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.

December 18, 2019

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K.D. v. Jevco Insurance (18-005057)

The claimant sought entitlement to NEBs and ACBs; the insurer argued that no NEBs were payable before a Disability Certificate was submitted and that no ACBs were payable before a Form 1 was submitted. Adjudicator Norris agreed with the insurer and held that no claims were payable until the requisite forms were submitted to the...

December 17, 2019

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B.C. v. Aviva Insurance Company (17-007448)

The claimant sought reconsideration of the Tribunal's refusal to remove him from the MIG. Adjudicator Norris rejected the reconsideration request. He wrote that the Tribunal had not failed to consider the OCF-3s, and had not overlooked diagnoses alleged by the claimant. Rather, the Tribunal had weighed the evidence differently and did not accept the claimants...

December 17, 2019

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W.M. v. Economical Mutual Insurance Company (18-010752)

The claimant sought to dispute various accident benefits; the insurer argued that the claimant had entered into a binding settlement. Adjudicator Watt concluded that the claimant had entered into a binding settlement. He held that the evidence was clear that the intentions of the parties was a full and final release of all benefits claimed...

December 17, 2019

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S.R. v. Aviva Insurance Canada (17-008249)

The claimant sought reconsideration of the Tribunal's decision that he was barred from pursuing his claim due to failure to attend an orthopaedic assessment. Vice Chair Marzinotto granted the reconsideration due to the failure of the insurer to note the IE assessor's regulated health profession. It was the insurer's obligation to provide that information, not...

December 16, 2019

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S.K. v. Aviva Insurance Canada (18-003544)

The claimant sought reconsideration of the Tribunal's refusal to remove her from the MIG. Adjudicator Lake rejected the reconsideration request, holding that claimant's arguments were an attempt to reargue the case and to reweigh the evidence.

December 12, 2019

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M.S. v. Dominion of Canada General Insurance (19-000579)

The claimant sought removal from the MIG and entitlement to six medical benefits. Adjudicator Norris held that the MIG applied to the claimant's injuries. There was no evidence that the claimant's pre-existing medical issues would impact his recovery under the MIG. He also held that the alleged psychological injuries and chronic pain were not outside...

December 11, 2019

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Aviva General Insurance Company v. N.G. (18-005588)

The insurer sought repayment of IRBs of $2,400 on the basis that the claimant had wilfully misrepresented his address at the time his policy was renewed, invalidating the policy. Adjudicator Norris held that the insurer failed to prove that the claimant had wilfully misrepresented his address. The insurer did not put before the Tribunal any...

December 11, 2019

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N.D. v. Aviva Insurance Company (18-009345)

The claimant sought entitlement to three medical benefits. Adjudicator Victor dismissed all of the claims. She held that the claimant could not prove that the partially denied psychological treatment was reasonable and necessary, and that further physical therapy was reasonable and necessary. The claimant had returned to work, had full range of motion, and was...

December 10, 2019

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J.W. v. Wawanesa Insurance (18-003407)

The claimant suffered catastrophic injuries in Quebec in 2000. She elected to receive no fault benefits under the Quebec SAAQ. Over time, Ontario had raised its hourly rates for service providers, while Quebec's hourly rates remained lower. The claimant argued that despite receiving Quebec no fault benefits, she should be entitled to payment at the...

December 9, 2019

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K.H. v. Gore Mutual Insurance Company (18-009689)

The claimant sought entitlement to a treatment plan that included physiotherapy, massage therapy, and swim passes, interest on the payment of overdue benefits, and a special award. Adjudicator Norris found that the claimant was entitled to the disputed treatment because it was reasonable and necessary to address the claimant’s ongoing pain and functional limitations. The...

December 9, 2019

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A.A. v. Certas Direct Insurance Company (18-00856)

The claimant sought entitlement to physiotherapy, a driver evaluation assessment, a neurological assessment, and interest. Adjudicator Watt found the following: the claimant was not entitled to a driver evaluation assessment since she had already been assessed and returned to driving; there was insufficient evidence to suggest that a neurological assessment would have a rehabilitative purpose...

