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 18, 2023

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TD General Insurance Company v. Duff-Foley (Estate) (2023 ONSC 2400)

The insurer appealed the Tribunal's decision that the settlement between the insurer was valid and enforceable. The claimant died 10 days after settling her tort and AB claims for $957,000, with 60 percent to be structured. The 60 percent was returned to the insurer based on the reversion; however, the claimant's estate took the position...

March 31, 2023

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Garvey v. Economical Insurance Company (20-009618)

The claimant brought a request for reconsideration of a motion order of the LAT dated December 5, 2022 (the "order"), where the LAT denied the claimant's request for an extension to file a request for reconsideration of a previous LAT decision dated August 11, 2022. The claimant's request for reconsideration was dismissed for multiple reasons....

March 31, 2023

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Vettivelu v. Intact Insurance Company (19-006122)

This is a reconsideration decision. The claimant had a written hearing submission deadline of October 19, 2022, but did not file submissions until November 10, which was eight days after the respondent filed a Notice of Motion for an order dismissing the application as abandoned. The claimant requested an adjournment. The motion adjudicator denied the...

March 27, 2023

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Darwich v. The Co-operators (20-015268)

The claimant applied to the LAT for a catastrophic impairment designation and the cost of a private addiction treatment centre. The claimant suffered injuries from an accident that culminated in him being prescribed increasingly higher amounts of morphine to relieve his accident-related back pain. At some point, the claimant’s historic substance abuse issues, which were...

March 23, 2023

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Tran v. Certas Home and Auto Insurance Company (21-004129)

The claimant applied to the LAT for the cost of CAT examinations. The claimant claimed the insurer did not provide adequate medical reasoning in the notice of the denial under section 38(8) of the SABS. The Respondent countered that the notice of denial was adequate based on the request made as there was no medical...

March 23, 2023

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Achaia-Shiwram v. Intact Insurance Company (20-004699)

The claimant applied to the LAT disputing her entitlement to IRBs and CAT impairment. The respondent raised a preliminary issue that the claimant did not dispute IRB entitlement within 2 years pursuant to s. 56. At the beginning of the in-person hearing, the claimant attempted to summons two witnesses, the claims adjuster and the CAT...

March 22, 2023

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Hathaway-Warner v. TD General Insurance Company (20-002110)

The claimant, who had previously been deemed CAT pursuant to Criteria 8, sought entitlement to attendant care benefits up to the $6,000 monthly maximum. The respondent had approved entitlement to ACBs up to $2,642.91 per month. The claimant also sought modifications to her home (totaling $399,763) or, in the alternative, funding for the purchase of...

March 20, 2023

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Cesario v. Intact Insurance Company (22-003001)

The claimant slipped and fell on ice while she was entering her vehicle in a Costco parking lot on December 16, 2019. She opened the door and was entering her vehicle when she slipped on a patch of ice. She grasped the door with her left hand before she fell and struck her back on...

March 16, 2023

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ZR v. Gore Mutual Insurance Company (18-000017)

The respondent filed a request for a partial reconsideration of a decision in which the Tribunal found that the clamant was not statute barred from disputing the respondent's denial of pre-104 attendant care benefits within the two year limitation period. The claimant argued that the Tribunal erred in law in its determination that the limitation...

March 15, 2023

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Shwaluk v. Royal & Sun Alliance (20-000137)

The claimant was injured in a 1994 accident. She received benefit under the relevant SABS until at least 1996. In 2015, the claimant contacted the insurer and requested that her claim be re-opened as her accident-related impairments had worsened, and that she required 24-hour supervisory care. The insurer agreed that care was required, but disputed...

March 14, 2023

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Tamayo v. Licence Appeal Tribunal (2023 ONSC 1692)

The claimant appealed the Tribunal's decision denying an adjournment of a scheduled hearing. The Court dismissed the appeal, holding that the denial of the adjournment was an interlocutory step from which no appeal was permitted. The Court also declined to grant a stay of the proceedings.

