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.

May 27, 2020

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T.B. v. Echelon General Insurance Company (19-001347)

The claimant sought a determination that she suffered a catastrophic impairment due to a Class 4 Marked Impairment in either concentration, persistence, and pace, or adaptation. Adjudicator Ferguson held that the claimant did not satisfy the criteria to meet a Class 4 marked impairment in either category. While the claimant did suffer mental impairments as...

May 27, 2020

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A.W.A. v. Certas Home and Auto Insurance (18-007207)

The claimant sought entitlement to IRBs, a series of catastrophic impairment assessments, and further physiotherapy. Adjudicator Gosio awarded IRBs up to the 104 week mark, but denied the remainder of the claims. The claimant worked as a machine operator, and his chronic neck pain inhibited his work. The claimant did not submit any evidence that...

May 27, 2020

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K.H. v. The Personal Insurance Company (18-009077)

The claimant sought entitlement to $26,000 in catastrophic impairment assessments. Adjudicator Ferguson concluded that none of the proposed assessments were reasonable. The claimant had very few visits to his family physician, and very little treatment; he did not use any prescription medications; there were no neurological impairments; he attended the gym; his mood was "okay";...

May 26, 2020

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C.B. v. Intact Insurance Company (18-011003)

The claimant was involved in an incident when she was shovelling her parking spot, which led to physical injuries. She applied to the insurer for accident benefits. The insurer denied payment of benefits on the basis that the incident did not fall under the definition of "accident" in the SABS. The incident was described as...

May 25, 2020

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N.F. v. Certas Direct Insurance Company (19-004334)

The claimant's adult son was killed in a motor vehicle accident. The claimant's son was a listed driver on the insurance policy of the motorcycle he was riding at the time of the accident. The named insured on the policy was a friend of the claimant's son. The claimant was the registered owner of the...

May 25, 2020

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J.A. v. Aviva Insurance Company of Canada (18-002124)

The insurer sought reconsideration of the Tribunal's decision awarding $10,500 for the cost of catastrophic impairment assessments. Adjudicator Boyce denied the reconsideration request. He concluded that the proposed assessments were not "rebuttal reports" because it was the claimant's first set of catastrophic impairment assessments (the insurer had conducted earlier IEs, but that did not make...

May 22, 2020

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J.S. v. Aviva General Insurance (18-012528)

The claimant applied to the LAT seeking entitlement to a variety of assessments and chiropractic treatment. Adjudicator Maleki-Yazdi found that three assessments and one of three treatment plans proposing chiropractic treatment were reasonable and necessary. The denied treatment plans were considered to be duplicative treatment. An attendant care assessment was found to be reasonable and...

May 21, 2020

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A.A. v. Unifund Assurance Company (18-008999)

The claimant had previously been deemed catastrophically impaired. She applied to the LAT seeking entitlement to ACBs, medical benefits that had been denied prior to her being deemed catastrophically impaired, and medical benefits that had been denied after she was declared catastrophically impaired. Adjudicator Punyarthi found that the claimant was entitled to ACBs, but based...

May 21, 2020

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L.C. v. Aviva Insurance Canada (19-005482)

The claimant applied to the LAT seeking entitlement to NEBs. Her submissions did not provide a detailed comparison of pre- and post-accident activities and functional abilities. Adjudicator Grant found that the claimant did not suffer a complete inability to carry on a normal life as a result of the accident, and was not entitled to...

May 21, 2020

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Unica Insurance Inc. v. K.B. (19-006165)

The claimant had been paid ACBs by the insurer based on the alleged economic loss sustained by his mother, who was seeking employment at the time of the accident. In an earlier decision by the Tribunal, it was held that the mother did not suffer an economic loss. The insurer then sought repayment of $19,170.90...