December 9, 2019

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S.S. v. RBC Insurance Company (18-000222)

The claimant sought entitlement to NEBs, a social work assessment, the cost of completing three disability certificates, and interest. Adjudicator Boyce found that the claimant did not meet the stringent test to qualify for NEBs. The claimant stated that her pain improved with treatment and was not debilitating; she also reported independently carrying out her...

December 9, 2019

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M.C. v. Aviva General Insurance Company (18-006840)

The claimant sought entitlement to NEBs, psychological services, and a psychological assessment. Adjudicator Watt found that the claimant had not proven that he met the requirements to qualify for NEBs, in light of evidence that the claimant had minimal physical functional impairment and the claimant’s own evidence under oath that he was able to perform...

December 6, 2019

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S.K-A. vs. Aviva General Insurance (18-011590)

The claimant sought entitlement to massage therapy, a cost award, and interest on the payment of overdue benefits. Adjudicator Norris found that there was no clear indication that massage therapy was a reasonable and necessary component of the claimant’s treatment. As such, no interest was owed to the claimant.

November 29, 2019

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M.A. v Certas Home and Auto Insurance (19-002077)

The insurer raised a preliminary issue regarding whether the claimant was statute barred from proceeding with her claim for a catastrophic impairment pursuant to section 55 of the SABS, because she refused to attend a neuropsychological IE. Adjudicator Boyce concluded that the claimant was barred from proceeding with her claim until she attended the requested...

November 29, 2019

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A.D. v. Certas Home and Auto Insurance (18-006204)

The claimant disputed his MIG determination and sought entitlement to a number of treatment plans for physical and psychological treatment. The claimant submitted no clinical notes and records, and there was no evidence to support that he was ever seen by a medical doctor for his accident-related impairments. Given the lack of evidence to demonstrate...

November 29, 2019

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M.F. v. Belair Insurance (18-003847)

The claimant sought entitlement to post-104 week IRBs and various medical benefits. In terms of post-104 IRBs, Adjudicator Grieves concluded that the claimant did not suffer a complete inability to engage in any employment for which he was reasonably suited. In doing so, the adjudicator noted that the claimant had only applied for IRBs a...

November 28, 2019

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R.R. v. State Farm Insurance Company (19-000226)

The claimant sought entitlement to IRBs and two treatment plans for chiropractic services. The insurer argued that the claimant was barred from proceeding with the three disputed claims because she failed to dispute the denials within the two year limitation period. Adjudicator Norris agreed with the insurer, finding that the insurer's refusals to pay the...

November 28, 2019

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G.R. v. Economical Mutual Insurance Company (18-010779)

The claimant fell and sustained injuries while clearing snow off of his parked vehicle. The insurer raised a preliminary issue regarding whether the incident met the definition of an "accident" as defined under section 3(1) of the SABS. Adjudicator Grant concluded that the claimant was involved in an "accident" as defined by the SABS, and...

November 27, 2019

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C.M. v. Wawanesa Mutual Insurance Company (18-008199)

The claimant sought entitlement to attendant care benefits and a number of treatment plans for occupational therapy and physiotherapy services. Adjudicator Boyce concluded that the claimant was not entitled to attendant care as she had not demonstrated that the services were "incurred" pursuant to section 3(7)(e) of the SABS. The claimant did not provide evidence...

November 26, 2019

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R.S. v. Aviva Canada Inc. (18-003440)

The claimant sought entitlement to a chronic pain treatment program. Adjudicator Moten concluded that the claimant was entitled to the denied treatment plan, preferring the claimant's expert report over the insurer's IE reports. Notably, none of the IE assessors were pain medicine specialists and none of the IE reports specifically addressed the issue of chronic...

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416.507.1850

eodonnell@tgplawyers.com

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150 York Street, Suite 1800
Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com