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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August 23, 2019

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G.L. v. TTC Insurance Company Limited (18-005322)

The claimant sought entitlement to five treatment plans. In addition to arguing that they treatment was reasonable and necessary, the claimant also argued that the insurer's denials of three medical benefits did not comply with section 38(8) of the SABS. Adjudicator Grant found that the proposed treatment was not reasonable and necessary due to the...

August 21, 2019

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Applicant v. Allstate Insurance (18-006253)

The claimant sought entitlement to over $24,000 in catastrophic impairment rebuttal reports. The insurer argued that dispute was statute barred. Adjudicator Grant held that catastrophic impairment assessments are not "benefits" and therefore not subject to the two year limitation period. Adjudicator Grant concluded that the proposed assessments were reasonable and necessary, and were therefore payable....

August 15, 2019

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T.A. v. Unifund Assurance Company (18-005029)

The claimant sought removal from the MIG and entitlement to three medical benefits. Adjudicator Reilly held that the claimant sustained soft tissue injuries falling within the definition of "minor injury". The claimant failed to provide any medical evidence from his family physician disputing the diagnoses of the IE assessors.

August 15, 2019

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M.N. v. Aviva Insurance Canada (18-006097)

The claimant sought reconsideration of the Tribunal's refusal to re-open her application for entitlement to certain psychological services. The claimant and the insurer had agreed to resolve entitlement to proposed psychological services that were proposed. The services proposed were to be provided by a psychologist at the Guideline rates. The claimant then incurred the treatment...

August 14, 2019

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L.G. v. Unifund (18-008089)

The claimant sought entitlement to over $15,000 for multidisciplinary catastrophic impairment assessments. The insurer denied the assessments because the claimant had exhausted her medical benefits limits. Adjudicator Victor held that the cost of catastrophic impairment assessments did not fall within the medical benefits limits. She held that the claimant had to prove that each assessment...

August 9, 2019

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S.A. v. Guarantee Insurance (18-002962)

The claimant sought reconsideration of the Tribunal's decision that he was not entitled to NEBs. He argued, among other things, that the Tribunal's refusal to allow closing arguments violated the rules of natural justice. Vice Chair Jovanovic agreed that the Tribunal breached the rules of natural justice by not allowing closing submissions. The Tribunal could...

August 9, 2019

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S.A. v. Guarantee Insurance (18-002962)

The claimant sought reconsideration of the Tribunal's decision that he was not entitled to NEBs. He argued, among other things, that the Tribunal's refusal to allow closing arguments violated the rules of natural justice. Vice Chair Jovanovic agreed that the Tribunal breached the rules of natural justice by not allowing closing submissions. The Tribunal could...

August 8, 2019

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F.F. v. Aviva Insurance Canada (18-002994)

The claimant sought entitlement to medical marijuana and the cost of an assessment. Adjudicator Grant awarded both claims. He accepted that medical marijuana was a superior reliever of pain, anxiety and depression for the claimant, and that it was being recommended by the claimant's family physician.

August 2, 2019

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D.M. v. Aviva Insurance Canada (17-006781)

The insurer sought reconsideration of the Tribunal's award of an orthopaedic assessment. Vice Chair Mather granted the reconsideration and denied the claimed assessment. She held that the Tribunal made a significant error of law in concluding that section 38(8) required a "clear and unequivocal" denial of the goods and services it was not agreeing to...

July 31, 2019

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M.A.A. v. RBC Insurance (18-004989)

The claimant sought entitlement to two treatment plans. Adjudicator Ferguson held that the treatment plans were not reasonable and necessary. The claimant's family physician did not support the need for further physical therapy and the IE assessor concluded that the claimant had met maximum medical recovery. The psychological assessment also was not reasonable because the...

July 31, 2019

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H.S. v. Aviva Insurance Canada (17-007384)

The claimant sought removal from the MIG and entitlement to four treatment plans for physical therapy. As a preliminary matter, the insurer sought to admit as evidence two addendum report authored after the production deadline. Adjudicator Harper refused to admit the addendum reports, reasoning that they could have been obtained much earlier, since the records...

