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 3, 2020

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K.K. v. Coseco Insurance (18-002839)

The claimant disputed his MIG determination and entitlement to various medical benefits. The respondent raised a preliminary issue, arguing that the claimant was statute-barred from proceeding with his claim in respect of two of the disputed treatment plans for failure to dispute entitlement within the two year limitation period. Adjudicator Norris agreed, noting that the...

February 3, 2020

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A.A. v. Technology Insurance Company Inc. (18-007493)

The claimant sought removal from the MIG and entitlement to chiropractic services and rebuttal assessments. Adjudicator Paluch concluded that the claimant suffered from chronic pain syndrome, which was not simply a clinically associated sequela to his minor injuries. There was also evidence of disc bulges, protrusion and canal stenosis which are not minor injuries. The...

January 31, 2020

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J.F. v. Aviva General Insurance Company (18-012511)

The insurer brought a preliminary issue hearing on the grounds that the claimant was barred from commencing a proceeding for failure to attend NEB IEs. The insurer made several attempts to schedule NEB IEs, in response to which the claimant asked for the IEs to be rescheduled. The IEs were ultimately scheduled to take place...

January 28, 2020

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M.A. v. TD General Insurance Company (18-005141)

The claimant applied to the LAT seeking entitlement to NEBs. Causation was an issue at the hearing. Adjudicator Johal held that the test to determine causation is the "but for" test. The claimant submitted that he had one episode of psychosis a couple of months prior to the accident, but a formal diagnosis of psychosis...

January 27, 2020

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J.P. v. Royal Sun Alliance (18-006654)

The insurer sought a determination that the claimant was barred from proceeding to the LAT on the basis that he failed to attend insurer's CAT assessments. The claimant took the position that he was not required to attend the assessments as the insurer failed to set out the medical and other reasons for requiring the...

January 27, 2020

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K.W. v. Aviva Insurance Company (18-006959)

The claimant applied to the LAT seeking entitlement to IRBs, the benefits proposed in two treatment plans, and a special award. The insurer conceded that the claimant qualified for IRBs during the disputed period but contested the quantum of IRBs being claimed. Adjudicator Watt held that post-accident "passive" income earned by a claimant was to...

January 27, 2020

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N.L. v. Aviva Insurance Company (18-011431)

The claimant applied to the LAT seeking entitlement to chiropractic treatment, a psychological assessment, and an orthopaedic assessment. The insurer raised the preliminary issue of whether the claimant was barred from proceeding with her claim for the psychological assessment as she failed to submit to an insurer's examination. Adjudicator Maleki-Yazdi found, pursuant to s. 55...

January 24, 2020

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J.V.M v. Aviva General Insurance Company (18-009606)

A preliminary issues hearing was held to determine whether the insurer was barred from claiming a repayment of IRBs. The claimant argued that the insurer's request was made outside of the 12 month period permitted by section 52. Adjudicator Grant held that the insurer was not barred from claiming a repayment of IRBs, as the...

January 24, 2020

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M.L. v. Intact Insurance Company (19-000607)

A preliminary issues hearing was held to determine whether the incident the claimant was involved in met the definition of "accident" as defined by s. 3(1) the SABS. The claimant testified that at 1:30 a.m. on the night of the incident he arranged for an Uber driver to pick him up after a staff Christmas...

January 24, 2020

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J.A. v. Aviva Insurance Company (18-011393)

The claimant applied to the LAT seeking entitlement to the benefits proposed in three treatment plans. Adjudicator Norris found that the proposed chiropractic treatment plan was not reasonable and necessary, but as the insurer's initial denial letter was non-compliant with s. 38 "medical and other all reasons" requirements, the claimant was entitled to payment for...

January 24, 2020

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F. A.-W. v. Aviva General Insurance Company (18-008742)

The claimant sought entitlement to a further $2,000 for catastrophic impairment clinic file review ($10,400 had been approved for other catastrophic impairment assessments). The insurer had initially denied entitlement on the grounds to the entire amount on the grounds that the claimant's medical benefits limits had been exhausted, but reversed that position eight months later....

