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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December 1, 2017

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G.T. v. Unifund Assurance Company (16-001283)

The insurer appealed a ruling in which the claimant was awarded an orthopaedic assessment. The insurer argued that the assessment was available through OHIP, and therefore not payable under the SABS. Executive Chair Lamoureux rejected the reconsideration. She held that the obligation was on the insurer to advance evidence establishing that a benefit at issue...

December 1, 2017

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G.K. v. Security National Insurance Company (16-001904)

The insurer sought reconsideration of the Tribunal's decision that the claimant was a resident of Ontario at the time of the accident, and therefore an "insured person." Executive Chair Lamoureux rejected the reconsideration. She held that the Tribunal was asked to make a determination that largely turned on the facts of the case, and that...

December 1, 2017

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F.S. v. Aviva Insurance Company (17-002313)

The claimant sought entitlement to various medical benefits. Adjudicator Sewrattan dismissed all of the claims, holding that the claimant had not demonstrated that the proposed treatment was reasonable and necessary. He also noted that the claimant had refused to provide her collateral benefits entitlement information and that he was unable to determine if any of...

December 1, 2017

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Aviva Canada Inc. v. R.R. (16-004445)

The insurer appealed the dismissal of its repayment claim, which had been denied because there was no proof that the claimant was given the notice of repayment. Executive Chair Lamoureux held that there had been a breach of procedural fairness because the issue of whether a notice was provided to the claimant was not addressed...

November 29, 2017

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D.K.M. v. Motor Vehicle Accident Claims Fund (16-004520)

The claimant sought the remainder of a partially approved home modification treatment plan (which sought the purchase of a new home) in the amount of $119,451.70. The insurer asserted the remaining balance of the treatment plan was not reasonable and necessary and given the claimant's "Indian" status HST would not apply to the figures originally...

November 29, 2017

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Applicant v. Pembridge Insurance Company (17-000162)

The claimant sought entitlement to various medical benefits and assessments. Adjudicator Harmison rejected all of the claims. In general, she preferred the evidence of the IE assessors, and noted that the family doctor's records did not comport with the position put forward by the claimant's assessors. She also wrote that the claimant had approved treatment...

November 28, 2017

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A.D. v. Aviva Insurance Canada (17-001145)

The claimant sought entitlement to one treatment plan for rehabilitation therapy. The claimant argued that the treatment plan was reasonable and necessary, and that as the respondent had failed to respond to the treatment plan within the required ten days under the SABS, it should be deemed paid under section 38(11) of the SABS. The...

November 28, 2017

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Applicant v. State Farm Mutual Automobile Insurance Company (16-000449)

The claimant had an ongoing FSCO arbitration addressing the same benefit in dispute. Adjudicator Watt granted an order on consent dismissing the LAT application.

November 28, 2017

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Applicant v. State Farm Mutual Automobile Insurance Company (16-000448)

The claimant had an ongoing FSCO arbitration addressing the same benefit in dispute. Adjudicator Watt granted an order on consent dismissing the LAT application.

November 28, 2017

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Applicant v. Dominion of Canada General Insurance Company (16-004660)

The claimant sought entitlement to a treatment plan that had not been submitted through HCAI. Adjudicator Watt concluded that the treatment plan was not payable because the claimant had failed to submit the plan in accordance with the Superintendent's Guideline.

November 27, 2017

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N.S. v. Aviva Insurance Company (16-000474)

The insurer sought costs after the claimant withdrew her LAT application. Adjudicator Trojek declined to award costs. She held that costs were not appropriate even though the claimant had filed the case conference brief late, among other things.

November 27, 2017

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C.D. v. Aviva Insurance Canada (17-002814)

The insurer approved a portion of the cost of a proposed psychological assessment based on an IE assessor's view on the appropriate hourly rate to conduct the assessment. The claimant sought the remainder of the proposed amount. Adjudicator Ferguson accepted the insurer's arguments and held that the remainder of the treatment plan was not payable....

November 24, 2017

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M.C. v. Aviva General Insurance (17-002614)

The insurer sought reconsideration of an order made by the Tribunal allowing the claimant to summons the adjuster who had handled his matter. The insurer argued that it should have been given a copy of the claimant's summons request, and should have had the opportunity to respond to that request. Executive Chair Lamoureux rejected the...

November 24, 2017

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K.G. v. Certas Direct Insurance Company (16-003633)

The claimant sought entitlement to income replacement benefits. The insurer asserted a limitations defense. The hearing was initially scheduled to proceed by teleconference. The claimant sought to change the venue to allow for the cross-examination affidavit evidence. Additionally, the insurer sought to add further documentation. On hearing the requests, Adjudicator Robert Watt set new timelines...

November 24, 2017

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Applicant v. Aviva Insurance (16-002568)

The claimant sought entitlement to a chronic pain program and an orthopaedic assessment. Adjudicator Hans awarded both benefits and wrote that he preferred the evidence from the claimant's experts over the opinions of the insurer's experts. In particular, he found the claimant's experts' reports to be more thorough in analysis and recommendation. He also did...

November 24, 2017

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Applicant v. Aviva Insurance (16-001990)

The claimant sought entitlement to income replacement benefits and a number of medical treatment plans. The insurer asserted a MIG position. On review of the medical evidence, Adjudicator Paul Gosio determined the claimant's injuries were minor and governed by the MIG. The treatment plans claimed were dismissed. As it pertained to the IRB claim, Adjudicator...

November 23, 2017

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Z.A. v. Aviva Insurance Canada (16-001928)

The claimant sought entitlement to physiotherapy. The insurer denied the treatment plan and asserted the treatment was not reasonable and necessary. Adjudicator Sandeep Johal reviewed the medical evidence and held that the claimant failed to meet the onus of proof. The treatment plan was deemed not reasonable and necessary.

November 23, 2017

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M.T.R. v. Aviva Insurance Canada (17-001721)

The claimant sought entitlement to non-earner and a number of medical benefits. On review of the claimant's evidence, Adjudicator Christopher Ferguson determined that claimant did not meet the onus to prove a complete inability to carry on a normal life. Moreover, the treatment plans claimed were considered not reasonable and necessary.

November 23, 2017

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F.K.T. v. Aviva Insurance Company (16-004565)

The insurer sought costs after the claimant withdrew his LAT application. Adjudicator Johal rejected the claim for costs and noted that the inconvenience and expense of preparing for a hearing was not grounds to award costs.

November 22, 2017

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D.G. v. TD Home and Auto Insurance Company (17-000608)

The claimant was an Ontario resident involved in an accident while traveling in Michigan. He elected to receive accident benefits pursuant to Michigan's accident benefits regime, rather than under the SABS. The claimant initially received accident benefits through Allstate Insurance pursuant to Michigan's accident benefits scheme. TD Insurance then accepted priority, and informed the claimant...

November 22, 2017

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N.F. v. Aviva Insurance Canada (17-003632)

The insurer sought costs after a claimant withdrew the claims at a case conference. Adjudicator Samia Makhamra reviewed the chronology of events that led to the withdrawal, which included the claimant using profane language during the case conference, and concluded that the behavior did not rise to the level to warrant a costs award.

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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