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.

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April 6, 2018

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J.T. v RBC Insurance (17-005328)

The claimant sought entitlement to NEBs and interest. The insurer relied on the opinions of two IE assessors when concluding that the claimant did not qualify for NEBs. The claimant argued that the denial was invalid, as the assessors did not have an opportunity to review the claimant's disability certificate. Adjudicator Watt disagreed with the...

April 6, 2018

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J.B. v. Coseco Insurance Company (17-005803)

The claimant sought removal from the MIG and entitlement to medical benefits. Adjudicator Ferguson held that the claimant suffered minor injuries and was restricted to MIG level benefits. He concluded that the claimant's rheumatoid arthritis was not caused by the accident, but was instead an unrelated degenerative disease. He also rejected the position that the...

April 6, 2018

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Applicant v. Aviva General (17-005134)

The claimant disputed his MIG status and entitlement to medical benefits for payment of chiropractic treatment. Adjudicator Driesel denied all of the claims. The claimant failed to provide compelling medical evidence to establish that maximal medical recovery could not be reached within the MIG limit. He sustained sprain and strain injuries as a result of...

April 5, 2018

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M.B. v. Travelers (17-003671)

The claimant sought removal from the MIG and entitlement to psychological and physical assessments and treatment. The claimant had a pre-accident medical history relevant for depression and anxiety stemming from infertility issues. Adjudicator Hines concluded that based on the medical records and the evidence of the s. 44 and s. 25 assessors, the claimant’s pre-existing...

April 5, 2018

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F.A. v Aviva Insurance Company (17-003364)

The applicant sought various medical benefits, as well as an award pursuant to section 10 of O. Reg 664. Adjudicator Truong held that the applicant was entitled to the balance of the treatment plan for a total body assessment and documentation, but was not entitled to medical benefits for physiotherapy. The adjudicator held that the...

April 5, 2018

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Applicant v. Aviva Insurance Canada (17-003575)

The claimant sought entitlement to a neurological assessment and driving evaluation assessment. The adjudicator dismissed the claim for a neurological assessment on the basis that the claimant did not submit any evidence as to why the proposed assessment was reasonable and necessary. The adjudicator also noted that the claimant did not submit any evidence to...

April 5, 2018

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T.F. v. Peel Mutual Insurance Company (16-003316)

The claimant sought reconsideration of the Tribunal's decision that she was barred from seeking entitlement to two treatment plans, arguing that the insurer's denials did not provider the requisite medical reasons. Executive Chair Lamoureux agreed with the claimant and overturned the decision. She held that the insurer's medical reasons had to engage the specific details...

April 5, 2018

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T.F. v. Peel Mutual Insurance Company (16-003316)

The claimant sought reconsideration of the Tribunal's decision that she was barred from seeking entitlement to two treatment plans, arguing that the insurer's denials did not provider the requisite medical reasons. Executive Chair Lamoureux agreed with the claimant and overturned the decision. She held that the insurer's medical reasons had to engage the specific details...

April 4, 2018

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K.B. v. Aviva Insurance Canada (17-006903)

The claimant made a motion to add a request for a special award, seek productions, change the format of the hearing, and to add witnesses to the hearing. Vice Chair Hunter ordered a Case Conference resumption to deal with the requests, and also ordered that an in-person hearing be set.

April 4, 2018

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B.B. v. Intact Insurance (17-005966)

This was a motion to adjourn an in-person hearing, heard via teleconference. The parties resolved the issues in dispute after commencement of the motion.

April 3, 2018

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Applicant v. CUMIS General Insurance (17-002592)

The claimant sustained serious injuries and required 24 hour care. She moved homes to receive care from her father. The claimant and insurer disputed how much money the claimant was entitled to for the cost of rent (as a rehabilitation benefit). The claimant argued that she was entitled to the full cost. The insurer argued...

April 3, 2018

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Applicant v. TD Insurance (17-005449)

The insurer brought a motion arguing that the LAT could not adjudicate a catastrophic impairment dispute without some other benefits also being in dispute. Adjudicator Ferguson rejected the insurer's position and held that the LAT does have jurisdiction to determine whether a claimant is catastrophically impaired regardless of any entitlement to benefits being disputed.

March 29, 2018

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Applicant v. Certas Direct Insurance Company (17-005290)

The claimant sought removal from the MIG and entitlement to three medical benefits. Adjudicator Parish concluded that the claimant's injuries fell within the MIG. She held that the claimant did not suffer psychological injuries or chronic pain. She noted that the claimant's assessors did not adequately consider objective findings and relied upon subjective reporting without...

March 29, 2018

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N.K. v. Certas Home and Auto Insurance (17-004337 and 17-004343)

The claimant, represented by counsel, entered into a settlement agreement with respect to LAT applications for disputed entitlement to various benefits. The claimant executed a full and final release and a settlement disclosure notice, and the LAT was notified that the claimant was withdrawing his applications. The claimant subsequently informed the LAT that he wished...

March 29, 2018

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T.H. v. The Personal Insurance Company (17-000121)

The insurer sought to rely on section 38(2) of the Schedule as a defence, asserting that the claimant incurred the expense of an assessment in dispute prior to submitting the OCF-18 to the insurer for approval. The claimant brought a motion for a declaration precluding the insurer from relying on the defence for a number...

March 29, 2018

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Applicant v. Aviva Insurance Canada (17-004325)

The claimant sought a declaration that her injuries were not predominantly minor injuries to be treated within the MIG, as well as entitlement to medical benefits for treatment. Adjudicator Watt held that the claimant was not entitled to any of the relief sought. The applicant failed to adduce any medical evidence to indicate that her...

March 27, 2018

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Applicant v. Aviva General (17-004847)

The claimant sought entitlement to various medical benefits, the costs of a chronic pain assessment, treatment outside of the MIG, and interest. Upon weighing the medical evidence, Adjudicator Boyce determined that the claimant's chronic pain warranted treatment outside of the MIG. Moreover, Adjudicator Boyce found the requested chronic pain assessment was reasonable and necessary. Adjudicator...

March 27, 2018

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V.K. v. Allstate Insurance Company (16-004273)

The claimant sought entitlement to attendant care benefits and medical benefits for vision-related expenses and transportation expenses. Adjudicator Truong held that the claimant was not entitled to any of the benefits or expenses at issue. The claimant's mother provided her with attendant care; however on the limited and unreliable evidence before the adjudicator, the claimant...

March 27, 2018

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

The claimant sought entitlement to further income replacement benefits and the insurer sought repayment of IRBs it paid to the claimant calculated on the understanding that he was an employee rather than self-employed. The claimant did not return to work after the accident citing his daily use of marijuana to control his anxiety, depression, stress,...

March 27, 2018

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Applicant v. Aviva Insurance Canada (17-003724)

The claimant sought removal from the MIG and entitlement to psychological treatment. Adjudicator Grant concluded that the insurer failed to respond to the treatment plan within 10 days. Even though the treatment plan was denied on HCAI, no letter with the medical and other reasons for the denial was sent to the claimant until two...

March 26, 2018

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Applicant v RBC General Insurance Company (17-005285)

The claimant argued that his injuries fell outside the MIG and sought medical benefits. Adjudicator Mazerolle held that the claimant's injuries fell within the MIG. Adjudicator Mazerolle preferred the insurer's psychological assessment that noted the claimant exhibited adjustment reactions which were mild symptoms and treatable within the MIG. The insurer's report relied on seven psychometric...

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Contact Us

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

416.507.1850

smilne@tgplawyers.com

© 2020 Thomas Gold Pettingill LLP