May 21, 2020

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A.A. v. Unifund Assurance Company (18-008999)

The claimant had previously been deemed catastrophically impaired. She applied to the LAT seeking entitlement to ACBs, medical benefits that had been denied prior to her being deemed catastrophically impaired, and medical benefits that had been denied after she was declared catastrophically impaired. Adjudicator Punyarthi found that the claimant was entitled to ACBs, but based...

May 20, 2020

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K.R. v. Certas Direct Insurance Company (19-003237)

The claimant sought payment of $11,865 for hockey training. The claimant had been actively engage in competitive hockey, and sought to regain physical strength and skill to return to pursue her goal of playing NCAA hockey. Adjudicator Parish dismissed the claim. She held that the claimant failed to comply with section 38(2) by incurring the...

May 20, 2020

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W.R. v. Aviva Insurance Company (19-000791)

The insured died while in his vehicle due to a suicide, in which he poured gasoline in his vehicle and set it on fire using the car's cigarette lighter and a doused dishtowel. The claimant (the insured's wife) sought death benefits and funeral benefits. Adjudicator Farlam held that the death was not a result of...

May 19, 2020

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L.M. v Portage La Prairie Mutual Insurance Company (19-004596)

The claimant disputed her entitlement to attendant care benefits and various medical benefits. Adjudicator Boyce determined that the claimant was not entitled to ACBs for the period in dispute, as they are not reasonable and necessary and the claimant did not provide evidence that the services were incurred. The claimant offered no evidence or substantive...

May 19, 2020

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L.R. v Economical Mutual Insurance Company (19-005496)

The claimant sought entitlement to a special award, taking the position that the insurer unreasonably delayed the payment of a treatment plan for physiotherapy services because the insurer approved the treatment plan after submission of the LAT Application. The claimant did not make any submissions or provide any evidence in support for an award, as...

May 19, 2020

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M.I. v. Coseco Insurance Company (18-000742)

The insurer suspended the claimant's entitlement to IRBs. The claimant applied to the LAT. Before the Case Conference, the insurer reinstated the IRBs. The insurer argued that the LAT did not have jurisdiction to consider the claim for IRBs. Adjudicator Kepman concluded that the Tribunal did not have jurisdiction under the Insurance Act to consider...

May 19, 2020

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A.T. v. TD Insurance Meloche Monnex (19-003627)

The claimant sought lost educational expenses following an accident. At the time of the accident, he was enrolled in a post-secondary computer programming program. He alleged that he was unable to continue in the program and did not qualify for a refund of tuition. Adjudicator Norris dismissed the claim, holding that the claimant failed to...

May 15, 2020

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Z.X.C. v Belair Insurance Company (19-000314)

The claimant disputed her MIG determination, as well as entitlement to various medical benefits and IRBs. Adjudicator Shapiro concluded that based on the medical evidence, the claimant suffered predominantly minor physical injuries - strains and sprains - as a result of the accident, and her injuries thus fell within the MIG. Adjudicator Shapiro also determined...

May 14, 2020

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T.H. v Allstate Insurance Company of Canada (19-004567)

The claimant disputed her entitlement to two denied treatment plans, one for optometric services and one for occupational therapy services. The insurer took the position that the claimant's impairments for which she sought treatment were not sustained as a result of the accident. Adjudicator Paluch disagreed, finding that but for the accident, the claimant would...

May 14, 2020

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Applicant v. TD Insurance Meloche Monnex (19-006032)

The claimant sought non-earner benefits, a special award and interest. The insurer raised a preliminary issue to determine whether the claimant was precluded from proceeding with her application as she failed to attend a s.44 IE. The insurer also sought costs of the failed IE attendance. The claimant argued that the insurer did not provide...

May 13, 2020

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Yang v. TD General Insurance Company (19-005396)

This is a preliminary issue decision addressing whether the claimant was barred from proceeding with the claim for failing to commence the LAT application within two years after the insurer's refusal to pay the amount claimed. Adjudicator Parish decided not to exercise her discretion to extend the limitation period under s. 7 of the LAT...

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Contact Us

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

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Contact Us

150 York Street, Suite 1800
Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com