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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March 21, 2018

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I.A. v. Allstate Insurance (17-006850)

The claimant sought entitlement to attendant care benefits as well as the benefits proposed in four treatment plans. Adjudicator Watt found that none of the benefits in dispute were reasonable and necessary as a result of the accident. Adjudicator Watt further noted that the claimant had not submitted a Form 1 or attendant care assessment...

March 20, 2018

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F.A. v. Aviva General Insurance (17-006302)

Seven days prior to an in-person hearing, the claimant brought a motion requesting an Order to add a special award to the issues in dispute and an Order for leave to examine the insurer's claims adjuster. Adjudicator Maedel granted both requests.

March 19, 2018

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Applicant v. Western Assurance (17-005066)

The insurer raised two preliminary issues in advance of a hearing. The first issue was whether the claimant was prevented from appealing the insurer's refusal to pay a number of claims because she failed to commence her appeal within two years of the date her claims for benefits was denied. Adjudicator Ferguson held that the...

March 16, 2018

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Applicant v. Royal and Sun Alliance (17-003732)

The minor claimant sought entitlement to NEBs, and four treatment plans. The insurer argued that the claim for NEBs was time barred, and that the claimant's injuries fell within the MIG. Adjudicator Hines held that the two year limitation period did not apply to the minor claimant until she hit the age of majority. She...

March 16, 2018

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Applicant v. Allstate Canada (16-004348)

The claimant sought entitlement to two treatment plans for chiropractic services. Adjudicator White held that the claimant was not entitled to the recommendations proposed in the treatment plans in dispute. The claimant did not meet her onus in establishing the reasonableness or necessity of the plans. There was no evidence that the claimant had benefitted...

March 15, 2018

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Applicant v. Primmum Insurance Company (18-000727)

The claimant's son sought an order appointing him as administrator of the estate and requested that the matter continue with him acting as administrator. Adjudicator Hunter ruled that the Tribunal did not have jurisdiction to appoint an administrator. She ruled that the son could represent the estate if he obtained the consent of all beneficiaries...

March 15, 2018

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Applicant v. Aviva Insurance Canada (17-002957)

The claimant sought entitlement to treatment outside of the MIG, attendant care benefits, medical benefits, the costs of three examinations, and a special award. After a review of the medical evidence, Adjudicator Anwar preferred the reports of the claimant's specialists and held that the claimant's injuries warranted treatment outside of the MIG. Adjudicator Anwar further...

March 15, 2018

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S.H. and H.S. v. Northbridge Personal Insurance Corporation (2018 ONSC 1801)

The insurer sought judicial review of the Tribunal's decision in which the two claimants were permitted to opt out of WSIB and seek accident benefits. The Court upheld the Tribunal's decision. The Court held that the standard of review is reasonableness, and that an appeal could only be made on a point of law. The...

March 14, 2018

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W.E. v. Wawanesa Mutual Insurance Company (17-002054)

The claimant sought entitlement to housekeeping expenses, and the cost of obtaining her employment file for the insurer. Adjudicator Gosio held that the claimant had proven that she suffered a substantial inability to perform the housekeeping services she normally performed prior to the accident, but that she did not prove that the expenses were incurred....

March 14, 2018

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Applicant v. Travelers Canada (17-005291)

The insurer requested the claimant's attendance at an IE shortly before the LAT hearing. The claimant refused to attend. The insurer argued that the claimant could not proceed with the hearing. Adjudicator Paluch held that the insurer's request for an IE was not reasonably necessary, and that the claimant could therefore proceed with the hearing....

March 13, 2018

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R.P. v. Wawanesa Insurance Company (16-002947)

The claimant requested reconsideration of the LAT's decision in favour of the insurer's denial of entitlement to certain medical benefits, expenses for prescription medication, and interest. He argued that the LAT violated procedural fairness by failing to either refer to or consider certain medical records in its decision. Executive Chair Lamoureux denied the request for...

