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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October 5, 2021

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Phillip v. Intact Insurance Company (20-000674)

The claimant was injured in an accident and sought benefits including IRBs from the insurer. The insurer denied the claimant's IRBs relying on the s. 31(1) exclusion based on the claimant failing to notify the insurer of his change of address from Brantford to Toronto and therefore, intentionally failing to disclose a material change in...

October 5, 2021

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Millar v. The Cooperators General Insurance Company (2021 ONSC 6643)

The insurer appealed the Tribunal's decision that the claimant was an insured person under its policy as a "dependant". A LAT hearing on the benefits was scheduled for six months later. The Divisional Court dismissed the appeal as being premature because the claimant's status as an insured person was only a preliminary matter that the...

October 1, 2021

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Kfouri v. TD General Insurance Company (19-006916)

The claim arose out of a dispute for the appropriate quantum for IRBs. The claimant argued that she was employed, rather than self-employed, at the time of the accident and that her IRB payments should be calculated based on employment income. The insurer argued that according to the claimant's tax returns she was actually self-employed...

September 27, 2021

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Villegas v. Travelers Canada (20-007827)

The claimant disputed the MIG determination and entitlement to chiropractic treatment outside of the MIG. The claimant argued that he had pain in his neck, back, and shoulder, as well as psychological symptoms that justified removal from and treatment beyond the MIG. Vice Chair Boyce dismissed the application. The physical injuries identified in the OCF-3...

September 27, 2021

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Villegas v. Travelers Canada (20-007827)

The claimant disputed the MIG determination and entitlement to chiropractic treatment outside of the MIG. The claimant argued that he had pain in his neck, back, and shoulder, as well as psychological symptoms that justified removal from and treatment beyond the MIG. Vice Chair Boyce dismissed the application. The physical injuries identified in the OCF-3...

September 27, 2021

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Ratnam v. Primmum Insurance Company (19-006706)

The claimant sought a determination that he suffered a catastrophic impairment due to a 2014 accident. He had already been found to suffer a catastrophic impairment from a 2011 accident. The insurer argued that the 2014 accident did not cause an exacerbation of the claimant's impairments, and argued that the claimant was not credible. Vice...

September 23, 2021

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Rios v. Chieftain Insurance (20-009779)

The claimant applied to the LAT seeking entitlement to accident benefits. A preliminary issues hearing was held to determine: (1) whether the claimant was disentitled to accident benefits because he did not have a reasonable explanation for failing to comply with the time limit imposed by s. 32(1) of the SABS, and (2) whether the...

September 21, 2021

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Carter v. Aviva Insurance Company of Canada (19-013446)

The insurer filed a Notice of Motion seeking to stay the claimant's application, alleging that the claimant failed to participate in a neuropsychological insurer's examination meant to assess his entitlement to IRBs. The insurer's request for a neuropsychological assessment was made after the claimant submitted his own neuropsychological assessment. The insurer corresponded with the claimant's...

September 20, 2021

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Young v. Cumis General Insurance Company (20-002837)

The claimant had attended a vehicle dealership to pick a van that she and her spouse had purchased. Construction was underway in the dealership parking lot. The claimant exited the dealership and proceeded towards her van, which was located by a sidewalk. As the claimant walked to the van to open its door, she slipped...

September 20, 2021

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Amiri and Mireskandari v. The Co-operators (20-003296)

The claimants were out for a walk with their spouses when a member of their group, a close relative, was struck by a motor vehicle in a pedestrian accident. The claimants, who were uninsured, applied for accident benefits under the driver's policy, claiming emotional shock and psychological distress. Adjudicator Norris had previously ruled that the...

September 20, 2021

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Aviva Insurance Company of Canada v. Suarez (2021 ONSC 6200)

The insurer appealed the Tribunal's decision awarding four treatment plans for chiropractic therapy, two as reasonable and necessary, and two others due to non-compliant section 38 notices. The insurer argued that because the claimant had not received the treatment, she was not permitted to apply to the LAT. The Court rejected the insurer's position, holding...

September 16, 2021

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M.N. v. Aviva General Insurance (19-001788 and 19-007595)

The claimant sought entitlement to attendant care benefits in the amount of $272.46 per month. Adjudicator Ferguson noted that to be payable, attendant care benefits must be incurred by the claimant, as defined by section 3(7) of the SABS, but the claimant submitted no evidence of same. The claimant relied on section 3(8) of the...

September 16, 2021

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M.N. v. Aviva General Insurance (19-001788 and 19-007595)

The claimant sought entitlement to attendant care benefits in the amount of $272.46 per month. Adjudicator Ferguson noted that to be payable, attendant care benefits must be incurred by the claimant, as defined by section 3(7) of the SABS, but the claimant submitted no evidence of same. The claimant relied on section 3(8) of the...

September 16, 2021

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Samuels v. BelairDirect Insurance Company (20-000929)

The claimant applied to the LAT disputing entitlement to the MIG status and medical/rehabilitation benefits. Concurrently, the insurer sought a repayment of approximately $5,000 in medical benefits paid above the MIG limits. Adjudicator Lake found the insurer was not entitled to the repayment. The claimant applied to two insurers for benefits: BelairDirect and Zenith. After...

September 15, 2021

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Stewart v. Certas Home and Auto Insurance Company (20-004275)

The claimant applied to the LAT seeking entitlement to ACBs and housekeeping expenses. The insurer had determined that the claimant was catastrophically impaired as a result of the accident and that ACBs were reasonable and necessary. The dispute was over the extent of ACBs to be provided and whether housekeeping benefits were reasonable and necessary....

September 14, 2021

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Giannoylis v. Travelers Insurance (20-000280)

The parties agreed that the claimant met the test for IRB entitlement, but disagreed on the quantum of IRBs payable. The claimant worked as a self-employed labourer for a construction business that was owned and operated by his father. Adjudicator Lake found that the claimant's weekly base income under the SABS was $355.58. However, the...

September 14, 2021

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Giannoylis v. Travelers Insurance (20-000280)

The parties agreed that the claimant met the test for IRB entitlement, but disagreed on the quantum of IRBs payable. The claimant worked as a self-employed labourer for a construction business that was owned and operated by his father. Adjudicator Lake found that the claimant's weekly base income under the SABS was $355.58. However, the...

September 13, 2021

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N.M. v. Aviva General Insurance (18-008710 and 18-008717)

The claimant requested reconsideration of the Tribunal's decision which found she was entitled to NEBs in the amount of $185.00 per week up to the two-year mark. The claimant submitted that the Tribunal made a significant error of fact and law when it ordered NEBs payable only up to the two-year mark by using the...

September 13, 2021

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N.M. v. Aviva General Insurance (18-008710 and 18-008717)

The claimant requested reconsideration of the Tribunal's decision which found she was entitled to NEBs in the amount of $185.00 per week up to the two-year mark. The claimant submitted that the Tribunal made a significant error of fact and law when it ordered NEBs payable only up to the two-year mark by using the...

August 31, 2021

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F.C. v. Intact Insurance Company (18-012357)

The claimant was a long haul truck driver taking a load from Brampton to Edmonton. The claimant testified that while driving, a fire started due to overheating of electrical wiring, and he was forced to jump out of the moving truck to prevent personal injuries. The insurer took the position that claimant deliberately set the...

August 30, 2021

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Tsiofa v. Wawanesa Mutual Insurance Company (20-001419)

The issue before the LAT was whether the claimant was involved in an accident. Adjudicator Farlam dismissed the claimant's application finding that the claimant was not involved in an accident as defined by the SABS. The claimant submitted that he sustained physical and psychological injuries when he had to move out of the way of...

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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