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 25, 2020

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Y.K. v. Aviva General Insurance Company (18-003926)

The claimant suffered a brain injury and was deemed catastrophically impaired as a result of a 2011 accident. He received personal care from his brother, who left multiple part-time jobs to care for him. The Form 1 supported $6,000 per month in ACBs, but the claimant's brother suffered an economic loss of $2,100 per month...

March 24, 2020

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N.C. v. TD Insurance Meloche Monnex (18-003656)

The claimant sought a determination that he suffered a catastrophic impairment due to a Class 4 marked impairment or 55 percent WPI, ACBs, HK expenses, and various medical benefits. The insurer sought repayment of IRBs. Adjudicator Neilson concluded that the claimant did not suffer a catastrophic impairment. She first noted that the claimant would only...

March 20, 2020

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M.G. v. Certas Direct Insurance Company (18-006807)

The claimant sought to add a claim for a physiatry assessment to the issues in dispute. The claimant had died one day after the physiatry assessment took place. The insurer argued that the issue should not be added because the claimant failed to attend the IE (after he had died). Vice Chair Marzinotto permitted the...

March 20, 2020

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Applicant v. TD Home and Auto Insurance Company (17-008493)

The claimant sought reconsideration of the Tribunal's decision that his claim for ACBs and HK expenses was barred by the limitation period. Adjudicator Boyce granted the reconsideration request based on the Court of Appeal's decision in Tomec v. Economical. The claimant's ACBs and HK expenses had been denied in 2005. In 2015, the insurer accepted...

March 19, 2020

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A.G. v. Aviva Insurance Canada (19-001973)

The claimant sought a special award in relation to the cost for medical cannabis. The insurer had requested information from the claimant regarding the costs for the medical cannabis in order to consider payment. The claimant responded, but only provided some of the information requested by the insurer. Adjudicator Parish noted the insurer should have...

March 19, 2020

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M.N.T. v. Certas Direct Insurance Company (19-000031)

The claimant sought non-earner benefits. An Tribunal Order of June 24, 2019, determined that the issues in dispute were NEBs and interest on overdue payments. In the claimant's submissions, she included 2 additional issues: (1) status under the MIG and (2) a medical rehabilitation benefit. The claimant provided physiotherapy records, which included only one page...

March 19, 2020

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H.S.H. v. Aviva Insurance Company of Canada (18-002204)

The claimant sought reconsideration of the Tribunal's denial of the cost of a catastrophic impairment assessment, arguing that the burden should not be on the claimant and that the "reasonable and necessary" test did not apply to section 25. Adjudicator Reilly dismissed the reconsideration request, holding that the "reasonable and necessary" test applied to each...

March 18, 2020

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M.M. v. Aviva Insurance Canada (17-006475)

The claimant sought entitlement to IRBs, various medical benefits, educational expenses, and an accounting report. Adjudicator Boyce found that the claimant was not entitled to payment of IRBs as claimed as she did not demonstrate a substantial inability to perform the essential tasks of her pre-accident employment for the period in dispute. Adjudicator Boyce had...

March 13, 2020

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J.W. v. Security National Insurance Company (18-008988)

The claimant sought entitlement to ACBs. Adjudicator Norris found that the claimant was entitled to attendant care benefits, even though the claimant had returned to an intellectually challenging vocation (litigation lawyer) which required long work days. Since the evidence indicated that the claimant suffered ongoing fatigue as a result of a traumatic brain injury and...

March 13, 2020

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A.P. v. Aviva Insurance Canada(18-007997)

The claimant sought entitlement to NEBs, medical benefits proposed in three treatment plans, and the cost of examination expense for an orthopaedic assessment. Adjudicator Grieves concluded that the claimant was not entitled to NEBs as the claimant failed to prove that he suffered a complete inability to carry on a normal life. Adjudicator Grieves found...

March 12, 2020

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G.N.K. v Aviva Insurance Canada (18-006631)

The claimant initially applied for and elected IRBs, but ultimately did not meet the criteria to receive IRBs. He sought to re-elect and receive NEBs. The insurer argued that he was not entitled to make a re-election. Adjudicator Marzinotto agreed with the insurer, and held that the claimant could only re-elect to receive NEBs if...

March 12, 2020

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Najeebdeen v. Economical Mutual Insurance (19-010850)

The claimant sought the particulars of, and production of, all surveillance the insurer had conducted. The insurer resisted the request, arguing that all surveillance was obtained after litigation privilege arose. Adjudicator Grieves held that the insurer was only required to produce surveillance obtained after litigation privilege arose if the insurer intended on using the surveillance...

March 11, 2020

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T.N. v. TD Insurance Company (19-005638)

The claimant sought entitlement to ACBs in excess of the total approved by the insurer. The insurer raised a preliminary issue that the Tribunal did not have jurisdiction to hear the matter because the claimant had not actually incurrent any attendant care expenses. Adjudicator Lester found that there was a dispute between the parties since...

March 10, 2020

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Economical Mutual Insurance Company v. A.S. (19-001820)

The insurer applied to the LAT for repayment of IRBs, and also for a determination on the claimant's entitlement to further IRBs, the application of a section 33 suspension, and whether the claimant sustained a catastrophic impairment. Adjudicator Boyce held that the insurer could not bring an application related to IRB entitlement, section 33 suspension,...

March 10, 2020

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I.Y. v. Pembridge Insurance Company (18-006724)

The claimant sought removal from the MIG, and entitlement to various medical benefits and cost of examinations. The insurer, in addition to opposing the claims, argued that the claimant failed to comply with section 33 requests, and sought costs. Adjudicator Ferguson concluded that the claimant had failed to comply with the numerous requests under section...

March 6, 2020

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S. S. v. Allstate Canada (18-002292)

The claimant sought reconsideration of the Tribunal's decision that the limitation period barred the claim for NEBs. Adjudicator Norris rejected the reconsideration, holding that there was no legal error made in the Tribunal's conclusions that the claimant did not have a bona fide intention to appeal within the two year period. He also concluded that...

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...

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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