilities that her injuries were not predominantly minor injuries because of her psychological injuries; the claimant's depression and anxiety did not...

January 7, 2020

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S.M. v. Wawanesa Mutual Insurance Company (18-008474)

The claimant suffered a catastrophic impairment in a 2000 accident due to a GCS of 4. He sought entitlement to ACBs of over $5,000 per month, and sought retro-active ACBs back to 2015. Adjudicator Johal held that the claimant was not entitled to elevated retroactive ACBs because he provided no evidence why it was impossible...

January 7, 2020

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C.C. v. Erie Mutual Insurance Company (18-010778)

The claimant sought entitlement to NEBs and ACBs. Adjudicator Boyce dismissed the claims. He held that the claimant failed to place sufficient evidence before Tribunal regarding her pre-accident activities, her post-accident activities, the changes she experienced because of the accident, and the activities she placed most importance on. Further, the evidence available suggested that the...

January 6, 2020

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M.B. v. Aviva General Insurance Company (19-000030)

The claimant sought entitlement to psychological treatment, a chronic pain program, and interest on the payment of overdue benefits. Adjudicator Boyce found that the claimant was entitled to the portion of the disputed psychological treatment plan for psychological sessions; however, with respect to the remaining elements of the disputed treatment plan, he agreed with the...

January 6, 2020

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S.G. v. Wawanesa Mutual Insurance Company (18-001861)

The claimant sought reconsideration of the Tribunal's denial of IRBs and the cost of an accounting report. Adjudicator Parish concluded that the Tribunal had not made a significant error or law or fact such that it likely would have reached a different conclusion. Most of the arguments made by the claimant were, in essence, an...

January 3, 2020

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J.P. v. Aviva General Insurance Company (18-007398)

The claimant sought entitlement to various medical/rehabilitation benefits, interest on the payment of overdue benefits, and a special award. In this amended decision, Adjudicator Punyarthi preferred the claimant's evidence over the insurer's, finding that it persuasively demonstrated the claimant was entitled to the disputed benefits. Adjudicator Punyarthi further found that the claimant was entitled to...

January 3, 2020

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D.K. v. Certas Direct Insurance Company (18-010057)

The claimant sought entitlement to NEBs and medical/rehabilitation benefits. Adjudicator Boyce found that the claimant did not suffer a complete inability to carry on a normal life, agreeing with the findings in the insurer's examination reports; while the reports noted headaches and intermittent neck and back pain, Adjudicator Boyce found it was "a stretch to...

December 31, 2019

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M.T. v. Intact Insurance Company (18-007131)

The claimant sought entitlement to IRBs, removal from the MIG, and entitlement to various medical benefits. Adjudicator Mazerolle found that the claimant's linger pain did not meet the definition of chronic pain because there was little indication of changes in her daily activities or reporting to the family physician. He also found that the claimant...

December 30, 2019

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W.C. v. Aviva Insurance Canada (19-000454)

The claimant sought entitlement to IRBs; the insurer argued that section 55 barred the dispute because the claimant failed to attend IEs. Adjudicator Punyarthi held that the insurer, rather than the claimant, failed to comply with section 44 by failing to make the IEs on a date, time, and location that was convenient to the...

December 27, 2019

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O.R.O. v. Aviva Insurance Canada (18-007650)

The claimant sought reconsideration of the Tribunal's denial of disputed medical benefits. Adjudicator Baker was not persuaded that there was an error in law committed by the Tribunal and that the claimant's reconsideration was a request to re-litigate the dispute.

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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