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.

June 5, 2023

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Temple v. Economical Mutual Insurance Company (21-005510)

The preliminary issue in dispute was whether the claimant was barred, pursuant to s. 55(1)(3) of the SABS, from proceeding with the application as the claimant failed to provide information to the respondent in accordance with s. 46.2 and s. 46.3 of the Schedule. The respondent made multiple requests for the particulars pertaining to the...

May 26, 2023

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Pinera v. Motor Vehicle Accident Claims Fund (2023 ONSC 3155)

The claimant appealed the Tribunal's decision that he was not involved in an accident. The Court dismissed the appeal, holding that the Tribunal's reasons had no error of law, and that the claimant's appeal was largely an attempt to relitigate the factual issues that were before the adjudicator.

May 25, 2023

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Reid v. Aviva Insurance Company of Canada (20-008924)

The claimant applied to the LAT seeking entitlement to attendant care benefits during two periods: April 2018 to May 11, 2022, and May 12, 2022, to date. In October 2018, the insurer had cancelled a s. 44 in-home assessment because the claimant's counsel had advised the claimant no longer wanted to claim ACBs. In July...

May 9, 2023

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Kathirgamanathan v. Aviva Insurance Company (20-011425)

The claimant applied to the LAT seeking entitlement to IRBs, physiotherapy, and interest on overdue payments. Adjudicator John found that the insurer was not liable to pay IRBs during the period in which the claimant was non-compliant with s. 33 requests for an OCF-2 and other reasonably required employment/income-related documents. Adjudicator John also found the...

May 5, 2023

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Chaffey v. Wawanesa Mutual Insurance Company (22-001049)

The claimant sought a determination that he was catastrophically impaired after a motorcycle accident in July 2018. Under Criterion 4 there is a two-prong test which must be satisfied. The parties agreed that the first prong of the test had been met as there was sufficient diagnostic evidence of brain trauma. Looking at the second...

May 4, 2023

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Ossipova v. BelairDirect Insurance Company (21-001405)

The claimant applied to the LAT for the balance of various partially approved medical benefits. The insurer's denials were almost entirely based on the position that the claimant sought rates in excess of the rates authorized in the Professional Services Guideline. In addition, the insurer had approved 1-hour sessions for psychological therapy, rather than the...

May 3, 2023

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Al-Basheky v. Co-operators General Insurance Company (20-008231)

The claimant commenced an application after he was involved in a motor vehicle accident on November 9, 2018. He claimed entitlement to IRBs, which the insurer denied on the basis that he did not produce an OCF-3 within 104 weeks of the accident. Vice-Chair Todd found that the claimant was barred from proceeding with his...

May 3, 2023

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Coban v. Allstate Insurance (21-012430)

The claimant was catastrophically impaired in a motor vehicle accident in October 2018. At the time of the accident, the claimant was participating in a Work Transition Program through the WSIB. The Work Transition Program included attending an educational programme and working for a company through a work placement programme. During his participation in the...

May 1, 2023

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Bennett v. Allstate Insurance Company of Canada (2023 ONSC 2609)

The claimant appealed the Tribunal's denial of a special award related to IRBs which were reinstated after the post-104 week mark following further medical assessments. The Court dismissed the appeal, holding that it did not raise an issue of law. The Tribunal's determination regarding the special award were factual in nature, and the Tribunal applied...

April 28, 2023

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Nguyen v. Economical Mutual Insurance Company (2023 ONSC 2541)

The claimant appealed the LAT's decision that the limitation period barred the application. The Court allowed the appeal and remitted the matter to the Tribunal for a new hearing. The Court found the Tribunal erred in concluding that the denial letter was received on the day it was authored, as no evidence was before the...

April 28, 2023

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Sahadeo v. Pafco Insurance Company (2023 ONSC 2542)

The claimant appealed the LAT's dismissal of his catastrophic impairment dispute, arguing that the Tribunal's supplemental reasons contained in the reconsideration decision violated the principles of fairness. The Court dismissed the appeal, holding that the SPPA gave the Tribunal the power to make rules to reconsider its own decision, and that the reconsideration process gave...

April 26, 2023

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Di Giulio v. Aviva General Insurance Company (2023 ONSC 2426)

The claimant sought a stay from Divisional Court of the LAT's decision that the dispute would proceed in writing rather than orally. The Court rejected the stay, holding that there was not a serious issue, there was no irreparable harm if the stay was not granted, and the balance of convenience did not favour the...

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...

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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