March 13, 2023

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Lengyel v. The Licence Appeal Tribunal (2023 ONSC 1623)

The claimant appealed and sought judicial review of the Tribunal's decision to dismiss her application due to non-attendance at an IE. The Court dismissed the appeal and judicial review, holding that the Tribunal properly considered the SABS and the materials before it, and the result was a reasonable outcome available to the Tribunal under the...

March 13, 2023

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Kaur v. Northbridge General Insurance Company (21-001035)

The claimant sought a determination that she sustained a catastrophic impairment as a result of the accident. Vice Chair Moore held that the claimant did not suffer a catastrophic impairment under Criterion 7 or Criterion 8. Vice Chair Moore found the insurer's WPI ratings more persuasive. In particular, the Vice Chair preferred the position of...

March 13, 2023

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Balon v. BelairDirect (22-001100)

The claimant was involved in an ATV accident and sought benefits pursuant to the SABS. The preliminary issue to be considered at the hearing was whether the incident the claimant was involved in was considered an accident. The adjudicator found that the claimant was not involved in an accident pursuant to s. 3 of the...

March 9, 2023

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Krzweski v. CUMIS General Insurance Company (20-013665)

The claimant disputed entitlement to a chronic pain assessment and a psychological assessment. The claimant argued that in denying these plans, the insurer did not specify a medical basis for the denial or request further medical documentation from the claimant. The claimant further contended that the insurer failed to provide a medical ground for maintaining...

March 6, 2023

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Amalathasan v. Certas Home and Auto Insurance Company (21-006393)

The claimant applied to the LAT for entitlement to medical benefits outside of the MIG. Adjudicator Cavdar found that the issue of whether the claimant sustained predominantly minor injuries was already determined by the LAT in a 2020 decision and was, therefore, res judicata. Accordingly, the claimant remained in the MIG and was not entitled...

March 6, 2023

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Hutchinson v. Aviva General Insurance Company (2023 ONSC 1472)

The claimant appealed the Tribunal's decision that she was not entitled to various medical benefits. The claimant argued that the Tribunal's refusal to convert the videoconference hearing to a written hearing was a breach of procedural fairness and natural justice. The claimant's counsel had argued that the claimant was unable to participate in the hearing...

February 28, 2023

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Panchadcharam v Aviva Insurance Company (20-013921)

The claimant initially applied to the LAT regarding a MIG determination and various denied OCF-18s. Prior to the LAT Case Conference, Aviva removed the claimant from the MIG and approved all disputed treatment, leaving only a special award in dispute. The claimant argued that they were entitled to a special award as Aviva had maintained...

February 28, 2023

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Chu v. Unica Insurance Inc. (20-001934)

The claimant applied to the LAT for a catastrophic impairment designation under Criteria 8. She had already exhausted her $65,000 non-CAT policy limit. The claimant bore the onus of proving on a balance of probabilities that she had a “Marked” or Class 4 impairment in at least three of the four domains set out in...

February 28, 2023

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Calderon v Allstate Canada (20-013275)

The main issue in this matter was whether the claimant was barred from pursuing accident benefits due to entitlement to WSIB benefits. The adjudicator found that the claimant was statute-barred under section 61 of the SABS, which states that insurers are not required to pay benefits to individuals entitled to workers’ compensation benefits. Despite the...

February 27, 2023

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Khalaf v The Dominion of Canada General Insurance Company (20-000264)

The claimant was involved in an accident on October 19, 2016, and applied for accident benefits. The dispute involved the insurer denying catastrophic impairment under criterion 8, based on the s. 44 psychiatry IE of Dr. Sivasubramanian, and involved a 7-day videoconference hearing. Initially, Dr. Sivasubramanian had opined that the claimant suffered 2 Class 4...

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Contact Us

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

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

416.507.1850

eodonnell@tgplawyers.com