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 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...

February 14, 2020

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M.J. v. Wawanesa Mutual Insurance Company (18-008501)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to medical benefits proposed in six physiotherapy and psychological treatment plans. Adjudicator Grant found that the claimant's injuries were predominantly minor and fell within the MIG. He found there was no objective medical opinion providing a thorough analysis to indicate...

February 14, 2020

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C.S. v. Aviva Insurance Canada (18-007039)

The claimant sought entitlement to a rehabilitation treatment plan and interest on the payment of overdue benefits. Adjudicator Grant found that the claimant did not demonstrate that the rehabilitation benefits in dispute for personal training and a gym membership were reasonable and necessary. The treatment plan was contradicted by the claimant's self-reporting that she had...

February 13, 2020

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C.D. v. Certas Home and Auto Insurance Company (18-006437)

The claimant sought reconsideration of the Tribunal's denial of mileage expenses related to her case manager. Vice-Chair Lester upheld the previous decision and dismissed the reconsideration. She noted that the claimant re-argued her case from the previous decision, and did not explain how the decision erred in fact or law. She also did not argue...

February 13, 2020

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L.H. v. Certas Direct Insurance Company (18-005475)

The claimant filed a request for reconsideration arising from a decision in which the Tribunal found that her injuries fell within the MIG. Adjudicator Lake dismissed the request for reconsideration on the grounds that the request was not submitted within 21 days of the date of the decision pursuant to Rule 18.1, as the claimant...

February 12, 2020

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F.S. v. Unica Insurance Inc. (19-001537)

The claimant sought various accident benefits, including post-104 IRBs. The insurer denied benefits based upon its MIG position. During the course of the claim, the insurer scheduled numerous IEs to determine the MIG and various benefits in dispute, which the claimant did not attend. Following the case conference, with agreement from claimant's counsel, the insurer...

February 12, 2020

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V.M.L. v. Aviva General Insurance Company (18-001713)

The claimant filed for reconsideration on a previous decision in which the Tribunal ruled that the claimant was statute barred from proceeding with her appeal of the denial of IRBs, and the Tribunal's decision not to extend the limitation period under section 7 of the LAT Act. Adjudicator Johal allowed the case to proceed, noting...

February 12, 2020

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Z.J. vs. Wawanesa Mutual Insurance Company (18-008967)

The claimant was involved in an accident on June 14, 2018 when he was struck by a BMW driven by a third-party who was making a left-hand turn. the insurer argued that the accident was staged, and that the claimant was not entitled to claim accident benefits as a staged accident did not meet the...

February 12, 2020

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R.B. vs. Aviva Insurance Company of Canada (18-011209/AABS)

The claimant was injured in an accident on February 2, 2017 and disputed his MIG status. The insurer argued that the claimant had failed to attend several IEs and was barred from proceeding to the LAT . Adjudicator Norris ruled in favour of the claimant as the insurer had failed to provide adequate medical or...

February 12, 2020

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J.A. v. Aviva Insurance Canada (18-002124)

The claimant sought entitlement to $16,320 for various catastrophic impairment assessments more than 10 years after his accident had occurred (and his medical benefits coverage had lapsed). The assessments were proposed after an OCF-19 had been submitted and IEs had taken place showing that the claimant did not suffer a catastrophic impairment. The insurer argued...

February 11, 2020

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S.A. vs. Aviva General Insurance (19-001903)

The claimant was involved in an accident on February 13, 2016 and disputed entitlement to three treatment plans on September 18, 2018; within the two-year limitation of the denied treatment plans. The insurer argued that the application was filed with the Tribunal on January 17, 2019, beyond the two-year limitation period. Adjudicator Norris ruled in...

February 11, 2020

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M.T.G. v. Aviva General Insurance (17-002122)

The claimant requested an extension under section 7 of the LAT Act to extend the limitation period beyond the two year statutory limits to dispute his entitlement to IRBs. The insurer denied IRBs on February 15, 2015, the claimant then initiated a FSCO dispute with a mediation scheduled for May 28, 2016. Claimant's counsel submitted...

February 11, 2020

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B.B. vs. Aviva General Insurance Company 18-006826)

The claimant disputed entitlement to IRBs in the amount of $400.00 per week from October 26, 2016 to January 7, 2019 with interest. As a preliminary issue, the claimant sought to add entitlement to IRBs beyond January 7, 2019. Adjudicator Lake dismissed the claim, and the preliminary issue. She noted that the claimant did not...

February 11, 2020

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Applicant v. Pafco Insurance Company (18-011583)

The claimant was involved in an accident in 1997. He applied to the LAT to dispute entitlement to IRBs, medical benefits, and a catastrophic impairment. The insurer argued that the claimant never submitted an OCF-1 and did not have a reasonable excuse for the delay. Adjudicator Kepman rejected the claimant's arguments that he was not...

February 10, 2020

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Applicant v. RSA Insurance (19-000560)

The claimant sought a determination that he suffered a catastrophic impairment based on the impairment under the American Spinal Injury Associate (ASIA) Impairment Scale. The claimant's injuries met the required level of impairment, but the insurer argued that the injury was not yet permanent, which is a requirement under section 3.1(1)1(ii)B of the SABS, because...

February 7, 2020

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P.K. vs. Aviva Insurance Canada (18-011533)

The claimant disputed entitlement to a partially approved OCF-18 for psychological services in the amount of $3,591.87. The insurer paid $2,444.15 of the OCF-18 based upon the Professional Services Guideline for psychological services. Adjudicator Norris noted that the insurer was correct in its payment of the services within the PSG. He commented that the $224.42...

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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