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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February 16, 2018

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Applicant v. Aviva General Insurance (17-003539)

The claimant sought removal from the MIG and three medical benefits. Adjudicator Norris held that the claimant's partial rotator cuff tear was an injury that fell within the MIG, and that the claimant's pre-accident reports of back pain did not constitute pre-existing injuries that would prevent recovery under the MIG. He also concluded that the...

February 14, 2018

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Applicant v. Wawanesa Mutual Insurance Company (16-002633)

The claimant sought removal from the MIG and two medical benefits. The insurer argued that the claim was time barred. Adjudicator Maedel held that the claimant had applied to the LAT within 90 days of receipt of the FSCO Report of Mediator, and was therefore within the limitation period. He concluded that the claimant's injuries...

February 14, 2018

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Applicant v. TD Insurance Meloche Monnex (17-000640)

The claimant sought entitlement to NEBs, removal from the MIG, and two treatment plans. Adjudicator Neilsen first exclude one report submitted by the claimant because it was given to the insurer 10 days prior to the hearing. In terms of the benefits in dispute, the adjudicator concluded that the claimant failed to adduce sufficient evidence...

February 14, 2018

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Applicant v. Co-operators General Insurance Company (16-003821)

The claimant sought removal from the MIG and entitlement to four medical benefits. Adjudicator Makhamra accepted that the claimant suffered from a compression fracture caused by the accident, and from psychological impairments; the claimant was removed from the MIG. The adjudicator awarded all of the claimed medical benefits, as being reasonable and necessary.

February 14, 2018

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Applicant v. Certas Direct Insurance Company (17-003571)

The claimant sought entitlement to treatment outside of the MIG and to three treatment plans. Adjudicator Johal dismissed the claimant's claim finding that her injuries fell within the MIG. As Adjudicator Johal concluded that the MIG applied, he held that he did not need to address whether the proposed treatment plans were reasonable and necessary.

February 13, 2018

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S.R. v. Aviva Insurance Canada (17-004556)

The insurer argued that the claimant was barred from seeking IRBs due to the limitation period. It had denied IRBs when the claimant returned to work. The denial letter stated that if the claimant was off work again due to injuries, the insurer would require an updated Disability Certificate. Adjudicator Ferguson held that the denial...

February 13, 2018

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M.K. v. Aviva Insurance Company (17-003608)

The claimant sought entitlement to NEBs, removal from the MIG, and one treatment plan. The insurer argued that the claimant failed to attend an IE. Adjudicator Watt agreed that the claimant failed to attend a scheduled IE, and he therefore could not dispute his entitlement to the denied treatment plan. In terms of NEBs, the...

February 12, 2018

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R.S. v. Wawanesa Mutual Insurance Company (17-000513)

In this preliminary decision relating to IRBs, the insurer argued that the claimant had failed to provide documents requested under section 33 of the SABS, and that the claimant failed to seek medical treatment as required under section 57 of the SABS. Adjudicator Norris held that the claimant had failed to provide relevant documents over...

February 9, 2018

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Z.M. v. Aviva Insurance Company (17-002894)

The claimant sought removal from the MIG and three treatment plans. The insurer argued that the claimant failed to attend scheduled IEs. Adjudicator Norris concluded that the insurer's IE notices complied with the SABS, and that the claimant failed to attend the IEs. He rejected the submission that the insurer had to provide the claimant...

February 9, 2018

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M.H.E. v. Aviva Insurance Company (17-002624)

The claimant sought removal from the MIG and entitlement to six treatment plans. Adjudicator Mather concluded that the claimant suffered from chronic pain, which was a non-"minor injury." The adjudicator accepted that pain relief was a valid treatment goal, and awarded four of the claimed treatment plans. Two of the treatment plans were denied due...

February 9, 2018

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D.N. v. Aviva Insurance Company (17-004104)

The claimant sought entitlement to two assessments, and argued that the treatment plans were denied more than 10 days after submission. The insurer argued that the claimant failed to attend IEs. Adjudicator Norris agreed with the claimant that the treatment plans had been denied more than 10 days after submission due to the deeming provision...