March 13, 2018

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Applicant v. Aviva Insurance (16-004312)

The claimant disputed the insurer's termination of income replacement benefits eight months after the accident. Adjudicator Paluch held the claimant was entitled to receive IRBs from the date of termination to the date of the decision and ongoing. The claimant's medical evidence with respect to her chronic pain satisfied the arbitrator on a balance of...

March 12, 2018

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V.A. v. Wawanesa Mutual Insurance Company (17-002948)

The claimant disputed his MIG status; entitlement to payment for treatment; entitlement to payment for examinations and completion of OCF-3s; and entitlement to IRBs. Adjudicator Sewrattan denied all of the claims. The claimant, allegedly suffering from chronic pain, failed to prove that he suffered from an injury not predominantly minor in nature. The expert reports...

March 12, 2018

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Z.A. v. Certas Direct Insurance (17-003297)

The claimant, who was catastrophically impaired in an earlier accident, sought entitlement to NEBs and treatment plans for medical marijuana and osteopathic treatment in relation to a subsequent accident. Adjudicator Go found that the claimant was entitled to the cost of the two disputed treatment plans plus interest, but he was not entitled to NEBs....

March 12, 2018

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W.C.C. v. Allstate Canada (17-001363)

The claimant sought entitlement to non-earner benefits, which had been denied by the respondent on May 22, 2013, and entitlement to two treatment plans. Adjudicator Daoud dismissed all the claims, finding that the claimant was limitation barred from disputing the denial of non-earner benefits and that the claimant had not proven that the disputed treatment...

March 12, 2018

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K.G. v. Certas Direct Insurance Company (16-003633)

The insurer argued that the claimant failed to apply to the LAT within two years of the refusal to pay in accordance with section 56 of the SABS. The claimant argued the insurer's explanation of benefits (EOB) did not constitute a denial in compliance with the SABS. Adjudicator Watt held the EOB did not constitute...

March 12, 2018

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Applicant v. The Guarantee Company of North America (17-003906)

The claimant sought entitlement to two treatment plans. Adjudicator Reilly denied entitlement to both. Regarding the first, she held that the insurer's initial denial was deficient because it failed to provide any medical or other reasons, but that the insurer rectified the notice with a subsequent denial. Because the claimant had not incurred the assessment...

March 10, 2018

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Applicant v. Certas Home and Auto Insurance (16-003480)

The claimant, who was working as a PSW at the time of the accident, sought entitlement to pre-104 IRBs and a treatment plan proposing a psychological assessment. Adjudicator Reilly found that the claimant was entitled to the cost of the proposed assessment plus interest, but she was not entitled to IRBs. Adjudicator Reilly concluded that...

March 9, 2018

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The Applicant v. The Guarantee Company of North America (17-001170)

The claimant sought payment of home renovations. Adjudicator Johal explained that the onus is on the claimant to prove on a balance of probabilities that the renovations were reasonable and necessary. In this case, the renovations would only be reasonable and necessary if they provided the claimant access to areas of the home that were...

March 9, 2018

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M.T.G. v. Aviva General Insurance (formerly RBC General Insurance) (17-002122)

The insurer requested the preliminary hearing to address whether the claimant was limitation barred from pursuing a claim for IRBs because the LAT application was not commenced within two years of the insurer's denial. Adjudicator Gottfried held that the claimant was not precluded from applying for IRBs. The limitations analysis involved a lengthy review of...

March 8, 2018

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F.H. v. Certas Direct Insurance Company (17-003735)

The claimant sought entitlement to treatment outside of the MIG, five treatment plans, and a special award. Adjudicator Sewrattan found that the claimant suffered from Chronic Post Traumatic Pain Syndrome and was entitled to treatment outside of the MIG. Adjudicator Sewrattan preferred the claimant's expert report over the insurer's, as the insurer's report failed to...

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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