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.

April 7, 2020

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R.S. v. Pafco Insurance Company (19-006331)

The claimant sought a determination that he sustained a catastrophic impairment, and entitlement to IRBs and various medical expenses. The insurer argued that the claimant was barred from proceeding with a catastrophic impairment determination until he attended a neurological IE, and also argued that the claimant was barred from proceeding with the claims for IRBs...

April 7, 2020

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Motor Vehicle Accident Claims Fund v. Z.M.H. (18-011392)

The Fund sought repayment of accident benefits on the basis that the claimant was not involved in an accident, and that she had misrepresented the facts of loss. The claimant alleged that she was part-way in her son's vehicle when he started driving, causing her to fall out of the vehicle onto her knees. The...

April 7, 2020

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M.Y. v Wawanesa Mutual Insurance Company (19-003973)

The insurer brought this preliminary issue hearing arguing that the claimant was barred from disputing her entitlement to medical/rehabilitation benefits beyond the MIG and attendant care benefits on the grounds that she failed to attend two section 44 IEs. The claimant took the position that she was not required to attend the IEs because the...

April 7, 2020

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G.K. v Coseco Insurance (18-007434)

The claimant disputed her MIG determination and sought entitlement to various medical/rehabilitation benefits and income replacement benefits. Adjudicator Hans concluded that the claimant's injuries did not fall within the MIG, as the medical evidence established that she suffered from chronic pain syndrome that was not merely a sequelae of the soft tissue injuries sustained in...

April 7, 2020

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Applicant v. Co-operators General Insurance Company (18-003622)

The claimant was involved in an accident in 2003. His entitlement to ACBs and HK expenses were denied in 2012. He applied to the LAT disputing further entitlement. The insurer argued that the claimed were barred by the limitation period. Adjudicator Helt concluded that the limitation period did not apply because the claimant was deemed...

April 7, 2020

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M.P. v. Allstate Insurance Company of Canada (18-012641)

The claimant applied for accident benefits; the insurer argued that the incident was not an accident. The claimant was burned by hot tea while at a red light. The tea had been passed to her through a drive-through window minutes prior and the lid was not securely placed on the cup. Adjudicator Reilly held that...

April 7, 2020

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U.P. v. Co-operators General Insurance Company (19-001881)

The claimant sought entitlement to one treatment plan and removal from the MIG. The insurer argued that section 55 barred the claim because the claimant failed to attend a physiatry IE. The claimant did not dispute the contents of the notice, but argued that she had not received it. Adjudicator Reilly accepted that the claimant...

April 6, 2020

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A.J. v The Guarantee Company of North America (19-001321)

The claimant sought entitlement to income replacement benefits and physiotherapy treatment, while the insurer sought a repayment of IRBs which it claimed were wrongly paid to the claimant at the outset of the claim. The insurer relied on an orthopaedic IE report to justify its termination of IRBs. Adjudicator Grant placed little weight on the...

April 6, 2020

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M.K. v TD General Insurance Company (19-003616)

The insurer brought this preliminary issue hearing arguing that the claimant was barred from disputing the denial of non-earner benefits on the grounds that the claimant did not do so within the two year limitation period. Adjudicator Grant found that the insurer issued a valid denial of non-earner benefits which triggered the limitation period. The...

April 6, 2020

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Z.R. v. Gore Mutual Insurance Company (18-000017)

The claimant sought a catastrophic impairment determination and entitlement to NEBs. Adjudicators Hines and Punyarthi held that the claimant suffered a catastrophic impairment as a result of a 55 percent WPI as a result of the accident, and that he was entitled to NEBs. The Tribunal accepted that the claimant was entitled to 26 percent...

April 6, 2020

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R.D. v. Pafco Insurance Company (18-004113)

The claimant sought a catastrophic impairment determination, attendant care benefits, and housekeeping expenses. The insurer argued that the claim for HK expenses was barred by the limitation period. Adjudicator Hines concluded that the claimant suffered a catastrophic impairment as a result of Class 4 Marked impairments in each of daily living, social functioning, and adaptation....

