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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January 22, 2018

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J.T. v. Aviva Canada Inc. (16-003674)

The claimant sought reconsideration of the underlying Tribunal decision, in which the adjudicator concluded that the ATV the claimant was occupying at the time of the accident was not an "automobile," and that the claimant was therefore not entitled to accident benefits. Executive Chair Lamoureux allowed the reconsideration and remitted the matter to a new...

January 22, 2018

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D.W. v. The Co-operators (17-000388)

The claimant sought reconsideration of the Tribunal's denial of IRBs. The crux of the issue was whether the claimant could claim IRBs after the first 104 weeks without first receiving IRBs during the first 104 weeks. The Tribunal initially ruled that the claimant could not seek IRBs. Executive Chair Lamoureux confirmed the result, but on...

January 22, 2018

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Applicant v. Unica Insurance Company (17-002059)

The insurer sought to have the application dismissed on the basis of the claimant's failure to attend the hearing. Adjudicator Maedel held that the claimant had abandoned his application, and had failed to substantiate his claims. The matter was dismissed.

January 19, 2018

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Applicant v. TTC Insurance Company Limited (17-002561)

The claimant sought a declaration that she suffered a catastrophic impairment as a result of the accident, and entitlement to a psychological paper review. The claimant had submitted two OCF-19s - the first alleged a catastrophic impairment due to a 55 percent Whole Person Impairment; the second alleged a catastrophic impairment due to a Class...

January 18, 2018

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Applicant v. Aviva Insurance Company (17-001007)

The claimant sought removal from the MIG and entitlement to two treatment plans for physical therapy. Adjudicator Watt held that the claimant's injuries fell within the MIG and wrote that the claimant had not explained why her pre-existing obesity, hypertension, and sciatic nerve problems would prevent maximal recovery under the MIG. He favoured the opinions...

January 17, 2018

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K.S.Y. v. Aviva Insurance Canada (16-003903)

The claimant sought a determination that her impairments were outside of the MIG and entitlement to benefits proposed in two treatment plans for physical rehabilitation and one treatment plan for a psychological assessment. The insurer raised a preliminary issue, submitting that the claimant was precluded from adjudicating the issues in dispute for failure to attend...

January 17, 2018

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T.H. v. Aviva Insurance (17-001125)

The claimant sought entitlement to non-earner benefits. The insurer argued the claimant had not suffered a complete inability to carry on a normal life. Adjudicator Robert Watt applied the factors found in the Ontario Court of Appeal decision of Heath v. Economical and determined that the claimant failed to meet the burden of proof. The...

January 16, 2018

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Applicant v The Guarantee Company of North America (17-002558)

The applicant sought medical benefits for physiotherapy services. The respondent brought a motion to strike the applicant's reply. The applicant filed a response to the motion to strike a day after the deadline. Adjudicator Goela held that despite being late, she would consider the applicant's response as it did not prejudice the respondent. Adjudicator Goela...

January 16, 2018

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E.E. v. Aviva Insurance Company (16-004281)

The claimant sought a determination that he sustained a catastrophic impairment, as well as entitlement to ACBs and various medical benefits. Adjudicator Bickley concluded that the claimant sustained a catastrophic impairment due to a WPI in excess of 55 percent. She accepted the claimant's position that his physical impairments should be rated under both Chapter...

January 16, 2018

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Unifund Assurance Company (17-001773)

The insurer sought repayment of income replacement benefits. Adjudicator Robert Watt reviewed the jurisprudence of section 52 and noted that a proper repayment notice should include: (i) identification of the type of benefit that was overpaid, (ii) the payment period for which repayment is sought, (iii) the amount of repayment sought, and (iv) the amount...

January 16, 2018

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C.W. v. Unifund Assurance Company (16-003336)

The insurer sought reconsideration of the Tribunal's decision that the claimant's injuries were non-minor due to a partial shoulder tear and pre-existing back pain. Executive Chair Lamoureux dismissed the reconsideration. She held that the Tribunal's decision was based on the evidence before it and that the Tribunal was entitled to weight the contradicting evidence as...

