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.

Search

Generic filters

August 11, 2017

/

tgp-admin

L.K. v. The Guarantee Company of North America (16-003577)

The claimant's entitlement to income replacement benefits had been suspended for about six months due to her failure to provide a copy of her CPP file, which had been requested by the insurer under section 33 of the SABS. Upon receipt of the CPP, the insurer reinstated income replacement benefits, but refused to pay for...

August 11, 2017

/

tgp-admin

Applicant v. Security National Insurance Company (16-003024)

The claimant sought entitlement to medical benefits and removal from the MIG. He also argued that the insurer's denials did not comply with section 38 of the SABS. Adjudicator Belanger-Hardy dismissed the claims. She held that the insurer's denials provided sufficient information to comply with the SABS. She also held that the evidence submitted supported...

August 10, 2017

/

tgp-admin

R.R. v. Aviva Insurance (16-001627)

The claimant sought entitlement to treatment plans requesting assistive devices and psychological treatment. The insurer denied the plans as not being reasonable and necessary. Adjudicator Chris Sewrattan reviewed the medical evidence and determined that the claimant did not provide sufficient evidence to show the devices were reasonable. However, the psychological treatment was considered payable. No...

August 9, 2017

/

tgp-admin

Applicant v. Yarmouth Mutual Fire (17-001057)

The minor claimant sought entitlement to medical benefits and mileage. Adjudicator Ferguson dismissed all claims. He held that proposed social worker services were duplicative of approved treatment; further the claimant was completing self-care and school tasks as expected for someone of his age. In terms of OT services, the claimant did not explain what in-home...

August 9, 2017

/

tgp-admin

Applicant v. Yarmouth Mutual Fire (17-001061)

The minor claimant sought entitlement to medical benefits and mileage. Adjudicator Ferguson dismissed all claims. He held that proposed social worker services were duplicative of approved treatment; further the claimant was completing self-care and school tasks as expected for someone of his age. In terms of OT services, the claimant did not explain what in-home...

August 8, 2017

/

tgp-admin

A.H. v. Belair Direct Insurance Company (16-001063)

The claimant sought entitlement to a number of treatment plans and attendant care benefits. Adjudicator Lori Marzinotto noted that some of the treatment plans sought were not submitted as evidence, nor specifically addressed in the claimant's submissions; those plans were denied. Other treatment plans sought mileage beyond the Professional Service Guidelines. Adjudicator Marzinotto highlighted no...

August 4, 2017

/

tgp-admin

L.F. v. Unifund Assurance Company (16-001020)

The claimant sought entitlement to IRBs and two treatment plans for a social emotional assessment and a functional abilities evaluation. The respondent initially paid weekly IRBs of $209.61. Payments were stopped when the claimant failed to attend three IEs in March and April 2016. After the claimant attended IEs in August 2016, the respondent denied...

August 4, 2017

/

tgp-admin

O.D. v. Unifund Assurance Company (16-004399)

The claimant applied for entitlement to non-earner benefits, which was rejected by the insurer. Adjudicator Treksler denied entitlement to non-earner benefits reasoning that the claimant had not submitted sufficient evidence of the activities she could no longer perform, and which activities were important to her prior to the accident. She also noted that the submission...

August 4, 2017

/

tgp-admin

C.W. v. Unifund Assurance Company (16-003336)

The claimant sought entitlement to medical benefits, interest, and costs as against the insurer and its representative. The insurer asserted a MIG designation and highlighted a long period of inactivity on the medical file. Adjudicator Blaine Baker reviewed medical reports as well as evidence of reduced workload on the part of the claimant and concluded...

August 4, 2017

/

tgp-admin

C.A. v. The Dominion of Canada General Insurance Company (16-004033)

The claimant sought further medical benefits and removal from the MIG. Adjudicator Hines concluded that the claimant's injuries were minor injuries, and rejected the expert opinion of his assessors. Adjudicator Hines was critical of the claimant's assessors for failing to be provided with full medical documentation, for relying largely upon the claimant's self-reporting, and for...

August 4, 2017

/

tgp-admin

B.H. v. Belair Direct Insurance (16-002779)

Shortly before the hearing, the insurer accepted that the claimant suffered a catastrophic impairment, and was entitled to IRBs. The only remaining issues were the claimant's entitlement to attendant care benefits, and a special award. In terms of the attendant care claim, the insurer accepted that the claimant was medically entitled to assistance; the dispute...