April 6, 2020

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M.S. v. Unifund Assurance Company (18-000715)

The claimant applied to the LAT for IRBs. The insurer approved entitlement eight days before the hearing. The claimant sought an order from the Tribunal that she was entitled to ongoing IRBs; the insurer argued that because there was no longer a dispute, the Tribunal did not have jurisdiction. Adjudicator Gosio held that once the...

April 3, 2020

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V.C. v. Unifund Assurance Company (18-005144)

The claimant applied to the LAT for NEBs. The insurer argued that the application was made after the two year limitation period. Vice Chair Shapiro agreed with the insurer and held that the application was made three months too late. He also rejected the request to apply section 7 of the LAT Act because none...

April 3, 2020

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M.K. v. Aviva General Insurance (18-009319)

The claimant sought reconsideration of the Tribunal's decision that she was not entitled to NEBs. Adjudicator Grant dismissed the reconsideration. He held that new evidence could not be admitted on reconsideration, since there was no explanation why the evidence was not available for the hearing. He also held that the exclusion of the family physician...

April 2, 2020

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S.K. v. Aviva Insurance Canada (19-003326)

The claimant sought entitlement to IRBs, removal from the MIG, and three treatment plans for chiropractic therapy. Adjudicator Conway concluded that the claimant suffered soft tissue injuries, which fell within the MIG. She also denied the claim for IRBs due to insufficient evidence regarding the claimant's inabilities.

April 1, 2020

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Applicant v. Aviva General Insurance (19-002362)

The claimant sought a catastrophic impairment determination. The insurer argued that the claimant's impairment were a result of degenerative changes to the claimant's spine rather than the accident. Vice Chair Flude agreed with the insurer, and found that the claimant's accident-related impairments were not sufficient to meet a 55 percent WPI. He held that the...

March 31, 2020

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Sonnet Insurance Company v. L.O. (19-004559)

The insurer sought repayment of income replacement benefits because of error, wilful misrepresentation or fraud, and interest. Adjudicator Conway held that the insurer was entitled to repayment of IRBs plus interest. The insurer made IRB payments based on the representations of the claimant. The documents submitted to the insurer by the claimant stating that he...

March 31, 2020

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K.D. v. Aviva Insurance Company (18-011646)

The claimant applied to the LAT seeking entitlement to IRBs. The issue in dispute was the calculation of the quantum of the weekly IRB. Vice Chair Farlam found that the claimant was self-employed at the time of the accident, and his gross self-employment income must be calculated according to the income declared in the last...

March 30, 2020

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T.I. v. TD Insurance Meloche Monnex (18-002932)

The claimant brought a motion for the insurer to provide an explanation for each and every redaction in the adjusting log notes that was sufficient enough to potentially allow the claimant to challenge any claim of solicitor-client privilege. Adjudicator Johal found that the claimant was entitled to a reasonable explanation for each redaction, and that...

March 30, 2020

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D.Y. v. Aviva General Insurance Company (18-011171)

The claimant sought entitlement to NEBs, medical treatment, various assessments, and a special award. In addition, the claimant sought entitlement to the balance of proposed catastrophic impairment assessments, which had been proposed in the amount of $26,400.00 and approved up to $12,400.00. The claimant was found entitled to NEBs, chiropractic and physiotherapy treatment, concussion management,...

March 27, 2020

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Q.S.Z. v. TD General Insurance Company (19-000403)

The insurer sought a preliminary issue hearing to determine whether the claimant was statute-barred from proceeding with her application for income replacement benefits for failing to dispute that insurer's denial within the 2 year limitation. Adjudicator Derek Grant found that the insurer had failed to properly deny the claimant's application for IRBs and the claimant...

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Contact Us

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

416.507.1850

eodonnell@tgplawyers.com

© 2020 Thomas Gold Pettingill LLP