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 14, 2020

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E.M. v Coachman Insurance Company (18-012570)

The claimant sought entitlement to medical benefits for chiropractic services, psychological services, and two examinations. Adjudicator Maleki-Yazdi found that the insurer's denials were vague and did not provide the claimant with a meaningful explanation, so the claimant was not able to make an informed decision about whether to accept or dispute the insurer's decision. Further,...

April 14, 2020

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R.T. v Coseco Insurance Company (18-004783)

The claimant filed a motion to withdraw some of the issues listed for an upcoming LAT hearing on a without-prejudice basis. The insurer submitted that the issues not identified for withdrawal (namely attendant care benefits) were still in dispute, while the claimant submitted that the issue of attendant care benefits was previously determined in a...

April 13, 2020

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W.E. v Aviva Insurance Company (18-011102)

The claimant sought removal from the MIG and entitlement to various medical benefits. Adjudicator Conway concluded that pursuant to section 38(11)(1), the insurer failed to comply with section 38(8) in its denial, and was barred from applying the MIG to the disputed benefits. While the adjudicator ultimately concluded that the disputed medical benefit was not...

April 9, 2020

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J.N. v Co-Operators General Insurance Company (18-012227)

The claimant submitted a LAT Application in August 2017 disputing attendant care benefits, among other benefits. The parties resolved the issues in dispute and entered into a partial settlement agreement. In 2018, the claimant filed a second LAT Application disputing entitlement to attendant care benefits. The insurer brought this preliminary issue hearing, arguing that the...

April 9, 2020

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Z.S. v Intact Insurance Company (19-000175)

The claimant was deemed catastrophically impaired, and sought entitlement to attendant care benefits which were denied by the insurer on the basis that the claimant's alleged service provider, his wife, did not meet the requirements for a provider under the SABS and did not incur an economic loss. The claimant's wife was laid off by...

April 9, 2020

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J.K. v Aviva Insurance Company of Canada (18-008054)

The insurer submitted a request for reconsideration following a decision in which the Tribunal found that the claimant was entitled to various medical benefits. In making its decision, the Tribunal addressed a procedural issue that arose as a result of the parties not filing the OCF-18s in dispute with their written submissions and evidence. As...

April 8, 2020

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A.K. v Aviva Insurance Canada (18-002488)

The claimant disputed his entitlement to non-earner benefits, which the insurer had discontinued six months post-accident based on the medical evidence on file and the results of multi-disciplinary insurer examinations. In determining whether the claimant was entitled to ongoing non-earner benefits, Adjudicator Kowal compared his pre and post-accident activities of daily living. Adjudicator Kowal concluded...

April 8, 2020

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D.M. v. Royal Sun Alliance Insurance (18-003146)

The claimant sought reconsideration of the Tribunal's decision that it could not adjudicate or enforce a purported full and final settlement. Vice Chair Hunter granted the reconsideration and held that the Tribunal did have a more robust jurisdiction under the Insurance Act than simply deciding entitlement to benefits. Whether an accident benefits settlement had been...

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...

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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