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 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...

November 26, 2019

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A.L. v. Aviva Insurance Canada (18-008991)

The claimant sought entitlement to two treatment plans, one for occupational therapy services and one for physiotherapy services. Adjudicator Manigat concluded that the denied treatment plans were not reasonable and necessary. With respect to the occupational therapy treatment plan, Adjudicator Manigat accepted that the claimant had to make certain adjustments to cope with some pain...

November 26, 2019

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N.S. v. Scottish & York (17-007962)

The insurer sought reconsideration of the Tribunal's decision that it had to fund a catastrophic impairment assessment over and above the $50,000 medical/rehabilitation limit for those with non-catastrophic injuries. Vice-Chair Flude confirmed the Tribunal's decision, finding that the Tribunal did not make any significant error of law. Section 18(5) of the SABS provides that assessments...

November 26, 2019

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N.S. v. Scottish & York (17-007962)

The insurer sought reconsideration of the Tribunal's decision that it had to fund a catastrophic impairment assessment over and above the $50,000 medical/rehabilitation limit for those with non-catastrophic injuries. Vice-Chair Flude confirmed the Tribunal's decision, finding that the Tribunal did not make any significant error of law. Section 18(5) of the SABS provides that assessments...

November 25, 2019

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E.D. v. Aviva General Insurance (18-004361)

The claimant sought entitlement to one treatment plan for chiropractic services. Adjudicator Grant found that the proposed treatment was not reasonable and necessary. He noted that a treating physician’s mention of a chronic pain condition, be it ‘syndrome’ or specific use of the term ‘chronic pain,’ is not enough to establish the necessity of a...

November 25, 2019

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A.G. v. Aviva General Insurance (18-012669)

The claimant sought entitlement to one treatment plan for physiotherapy services. Adjudicator Grant found that the proposed physiotherapy was not reasonable and necessary. He found that the claimant had previously undergone physiotherapy, there was a lack of evidence of benefit from the previous treatment, and that none of the medical evidence established the benefit of...

November 25, 2019

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D.K. v. The Guarantee Company of North America (18-007722)

The claimant sought entitlement to attendant care benefits in the amount of $3,022.33 per month, physical treatment proposed in three treatment plans, and the cost of various expenses related to food, prescriptions, assistive devices, and other goods. Vice Chair Lester found that the claimant was entitled to the physical treatment plans and the cost of...

November 25, 2019

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J.T. v. Aviva General Insurance (18-003238)

The claimant sought entitlement to 8 treatment plans, the cost of completion of two OCF-3s, and a special award. Adjudicator Lake found that the claimant was entitled to the majority of the treatment plans in dispute. She was not entitled to the cost of the two OCF-3s that were not requested by the insurer. She...

November 25, 2019

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M.H. v. Aviva General Insurance (17-006910)

The claimant's son was struck by a car and passed away several months later. The claimant sought death benefits from the insurer. The insurer argued that the son was not a dependent of the claimant, and therefore no death benefit was payable. Adjudicator Mazerolle agreed with the insurer and held that the son was not...

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Toronto, Ontario M5H 3S5

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