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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May 13, 2020

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Yang v. TD General Insurance Company (19-005396)

This is a preliminary issue decision addressing whether the claimant was barred from proceeding with the claim for failing to commence the LAT application within two years after the insurer's refusal to pay the amount claimed. Adjudicator Parish decided not to exercise her discretion to extend the limitation period under s. 7 of the LAT...

May 7, 2020

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Bouianov v. Travelers Insurance (19-005097)

The claimant sought entitlement to treatment outside of the MIG and benefits proposed in two treatment plans. The insurer raised the preliminary issue of whether the claimant was barred from proceeding with the claim as he failed to commence his application within two years after the insurer's refusal to pay the amount claimed. The LAT...

May 6, 2020

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Applicant v. Aviva General Insurance (19-007805)

The claimant sought payment of medical benefits and the cost of an assessment, which the insurer agreed to pay by the time of the hearing. The claimant then sought interest on the cost of the assessment. The claimant argued that an OCF-18 for an assessment and invoices were submitted to the insurer on March 28,...

May 5, 2020

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J.P. v. Aviva General Insurance (19-004854)

The claimant sought attendant care benefits for two separate periods post-accident, a special award and interest on overdue payments. The insurer argued that the claimant failed to provide proof of expenses incurred for the periods claimed and his wife, who was a retired nurse at the time that she provided care to the claimant, failed...

May 1, 2020

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P.A. v. TD General Insurance Company (19-001349)

The claimant's spouse and children were injured in an accident. He was not involved in the accident, but claimed he suffered from psychological impairments including post-traumatic stress (PTSD), anxiety, depression and insomnia as a result of the accident. He was prescribed medical cannabis to treat the accident related impairments. The insurer paid for the medical...

May 1, 2020

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P.S. v. Aviva General Insurance Company (19-000891)

The claimant sought removal from the MIG and entitlement to various medical benefits, and argued that the insurer failed to comply with section 38. Adjudicator Maleki-Yazdi held that the claimant's injuries fell in the MIG. However, one of the disputed treatment plans was awarded because no denial was ever provided by the insurer. An OCF-23...

April 30, 2020

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M.A. v. Travelers Insurance Company of Canada (19-008748)

The claimant sought reconsideration of the Case Conference order that an in-person hearing be held rather than a written hearing. Vice Chair Jovanovich dismissed the reconsideration as the order was not a final order disposing of an appeal.

April 30, 2020

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L.M. v. The Co-operators General Insurance Company (19-003485)

The claimant's brother was involved in an accident. The 21 year old claimant sought AB coverage under his mother's policy. The insurer argued that the claimant was not an insured person, because he was not a dependant of his mother. Adjudicator Conway concluded that the claimant was principally dependent for financial support on his mother...

April 29, 2020

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K.W. v. Aviva General Insurance (18-012007)

The claimant sought entitlement to a physiatry assessment and a special award. The assessment had been denied on HCAI, but no denial letter was sent to the claimant until more than two years later. Adjudicator Hines ruled that the insurer was liable to pay for the assessment in accordance with section 38, and granted a...

April 29, 2020

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H.M. v. The Dominion of Canada General Insurance Company (19-001752)

The claimant sought non-earner benefit, medical benefit, a special award and interest. Adjudicator Grant dismissed the claim. Adjudicator Grant held that the claimant did not suffer a complete inability to carry on a normal life as she did not meet the complete inability test based on pre-existing injuries and impairments, post-accident treatment and function of...

April 29, 2020

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C. V. D. W v. Heartland Farm Mutual Inc. (19-001892)

This preliminary issue hearing was brought to determine whether the claimant's application for IRBs and attendant care benefits was statute-barred under s. 55 of the Schedule because it was filed outside of the time limits under s. 32 of the Schedule. Adjudicator Ferguson found that the claimant's application was barred, as she did not submit...

April 28, 2020

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D.G. v. RSA Insurance Company (19-004884)

The claimant sought entitlement to ACBs and HK expenses. The insurer argued that the claimant was barred from contesting the denials as she filed her application over two years after the benefits were denied. Adjudicator Mazerolle ruled that the claimant was allowed to proceed with her claim in accordance with Tomec v. Economical. He noted...

April 28, 2020

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T.S. v Aviva Insurance Canada (18-002858)

The claimant sought entitlement to IRBs which had been terminated, a special award, costs, and interest. The claimant argued that the insurer did not take into account all of his pre-accident employment in calculating his weekly IRB, and that the insurer failed to respond to his IRB application within 10 days and therefore should be...

April 27, 2020

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L.D. v. Gore Mutual Insurance Company (18-011978)

The claimant sought reconsideration of the Tribunal's Case Conference order that a preliminary issue hearing take place to address the IE non-attendance issue, and of the Case Conference adjudicator's refusal to "strike" the issue, arguing that the adjudicator was biased. Vice Chair Jovanovich dismissed the reconsideration request because it was not a final order. Rather,...

April 27, 2020

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J.T. v. Cayuga Mutual Insurance Co.(18-006061)

The claimant sought entitlement to various medical benefits and the cost of an OCF-3. Prior to the hearing, the insurer approved the denied medical benefits, leaving only two issues remaining: a special award, and payment of an OCF-3. The claimant argued that the insurer acted unreasonably by requiring her to attend IEs prior to her...

April 27, 2020

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C.C. v Aviva Insurance Canada (19-003244)

This preliminary issue hearing was brought to determine whether the claimant was barred from seeking a determination that the injuries sustained in the accident were not subject to the MIG, as that issue had already been determined by the FSCO. Adjudicator Watt found that the claimant was barred from seeking a determination that her injuries...

April 24, 2020

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C.Z. v Security National Insurance Company (18-012296)

The claimant sought entitlement to IRBs, removal from the MIG, and entitlement to a psychological assessment. Adjudicator Johal concluded that the claimant was not entitled to either IRBs or removal from the MIG. The claimant failed to provided any evidence to support his submissions that he suffers a substantial inability to perform the essential tasks...

April 24, 2020

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D.S. v Economical Insurance Company (19-004414)

The claimant was involved in an accident in Quebec and elected to receive SABS in accordance with the SAAQ system. The insurer paid a lump sum in accordance with the SAAQ. The claimant disputed the lump sum, but the insurer argued that the limitation period applied. Adjudicator Grant concluded that the dispute was barred by...

April 24, 2020

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M.G. v. Intact Insurance Company (17-008078)

The claimant sought entitlement to the cost of an accounting report related to IRBs. Adjudicator Parish dismissed the dispute. She found that the delays which occurred with the file while the insurer was conducting an investigation regarding the accident did not establish that the accounting report was reasonable and necessary. Further, she found that the...

April 23, 2020

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U.Y. v. TD Insurance Meloche Monnex (18-002397)

The claimant filed a request for reconsideration arising from a decision in which the Tribunal found that her application for IRBs and housekeeping and home maintenance benefits were statute-barred as a result of the two-year limitation period. Adjudicator Maedel dismissed the request for reconsideration on the grounds that the claimant received a valid denial of...

April 22, 2020

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Y.M. v Security National Insurance Company (19-001141)

The claimant sought removal from the MIG, and entitlement to various medical benefits. The insurer argued that the claimant was barred from disputing the claimed benefits due to the limitation period and due to failure to attend an IE. Adjudicator Grant agreed that two of the disputed medical benefits were barred by the limitation period,...

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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