January 24, 2020

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P.V. v. Economical Insurance (19-000069)

The claimant sought reconsideration of the Tribunal's decision that the limitation period applied to his IRB claim. The claimant had continued to work for over three years after the accident, and the insurer had denied entitlement to IRBs during that period because he did not meet the "substantial inability" test. Adjudicator Boyce granted the reconsideration...

January 23, 2020

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G.T. v. The Guarantee Company of North America (18-003334)

The claimant sought a declaration that she was catastrophically impaired as result of the accident due to a 55 percent WPI. The claimant's assessors opined that the claimant had a 67 percent WPI. The insurer's assessors opined that she had a 39 percent WPI. Causation and interpretation of the AMA Guides were in dispute. Adjudicator...

January 22, 2020

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K.L. v. CAA Insurance (19-000029)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to medical benefits and costs of examinations proposed in five treatment plans. Adjudicator Sharma found that the claimant's injuries were predominantly minor and fell within the MIG. Contrary to the claimant's submissions arguing otherwise, Adjudicator Sharma found no compelling evidence...

January 22, 2020

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N.S v. Wawanesa Insurance Company (19-000300)

The claimant sought a determination that her impairments were outside of the MIG and entitlement to medical benefits proposed in two treatment plans. Adjudicator Boyce found that the claimant's psychological and/or neurological impairment took her outside of the MIG, based on the medical opinions of her assessors. The claimant was subsequently found entitled to payment...

January 22, 2020

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S.W. v. Aviva General Insurance (19-002127)

The claimant sought entitlement to IRBs. The insurer argued that the limitation period barred the claim. Adjudicator Boyce concluded that the IRB denial was clear and unequivocal and that the limitation period expired on February 13, 2019, and that the claimant applied to the LAT on February 22, 2019. However, he allowed the claim to...

January 21, 2020

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J.C. v. Intact Insurance Company (18-010894)

The claimant sought entitlement to IRBs. The insurer argued that the limitation period barred the claim. Adjudicator Parish held that the limitation period barred the claim. The insurer's denial was clear and unequivocal, and the limitation period expired May 20, 2016. The LAT application in November 2018 was out of time, and was not saved...

January 17, 2020

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I.L.G. v. Aviva General Insurance Company (18-009010)

The claimant sought removal from the MIG and entitlement to a chronic pain assessment, a neurological assessment, an orthopedic assessment, assistive devices, and interest on the payment of overdue benefits. Adjudicator Grant found that the claimant's injuries were predominantly "minor injuries" and that injuries she suffered later, as a result of a July 21, 2016...

January 17, 2020

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M.Z. v. Aviva Insurance Canada (18-001324)

The claimant sought entitlement to the balance of a chiropractic treatment plan, four other treatment plans, and an award. The claimant argued the balance of the chiropractic treatment plan should be approved because the insurer failed to provide a response within 10 business days pursuant to section 38(3) of the Schedule. The insurer argued that...

January 17, 2020

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R.S. v. Aviva Insurance Canada (18-001324)

The claimant sought a determination that her impairments were outside of the MIG and entitlement to medical benefits proposed in seven chiropractic, attendant care, and psychological treatment plans and assessments. The claimant also argued the MIG limit did not apply to the psychological-based treatment plans, citing the insurer's failure to state in its denial letters...

January 16, 2020

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G.N. v. The Guarantee Company of North America (18-007546)

The claimant sought entitlement to the cost of a capacity assessment and the cost of a court application for guardianship. Adjudicator Ferguson dismissed both claims. He held that the capacity assessment was not payable because it was not incurred within five days of the accident, so the exception at 38(2) did not apply. He also...

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Contact Us

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

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Contact Us

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

416.507.1850

eodonnell@tgplawyers.com