August 3, 2017

/

tgp-admin

K.S. v. The Dominion of Canada General Insurance Company (16-002099)

The claimant sought entitlement to attendant care benefits and multiple treatment plans. A preliminary issue was whether late submitted medical records should be excluded from the hearing. Regarding the late records, Adjudicator Treksler admitted the records reasoning that third parties had control over the records and that the claimant could not control the date of...

August 1, 2017

/

tgp-admin

S.U. v. Wawanesa Mutual Insurance Company (16-003333)

The claimant sought entitlement to medical benefits; the insurer argued that the claimant had not complied with section 33 requests and that the claimed benefits were not reasonable and necessary. Regarding the section 33 argument, Adjudicator Ferguson held that the information requested by the insurer was not "reasonably necessary" to determine entitlement as the insurer...

August 1, 2017

/

tgp-admin

H.A. v. Aviva General Insurance (16-003279)

The claimant sought entitlement to the form fee and HST associated with an assessment plan. The insurer indicated that the treatment plan was subject to the monetary cap under section 25(5). The claimant asserted the form fee was a separate cost, not subject to the cap. Adjudicator Christopher Ferguson referred to Superintendent's Guideline No. 03/14...

July 31, 2017

/

tgp-admin

C.J. v. The Personal Insurance Company of Canada (16-002815)

The insurer sought an order for costs given the claimant twice failed to meet the filing deadlines prescribed by the case conference adjudicator. The representative of the claimant indicated that the deadlines were missed due to workload and illness. A doctor's note was produced but did not provide an explanation as to why the claimant's...

July 31, 2017

/

tgp-admin

C.J. v. The Personal Insurance Company of Canada (16-002815)

The claimant sought entitlement to medical treatment plans. The insurer denied payment and maintained a MIG defense. On review of the evidence, Adjudicator Rebecca Hines determined the claimant did not provide compelling evidence to warrant removal from the MIG. It was also noted the claimant did not consume treatment previously approved. Accordingly, the treatment plans...

July 31, 2017

/

tgp-admin

Applicant v. Aviva Insurance (16-000218)

This preliminary issue hearing was held to address whether the claimant was involved in an "accident" as defined in the SABS. The claimant (a minor with developmental disabilities) was inadvertently locked on a school bus for two hours, causing the claimant to become anxious and frightened. She applied for accident benefits to treat psychological injuries....

July 25, 2017

/

tgp-admin

K.R. v. TD Insurance Company (16-004073)

The claimant sought attendant care benefits up to the 104 week mark. Adjudicator Treksler found that the claimant suffered injuries that entitled her to attendant care of $873.30 per month. The second issue was whether the claimant's attendant care expenses were incurred. For a period of five months, the claimant used a professional service provider...

July 25, 2017

/

tgp-admin

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

The insurer brought a motion to dismiss the claimant's application on the basis of abandonment per Rule 3.4(d). Adjudicator Deborah Neilson noted three failed case conferences and confirmed the insurer served the proper motion materials. in response, the claimant described having a mental breakdown as reason for not attending previous case conferences. Adjudicator Neilson noted...

July 25, 2017

/

tgp-admin

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

The insurer brought a motion to dismiss the claimant's application on the basis of abandonment per Rule 3.4(d). Adjudicator Deborah Neilson noted three failed case conferences and confirmed the insurer served the proper motion materials. in response, the claimant described having a mental breakdown as reason for not attending previous case conferences. Adjudicator Neilson noted...

July 24, 2017

/

tgp-admin

Applicant v The Personal Insurance Company (16-000653)

The claimant sought entitlement to a treatment plan in which the claimant and her attendant care provider would fly to Iran to visit family. The insurer denied the benefit as not being reasonable as contemplated under section 16. Adjudicator Chris Sewrattan agreed with the insurer. A two-person trip to Iran was considered outside the scope...

Contact Us

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

416.507.1850

smilne@tgplawyers.com

© 2020 Thomas Gold Pettingill LLP Disclaimer | Privacy Policy | Statement of Principles

Powered by Crow & Pitcher

Subscribe to get TGP’s case summaries straight to your inbox

Subscribe to get TGP’s case summaries straight to your inbox

Contact Us

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

416.507.1850

smilne@tgplawyers.com

© 2020 Thomas Gold Pettingill LLP