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.

March 3, 2020

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L.F. v. Aviva General Insurance Company (18-008308)

The claimant sought reconsideration of the Tribunal's decision that she was barred from disputing entitlement to medical benefits because she failed to attend an IE assessment. Adjudicator Norris concluded that he did not commit an error in regard to the proper medical and other reasons for the insurer's denial since the insurer's letter noted that...

March 2, 2020

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A.V. v. Certas Direct Insurance Company (18-007875)

The claimant sought entitlement to NEBs, a determination that her impairments were outside of the MIG, and the cost of psychological assessment. Adjudicator Lake found that the claimant failed to prove on a balance of probabilities that she suffered from psychological issues or chronic pain arising from the accident and, as a result, her injuries...

March 2, 2020

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S.L. v. Aviva Insurance Company (19-00278)

The claimant sought entitlement to IRBs, removal from the MIG, and entitlement to medical benefits proposed in eight treatment plans. Adjudicator Lester found that the claimant's injuries fell with the MIG and that none of the treatment plans in dispute were payable as the MIG limits had been exhausted. However, the claimant was deemed entitled...

March 2, 2020

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S.L. v. Aviva Insurance Company of Canada (19-002783)

The claimant sought entitlement to income replacement benefits and to medical benefits proposed in eight treatment plans, and the cost of $26,400 for catastrophic impairment assessments. The claimant argued that he suffered from pre-existing lower back pain which was exacerbated as a result of the accident and would prevent him from reaching maximum recovery under...

March 2, 2020

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A.V. v. Certas Home and Auto Insurance Company (18-007875)

The claimant sought entitlement for weekly non-earner benefits and entitlement to one treatment plan for a psychological assessment. Adjudicator Lake found that the claimant was not entitled to the benefits in dispute. Adjudicator Lake noted that the claimant failed to prove on a balance of probabilities that she suffered from a psychological impairment or from...

March 2, 2020

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A.T. v. Aviva Insurance Canada (18-008856)

The claimant sought reconsideration of the Tribunal's denial of post-104 week IRBs. Adjudicator Go dismissed the reconsideration request. The claimant used the wrong test in arguing for entitlement to IRBs. Further, Adjudicator Go noted that the claimant's own family physician did not support that she suffered a complete inability to engage in any suitable employment.

February 27, 2020

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W.C.P. v. Certas Home and Auto Insurance Company (18-010692)

The claimant sought determination that his impairments were outside of the MIG and sought entitlement to the costs of an examination for an in-home attendant care assessment. Adjudicator Reilly found that there was no evidence before the Tribunal that would take the claimant outside of the MIG, therefore, the claimant was subject to the MIG...

February 27, 2020

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V.P. v. Aviva Insurance Canada (18-011026)

The insurer brought a motion requesting the production of unredacted treating psychotherapist records and the claimant brought a motion to exclude certain records from the insurer's brief. Adjudicator Paluch found that the psychotherapist notes were prepared to document the claimant's treatment and not for the sole purpose of litigation, therefore, litigation privilege did not apply....

February 27, 2020

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S.P. v. Jevco (19-001613)

The claimant sought entitlement to income replacement benefits, to the costs of four assessments for examinations, to four treatment plans for physiotherapy services, and to payment for a disability certificate invoice. Adjudicator Watt found that the claimant was not entitled to the medical benefits, attendant care assessment, psychological assessment, functional abilities evaluation, and chronic pain...

February 27, 2020

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S.F. v. Aviva Insurance Company of Canada (18-012486)

The claimant sought entitlement to the costs of three assessments for examinations and one treatment plan for assistive devices. Adjudicator Norris found that the claimant was not entitled to any of the benefits. Adjudicator Norris concluded that the Neurological, FAE, and In-Home Ergonomics assessments were not reasonable and necessary as a result of the accident....

