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 6, 2020

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M.S. v. Aviva General Insurance Company (18-007082)

The claimant sought entitlement to four treatment plans for medical rehabilitation and cost of examinations, including chiropractic treatment, concussive therapy, and optometric services. Vice-Chair McQuaid found that the proposed treatments were not payable. In her decision, she noted that, although, she gave more weight to the evidence provided by the claimant's family physician and treating...

March 6, 2020

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R.B. v. RSA Insurance (19-002329)

The claimant sought entitlement to four treatment plans for medical rehabilitation and cost of examinations, including a catastrophic impairment assessment and medications. The insurer denied the benefits in dispute on the basis that the claimant's medical limits had been exhausted. Adjudicator Kaur concluded that that cost of examination for a catastrophic assessment are not subject...

March 5, 2020

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F.A. v. Wawanesa Mutual Insurance Company (18-008453)

The claimant sought entitlement to IRBs. The insurer argued that the claimant failed to provide relevant records requested under section 33, including pre-accident income documentation, employment file, and post-accident income records. The insurer also argued that the claimant's revocation of the right to conduct a paper IE was non-compliance with IE attendance. Adjudicator Chakravarti concluded...

March 5, 2020

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H.M. v. Intact Insurance Company (18-003979)

The claimant sought entitlement to a treatment plan for physiotherapy, and cost of examinations for a neurological assessment and a chronic pain assessment. Adjudicator Johal reviewed the medical records on file, which indicated numerous treating practitioners' opinion that further physiotherapy would be beneficial, and concluded that the disputed treatment for ongoing physiotherapy was reasonable and...

March 5, 2020

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A.U. v. TD Insurance Meloche Monnex (19-000276)

The claimant sought entitlement to the cost of a chronic pain assessment. The insurer argued that the claimant failed to attend an IE and was barred from disputing entitlement. The claimant argued that the denial was not sufficient under section 44, as there was no reference to medical records or having reviewed the treating practitioner’s...

March 3, 2020

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A.H. v. Aviva Insurance Canada (18-004237)

The claimant disputed her entitlement to a treatment plan for chiropractic services. Vice-Chair Farlam concluded that the disputed treatment plan was not necessary. Although the claimant consistently complained of back pain from 2015 to 2019, a review of the medical evidence did not show a direct relation to proposed treatments and subject accident as the...

March 3, 2020

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S.A. v. Aviva Insurance Canada (19-000995)

The claimant disputed entitlement to two treatment plans for treatments focused on neurological and concussive injuries. Adjudicator Norris noted that the claimant appeared to have predominantly psychological injuries as a result of the accident. He cited the insurer examination reports of Dr. Smyth (neurologist) and Dr. Belfon (physician) as holding greater weight than the claimant's...

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...

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com