February 8, 2018

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K.K. v. Unifund Assurance Company (17-003303)

The insurer brought a motion to dismiss the application after the claimant's failure to submit any written materials. Adjudicator Watt granted the motion and dismissed the application. He reasoned that the claimant's failure to bring a motion to extend the deadline for submissions after retaining new counsel amounted to an abuse of process, and that...

February 8, 2018

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Applicant v. Aviva Insurance Company (17-002907)

The claimant sought removal from the MIG and entitlement to four medical benefits. Adjudicator Lester held that the claimant's disc bulges, degenerative changes, and chronic pain disorder were not minor injuries, and removed the claimant from the MIG. She also awarded the cost of a chronic pain assessment, chronic pain treatment plan, and a psychological...

February 6, 2018

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J.N. v. Aviva General Insurance Company (17-000518)

The claimant sought entitlement to NEBs and the cost of an in-home assessment. Adjudicator Truong dismissed the claim for NEBs, but awarded the in-home assessment. She found the reports by the claimant's assessors to be contradictory and unhelpful in supporting the NEB claim. There were also injuries that the claimant's assessor tried to link to...

February 6, 2018

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J.D. v Aviva General Insurance (17-002713)

The claimant sought the cost of an orthopaedic assessment. Adjudicator Goela held that the respondent's denial letter did not provide a medical reason why an orthopedic examination was not reasonable or necessary pursuant to section 38(8) of the SABS. The denial letter stated that pursuant to the physiatrist report, further physical intervention would not affect...

February 6, 2018

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S.T. v. Wawanesa Mutual Insurance Company (17-003874)

The insurer sought production of the settlement documents from an earlier accident the claimant was involved in. Adjudicator Neilson ordered the records produced. She held that it was relevant to the current dispute what the claimant was paid in her earlier claim, and how the benefits were allocated. She noted that there was no evidence...

February 6, 2018

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Applicant v. State Farm Insurance (16-004619)

The claimant sought ongoing IRBs. Adjudicator Gosio rejected the claim. He held that the claimant had failed to meet her burden under the post-104 week test. In particular, he was critical of the claimant's assessors basing their report solely on the claimant's self-reporting, the assessors failure to consider the claimant's vocational background, and the failure...

February 5, 2018

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Applicant v. The Sovereign General Insurance Company (16-004501)

The claimant sought entitlement to various denied catastrophic impairment assessments, and the cost of x-rays. The insurer had approved some of the catastrophic impairment assessments, but denied others. At the time of the hearing, the claimant had been declared catastrophically impaired. Adjudicator Sewrattan awarded the cost of the physiatry assessment, even though an orthopaedic assessment...

February 5, 2018

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Applicant v. TD Insurance (17-003496)

The claimant sought entitlement to six assessments to address his potential catastrophic impairment. Each assessment was in excess of $2,000. The insurer denied the assessments on the basis that the claimant had failed to prove causation (i.e. the accident was minor, and the claimant suffered psychological difficulties before the accident). Adjudicator Sewrattan granted the claimant's...

February 5, 2018

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Applicant v. Aviva Insurance Canada (17-002465)

The insurer argued that the claimant was barred from seeking NEBs due to her failure to submit a Disability Certificate. Adjudicator Sewrattan rejected the insurer's position and held that the claimant likely had submitted a Disability Certificate. He relied upon a billed invoice from the clinic showing that a Disability Certificate had been completed. He...

February 1, 2018

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Applicant v. Unifund (17-000982)

The claimant sought entitlement to NEBs, removal from the MIG, and further medical benefits. The insurer argued that the claimant was barred from seeking NEBs due to the limitation period. Adjudicator Harmison accepted that the insurer had denied NEBs more than five years prior, and that the denial was clear and unequivocal. In terms of...

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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