July 31, 2019

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M.B. v. TD Insurance Meloche Monnex (18-010696)

The claimant sought entitlement to NEBs. Adjudicator Lake concluded that the claimant did not meet the "complete inability" test. The claimant argued that his pre-existing cerebral palsy combined with the accident related injuries satisfied the test. Adjudicator Lake held that the claimant continued to engage in most of his pre-accident activities, including driving, sledge hockey,...

July 30, 2019

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A.R. v. Aviva General Insurance (18-000838)

The insurer sought reconsideration of the Tribunal's award psychological treatment and a psychological assessment, and the calculation of interest. Adjudicator Hines dismissed the reconsideration requests for the treatment plan and assessment, concluding that the Tribunal did not make an error in weighing the evidence. Adjudicator Hines granted the reconsideration in terms of interest, holding that...

July 30, 2019

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R.D. v. Aviva Insurance Company (18-000725)

The claimant sought reconsideration of the Tribunal's decision that he was barred from proceeding with his claim due to IE Non-Attendance. He argued that he was unable to attend due to mental and physical disabilities. Vice Chair Trojek dismissed the reconsideration. She found no support for the claimant's position that the Tribunal did not consider...

July 29, 2019

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P.Y. v. Aviva General Insurance Company (17-003692)

The claimant sought reconsideration of the Tribunal's decision that the claimant's injuries fell within the MIG and the denial of three treatment plans. Following the Tribunal's decision, the insurer removed the claimant from the MIG. The claimant argued that this was new evidence that could not have reasonably been obtained earlier. Adjudicator Grieves granted the...

July 25, 2019

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J.Y. v. Aviva Insurance Canada (17-009034)

The claimant sought reconsideration of the Tribunal's decision to dismiss all of his claims. Adjudicator Watt dismissed the reconsideration request. He held that the claimant had failed to provide written submissions to the Tribunal as ordered by the hearing adjudicator; that the surveillance considered by the Tribunal was not improper; that the Tribunal considered the...

July 24, 2019

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D.M. v. Belair Direct Insurance Company (18-005470)

The claimant sought entitlement to over $22,000 for multidisciplinary catastrophic impairment assessments. The insurer had approved a total of $7,000. The claimant disputed entitlement to the remainder. Adjudicator Parish approved entitlement to an executive summary and the cost of the OCF-19, but denied the remainder. She held that the remaining assessments were duplicative of the...

July 22, 2019

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A.E. v. Aviva General Insurance Company (18-006132)

The claimant sought removal from the MIG and entitlement to six treatment plans. Adjudicator Grant concluded that the claimant's accident-related injuries were "minor." The claimant's post-accident complaints were similar to pre-accident complaints; the accident caused only soft tissue injuries; and the claimant returned to work and was engaging in her regular activities of daily living.

July 22, 2019

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N.H. v. Coachman Insurance Company (18-006770)

The claimant sought further IRBs; the insurer argued that the claimant failed to attend an IE. Adjudicator Ferguson held that the subject IE was not reasonably necessary to determine the claimant's entitlement to benefits. The IE was scheduled after the Case Conference; the scheduling of the IE would delay the hearing of the merits of...

July 22, 2019

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F.P. v. Aviva Insurance Company of Canada (18-006800)

The claimant sought entitlement to a treatment plan for chiropractic services. Adjudicator Grant dismissed the claim. He noted there was no supporting evidence that the treatment was reasonable and necessary; the claimant had returned to work immediately after the accident and had not missed any time from work; and that the claimant's pre-accident pain complaints...

July 18, 2019

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S.M. v. Federated Insurance Company of Canada (18-004533)

The claimant sought entitlement to $6,000 per month in ACBs from April 2012 onwards, and the cost of two assessments. Adjudicator Lake considered the time period prior to and after the February 1, 2014 changes to the incurred expense definition for non-professional service providers. She held that the claimant failed to prove that her niece...

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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