February 27, 2020

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K.B. v. Aviva General Insurance (18-011950)

The Tribunal addressed three preliminary issues in this decision: whether the claimant's failure to attend an IE barred the dispute for a chronic pain assessment and IRBs, whether the claimant's failure to submit documentation resulted in a section 33 suspension, and whether the insurer was entitled to repayment of IRBs. Adjudicator Norris held that failure...

February 27, 2020

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J.M. v. Wawanesa Mutual Insurance Company (18-006148)

The insurer sought reconsideration of the Tribunal's award of $6,000 per month in ACBs. The claimant was involved in an accident in 2015 and deemed catastrophically impaired three years later. The claimant's Form 1 recommended $8,467.65 worth of ACBs per month; the insurer's Form 1 supported $1,583.45 in ACBs per month. The insurer argued that...

February 27, 2020

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Aviva General Insurance v. Khan (2020 ONSC 1290)

The insurer sought judicial review of the Tribunal's decision to award various medical benefits. The Court reviewed the Tribunal's decision on a correctness standard and dismissed the appeal. It agreed with the insurer that a benefit could not be deemed incurred without a specific finding that the insurer unreasonably withheld or delayed payment of a...

February 27, 2020

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J.M. v. Wawanesa Mutual Insurance Company (18-006148)

The insurer sought reconsideration of the Tribunal's award of $6,000 per month in ACBs. The claimant was involved in an accident in 2015 and deemed catastrophically impaired three years later. The claimant's Form 1 recommended $8,467.65 worth of ACBs per month; the insurer's Form 1 supported $1,583.45 in ACBs per month. The insurer argued that...

February 26, 2020

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P.F. v. Economical Mutual Insurance Company (18-010791)

The claimant was the operator of a vac-truck that responded to a fatal tractor-trailer collision. The claimant alleged that, as a result of cleaning up the spilled substances resulting from the accident and seeing the deceased bodies, he suffered from both physical and psychological injuries. The Tribunal denied the claim on the grounds that it...

February 25, 2020

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P.B. v. Aviva Insurance Company of Canada (18-009287)

The claimant filed a request for reconsideration arising from a decision in which the Tribunal found that the OCF-10 election by the claimant was final, and that the claimant was not entitled to a non-earner benefit. Adjudicator Watt dismissed the request for reconsideration, noting that the claimant was simply trying to re-argue its case, and...

February 25, 2020

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A.A. v. Aviva General Insurance Company (18-009541)

The claimant applied for medical benefits, which the insurer denied on the basis that his injuries fell within the MIG and that the benefits were not reasonable and necessary. Prior to the first case conference, all issues in dispute were agreed to paid including interest, and the insurer removed the claimant from the MIG. The...

February 25, 2020

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X.J.W. v. Certas Home and Auto Insurance Company (19-000222)

This preliminary hearing was brought to determine whether the claimant was statute barred from appealing the insurer's denial of his claims for medical benefits and IRBs because the appeal was filed more than two years after the denials. The claimant had applied for a FSCO mediation in April 2016 in regard to the denials, and...

February 25, 2020

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S.S. v. Unifund Assurance Company (18-010682)

The claimant sought a determination that her impairments were outside of the MIG, entitlement to medical benefits proposed in two physiotherapy treatment plans that had been partially approved, entitlement to IRBs which had been suspended for non-attendance of IEs, and a special award. Adjudicator Lester rejected the claims. She agreed with the insurer that the...

February 24, 2020

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M.D. v. Certas Home and Auto Insurance Company (18-011652)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to medical benefits proposed in two treatment and assessment plans for physiotherapy services and a chronic pain assessment. Adjudicator Grant found that the claimant's chronic pain took him outside of the MIG, based on the chronic pain assessment report of...

February 21, 2020

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Applicant v. Northbridge Personal Insurance Company (18-000729)

The claimant sought entitlement to income replacement benefits, while the insurer sought a repayment of $59,817.21 in IRBs paid from October 2011 to August 2017 on the basis of wilful misrepresentation. Vice-Chair Marzinotto dismissed the claimant's application and found that the insurer was entitlement to repayment of IRBs paid to date. The Vice-Chair was satisfied...

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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