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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December 28, 2017

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F.W. v. Certas Direct Insurance Company (17-004604)

The claimant sought a determination that his impairments were outside of the MIG, and entitlement to two treatment plans. Adjudicator Johal concluded that the claimant sustained an impairment that is predominantly a minor injury. The claimant provided no evidence to show that his injuries fell outside of the MIG. The Adjudicator noted that clinical notes...

December 27, 2017

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B.T. v. St. Paul Fire and Marine Insurance Company(17-000086)

The claimant sought entitlement to IRBs and costs of examinations. As a preliminary issue, the respondent argued that the claimant was barred from appealing her claims as she had not followed the procedures for claiming accident benefits under section 32 of the SABS. The claimant did not file a claim for accident benefits until July...

December 27, 2017

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Applicant v. Certas Home and Auto Insurance Company (17-001090)

The claimant disputed his entitlement to income replacement benefits (IRBs). The insurer sought repayment for overpayment of IRBs in the amount of $16,000. Adjudicator Bickley dismissed the claimant's claim for IRBs and the insurer's repayment request. Adjudicator Bickley dismissed the claimant's special award claim and the insurer's cost award claim. Adjudicator Bickley dismissed the claimant's...

December 22, 2017

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S.B. v. State Farm Insurance (17-003290)

The claimant sought entitlement to a number of medical benefits. On review, Adjudicator Christopher Ferguson determined that a number of treatment sought exceeded the monetary value claimed in the treatment plans, as well as in the Professional Service Guideline. Where the claims exceeded the PSGs, the treatment was not awarded. However, the remaining treatment plans,...

December 22, 2017

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O.C. v. State Farm Mutual Automobile Insurance Company (17-004055 and 17-004060)

The claimant was involved in two accidents and sought non-earner benefits for each date of loss. The insurer brought a motion seeking to bar the claimant pursuant to the limitations provision. Adjudicator Christopher Ferguson reviewed the denial letters and concluded that one of the two denials was not clear and unambiguous. While it is permissible...

December 21, 2017

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T.T. v. Certas Direct Insurance Company (16-003055)

The claimant sought entitlement to IRBs and a number of treatment plans. Adjudicator Jeffrey Shapiro, on review of the medical evidence, as well as surveillance and employment records, noted that the claimant's self-reporting was unreliable and had "failed to timely, honestly and accurately disclose his multiple actual returns to work and his ability to work."...

December 21, 2017

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M.T. v. TD Insurance Meloche Monnex (17-001552)

The claimant sought entitlement to a number of prescription medications. The insurer denied payment and asserted the MIG governed, which had been exhausted. Adjudicator Rupinder Hans reviewed the medical evidence and concluded that the claimant suffered nothing more than soft tissue injuries and that no pre-existing condition was evidenced to prevent maximal recovery within the...

December 20, 2017

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Applicant v. Aviva Insurance Canada (16-003997)

The claimant sought entitlement to treatment in the form of physical rehabilitation and acupuncture services. Adjudicator Cezary Paluch reviewed the medical evidence and determined that the injuries asserted by the claimant were as a result of the accident. On further review, the treatment sought was also deemed reasonable and necessary; the claims were found payable...

December 19, 2017

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Applicant v. Aviva General Insurance (17-004754)

The claimant sought entitlement to three medical benefits for physiotherapy and chiropractic treatment. After reviewing the available medical evidence, Adjudicator Fricot held that the requested treatment plans were not reasonable and necessary. More specifically, the claimant's accident-related injuries had largely resolved, and Adjudicator Fricot determined that further treatment was not warranted.

December 19, 2017

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S.M. v. Motor Vehicle Accident Fund (17-001681)

The claimant brought a motion to add costs and a special award as issues in dispute. The motion also sought to compel the claims handler to submit to cross-examination as well as production of the entire accident benefits file and IE assessors records, inclusive of correspondence between the vendor and assessor. The insurer eventually consented...