January 16, 2018

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Applicant v. Aviva Insurance Canada (16-003323)

The claimant sought entitlement to non-earner benefits, as well as a number of medical treatment plans. The insurer denied entitlement to all claims. Adjudicator Rebecca Hines reviewed the medical evidence and determined the claimant failed to prove the treatment plans were reasonable and necessary, and also failed to establish a complete inability to carry on...

January 16, 2018

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A.R. v. Wawanesa Mutual Insurance Company (17-000149)

The claimant sought entitlement to two proposed orthopaedic assessments. Adjudicator Msosa denied both assessments. He first wrote that without the treatment plans before him, he could not determine whether they were reasonable. He also accepted the opinion of the insurer's expert that the claimant had not sustained orthopaedic injury in the accident and there was...

January 15, 2018

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Y.L. v. Pafco (17-000480)

The claimant sought entitlement to IRBs. Arbitrator Neilson found that the claimant was not entitled to IRBs as she found the claimant was not employed or receiving employment insurance at the time of the accident and had not worked for at least 26 weeks during the 52 weeks prior to the accident. Arbitrator Neilson preferred...

January 12, 2018

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The Applicant v. State Farm Insurance Company (16-002503)

The minor claimant sought a determination that he was catastrophically impaired. Both parties agreed that the claimant suffered a traumatic brain injury and soft tissue injuries in the accident, but the claimant had significant pre-existing medical problems, including a brain injury, epilepsy, developmental delay and autism spectrum disorder. Insurer examinations determined that the claimant was...

January 12, 2018

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Applicant v. Traditional Mutual Insurance Company (17-002734)

The claimant sought entitlement to a psychological assessment. Adjudicator Norris held that the proposed assessment was reasonable and necessary. He relied upon the claimant's consistency of reporting, prescription for antidepressants, and more than one medical practitioner opining that the claimant may suffer a psychological disorder.

January 12, 2018

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A.R. v. TD General Insurance Company (16-003487)

The claimant sought interest on re-instated IRBs and entitlement to an orthopaedic mattress. The insurer opposed paying interest, arguing that the claimant had not provided evidence earlier in her claim supporting IRB entitlement. Adjudicator Maedel held that once the insurer re-instated IRBs, the claimant was entitled to interest for the period IRBs had not been...

January 11, 2018

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Applicant v. RSA Insurance (17-000233)

The claimant disputed his entitlement to income replacement benefits (IRBs), medical benefits and the MIG. Adjudicator Treksler concluded that the claimant's injuries fell outside of the MIG due a post-accident psychological impairment and diagnosis of chronic pain syndrome. In her reasons, Adjudicator Treksler noted that she preferred the evidence of the claimant's family physician to...

January 11, 2018

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Economical Mutual Insurance Company (17-002716)

The insurer sought repayment of overpaid income replacement benefits, as well as the cancellation fee for a missed examination under oath. Adjudicator Sandeep Johal reviewed the evidence of the insurer and determined that it failed to establish the claimant made a willful misrepresentation resulting in an error. Because a willful misrepresentation was not established, repayment...

January 11, 2018

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Applicant v. Allstate Insurance Company (16-004309)

The claimant sought entitlement to ongoing NEBs and two proposed treatment plans for physiotherapy. Adjudicator Baker denied entitlement to NEBs but awarded the treatment plans. In terms of NEBs, Adjudicator Baker wrote that the claimant had submitted only limited evidence about his pre-accident and post-accident life, which did not support entitlement to NEBs. He also...

January 10, 2018

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Applicant v. Unifund Assurance Company (16-003709)

The claimant sought entitlement to IRBs and ACBs. The insurer sought repayment of IRBs paid for a period that the claimant was working. Adjudicator Bickley denied entitlement to both IRBs and ACBs. She held that the claimant's return to work shortly after the accident and frequency gym attendances suggested that the claimant did not suffer...

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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