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.

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...

February 20, 2020

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Applicant v. Aviva General Insurance Company (19-002413)

This preliminary issue hearing was brought to determine whether the claimant was statute barred from proceeding with his claim for attendant care benefits on the ground that he failed to attend an Otolaryngologist IE requested under section 44 of the SABS. Adjudicator Chakravarti found that the insurer failed to provide "medical and other reasons" for...

February 20, 2020

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D.S. v. Aviva Insurance Company of Canada (17-006952)

The claimant sought entitlement to the cost of a psychological assessment and a special award. Adjudicator McQuaid found that the assessment was reasonable and necessary, as the evidence from the ongoing adjustment of the claim supported the need for a psychological assessment. The result of assessments and examinations by four different doctors was a recommendation...

February 20, 2020

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D.P.V. The Co-operators (19-000079)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to medical benefits for two chiropractic treatment plans. 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 if his benefits were...

February 19, 2020

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A.H. v. TD General Insurance Company (18-011072)

The claimant sought a determination that her impairments were outside of the MIG and entitlement to medical benefits proposed in five physiotherapy, functional abilities evaluation, psychological, chronic pain, and chronic pain management treatment plans and assessments. Adjudicator Paluch found that the claimant's injuries fell within the MIG. Adjudicator Paluch found the claimant's medical evidence provided...

February 18, 2020

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C.P. v. Certas Home and Auto Insurance Company(17-003172)

The claimant filed a request for reconsideration arising from a decision in which the Tribunal found that that he was not entitled to income replacement benefits. Vice-Chair Marzinotto dismissed the request for reconsideration, finding no error or misapprehension of evidence in the Tribunal's decision.

February 18, 2020

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A.B. v. Aviva General Insurance Company(18-010200)

The claimant sought entitlement to non-earner benefits. Adjudicator Farlam found that the claimant had not met his onus of establishing that he suffered a complete inability to carry on a normal life, and was thus not entitled to non-earner benefits. The adjudicator noted that the weight of the evidence supported that the claimant’s physical and...

February 18, 2020

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Applicant v. State Farm Mutual Automobile Insurance Company (18-000605)

The claimant sought a catastrophic impairment determination, entitlement to attendant care benefits, and the cost of various assessments. The claimant suffered from chronic pain, had not worked in the 10 years since the accident, and had been diagnosed with major depressive disorder. Pain prevented the claimant's participation in home-based activities, and she rarely left the...

February 14, 2020

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Applicant v. Unifund Assurance Company (18-008089)

The insurer filed a request for reconsideration arising from a decision in which the Tribunal found that CAT Assessments were not a medical benefit and therefore their funding did not fall within the $50,000 limit under section 18 of the SABS. Adjudicator Victor dismissed the insurer's request for reconsideration and granted the claimant's request for...

February 14, 2020

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Applicant v. The Dominion of Canada General Insurance Company(18-002185)

The claimant sought a determination that the HST paid with respect to the attendant care services provided should be paid outside of the attendant care benefit limit, and a special award for unreasonably withholding payments of the attendant care benefit by paying HST out of the benefit limit. Adjudicator Gosio was persuaded by the claimant's...

February 14, 2020

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T.C. v. TD General Insurance Canada (19-000267)

The claimant sought entitlement to income replacement benefits. The insurer argued that the claimant had not produced any pre-accident or post-accident medical records, and thus, had not produced sufficient medical evidence to meet the IRB test. The insurer also relied on its section 44 IE reports, which opined that the claimant could return to work....

February 14, 2020

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E.M. v. Pembridge Insurance Company (18-011207)

The claimant sought a determination that her impairments were outside of the MIG and entitlement to medical benefits proposed in three physiotherapy and one psychological treatment and assessment plans. Adjudicator Norris found that the claimant's injuries were predominantly minor and fell within the MIG. He relied on the psychological IE report of Dr. Saunders which...

February 14, 2020

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S.P.F. v. Aviva General Insurance (18-010856)

The claimant sought entitlement to medical benefits proposed in two psychological treatment plans. Adjudicator Grant found that the treatment plans were not reasonable and necessary, based on the claimant's self-reporting and the reports of section 44 assessors. The claimant had acknowledged that he had not experienced any significant disruption, and he denied a desire to...

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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