December 19, 2017

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N.N. v. Certas Direct Insurance Company (17-001002)

The claimant sought entitlement to attendant care benefits and two treatment plans. Adjudicator Billeh Hamud reviewed the medical evidence and determined that the claimant was independent with his day to day activities and was functional to the point that attendant care benefits were not reasonable and necessary. In the alternative, Adjudicator Hamud also determined that...

December 19, 2017

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Applicant v. Certas Home and Auto Insurance Company (16-004624)

The claimant sought entitlement to non-earner benefits. On review of the limited medical evidence Adjudicator Gregory Flude determined the claimant had not satisfied the disability test for non-earner benefits. In making the determination, Adjudicator Flude indicated that submissions that were not supported by evidence were not considered. As an example, a chart purportedly identifying pre-...

December 18, 2017

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Aviva Insurance Canada v. "Mr.P" (16-004349)

The claimant applied for and received various accident benefits from Aviva, including $14,514 in IRBs. Aviva subsequently voided the policy because the claimant failed to disclose that his partner, who had a poor driving record, had moved in with him one year prior to the accident. Aviva applied for an order requiring the claimant to...

December 18, 2017

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D.P. v. Aviva General Insurance (17-000636)

The claimant sought entitlement to an orthopedic assessment at a cost of $2,912.00. The insurer asserted the claim was governed by the MIG and that the maximum allowable fee for an assessment was $2,000.00. Adjudicator Blaine Baker determined that since the claimant had broken her arm, the MIG did not apply. On review of the...

December 18, 2017

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Certas Direct Insurance Company v. T.T. (17-000272)

The insurer sought repayment of income replacement benefits, asserting the claimant failed to disclose post-accident income. The claimant did not participate in the hearing. Adjudicator Sandeep Johal determined that the claimant was indeed employed during the payment period, and that the insurer had given adequate and timely notice regarding repayment. Furthermore, the claimant committed a...

December 17, 2017

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Applicant v. State Farm Insurance (17-000018)

The claimant disputed her entitlement to IRBs. Adjudicator Paluch dismissed the claimant's application finding that the claimant was not entitled to IRBs for either the pre- or post-104 week period. Adjudicator Paluch also concluded that the claimant did not comply with s. 33 and did not provide a reasonable explanation for her delay in providing...

December 15, 2017

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M.D. v. Intact Insurance Company (17-000532)

The insurer defended the claim on the basis that the accident was staged and that no accident benefits were payable. Adjudicator Neilson accepted the insurer's position. She first rejected FSCO case law that held that a staged accident still qualified for accident benefits. She noted that section 118 of the Insurance Act states that a...

December 15, 2017

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Applicant v. Wawanesa Mutual Insurance Company (17-001083)

The claimant sought entitlement to eight treatment plans for various physical and psychological treatment and assessments. Adjudicator White denied entitlement to all of the claims. She held that the claimant had sustained relatively minor injuries in the accident. She was critical of the claims for in-home treatment and the proposal for various assistive devices as...

December 15, 2017

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A.K. v. Aviva Canada (17-000746)

The claimant sought entitlement to two chiropractic treatment plans as well as an attendant care assessment. The insurer denied the claims and asserted none were reasonable and necessary. Adjudicator Marisa Victor determined that the claimant failed to provide sufficient medical evidence to establish the treatment plans were reasonable and necessary. Adjudicator Victor also favoured the...

December 14, 2017

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Aviva Insurance Company of Canada v. N.S. (17-001880)

The insurer sought repayment of IRBs after the claimant was retroactively approved for LTD benefits. The claimant argued that the insurer was only entitled to recoup the repayment by way of deduction from her weekly IRB payments. The insurer argued that it was entitled to an order for lump sum repayment. Adjudicator Mather agreed with...

December 14, 2017

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R.P. v. Wawanesa Mutual Insurance Company (16-002947)

The claimant sought entitlement to attendant care benefits and a number of treatment plans. Adjudicator Eleanor White reviewed the claimant's submissions for attendant care and noted that no evidence was provided showing that attendant care had been incurred. Accordingly, Adjudicator White determined that regardless of a determination regarding the reasonableness and necessity of the claimant's...

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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