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 6, 2020

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Heartland Farm Mutual Inc. v. Desjardins (19-008574)

The insurer sought repayment of $9,197.65 in IRBs it had paid to the claimant. The claimant's initial application stated that he had been working at the time of the accident, and an OCF2 was submitted with income information supporting $303.65 per week in payments. The insurer was eventually provided with two Records of Employment that...

October 5, 2020

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R.M. v. Certas Home and Auto Insurance Company (18-007521)

The claimant requested reconsideration of the Tribunal's decision that her claim for NEBs and medical benefits was barred by the limitation period. She argued that the Tribunal should have applied Tomec v. Economical to conclude that the claimant could not have discovered her claim until receiving an MRI result. Adjudicator Johal dismissed the reconsideration. He...

October 5, 2020

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K.A.J. v. Aviva General Insurance (19-007068)

The claimant sought entitlement to a chronic pain assessment. Adjudicator Goela held that the assessment was not reasonable and necessary, and not payable. Additionally, she held that the treatment plan did not comply with section 38(3) as it was not signed by the claimant or the proposed assessor, nor did assessor provide information or opinion...

October 5, 2020

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R.M. v. Certas Home and Auto Insurance Company (18-007521)

The claimant requested reconsideration of the Tribunal's decision that her claim for NEBs and medical benefits was barred by the limitation period. She argued that the Tribunal should have applied Tomec v. Economical to conclude that the claimant could not have discovered her claim until receiving an MRI result. Adjudicator Johal dismissed the reconsideration. He...

October 5, 2020

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tgp-admin

R.M. v. Certas Home and Auto Insurance Company (18-007521)

The claimant requested reconsideration of the Tribunal's decision that her claim for NEBs and medical benefits was barred by the limitation period. She argued that the Tribunal should have applied Tomec v. Economical to conclude that the claimant could not have discovered her claim until receiving an MRI result. Adjudicator Johal dismissed the reconsideration. He...

October 5, 2020

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tgp-admin

R.M. v. Certas Home and Auto Insurance Company (18-007521)

The claimant requested reconsideration of the Tribunal's decision that her claim for NEBs and medical benefits was barred by the limitation period. She argued that the Tribunal should have applied Tomec v. Economical to conclude that the claimant could not have discovered her claim until receiving an MRI result. Adjudicator Johal dismissed the reconsideration. He...

October 2, 2020

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Amitofski v. Traders General Insurance Company (19-008148)

The claimant sought entitlement to NEBs and further physiotherapy treatment. Adjudicator Johal dismissed both claims. He held that the claimant failed to provide evidence of her pre-accident and post-accident activities, so the Tribunal could not consider what change was caused by the accident. He also noted that the claimant was on ODSP for 20 years...

October 1, 2020

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E.Z. v. Co-operators General Insurance Company (19-006441)

The claimant applied to the LAT disputing entitlement to IRBs. The insurer paid IRBs prior to the hearing. The claimant requested a special award. Adjudicator Maleki-Yazdi granted a special award of 15 percent on the late payment of IRBs. She held that the insurer's decision to not pay IRBs until after an EUO almost 12...

October 1, 2020

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TD General Insurance Company v. Altaweel (19-010100)

The insurer sought repayment of $1,114.60 that had been paid to the claimant rather than to a court reporter for the cost of an EUO. The claimant never responded to the insurer's requests for repayment, nor did he participate in the LAT dispute. Adjudicator Boyce awarded the insurer repayment. He held that the funds had...

September 30, 2020

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K.L. v. Aviva Insurance Company (19-004368)

The sole issue in dispute was whether the claimant was entitled to a special award under Ontario Regulation 664. The insurer initially denied a treatment plan, and referred the claimant to an IE to determine whether the plan was reasonable and necessary. Upon receipt of the IE reports, the insurer wrote to the claimant confirming...

September 29, 2020

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Staszewski v. Intact Insurance Company (19-012409)

The claimant applied to the LAT seeking entitlement to pre- and post-104 IRBs. Three medicolegal reports noted the claimant had returned to work in some capacity since the accident. The insurer suspended the claimant's entitlement to IRBs pursuant to section 33 of the SABS for failure to provide documentation regarding post-accident employment and income. The...

September 28, 2020

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B.M. v. Unica Insurance Inc. (19-009381)

The claimant sought entitlement to two medical benefits for physiotherapy and occupational therapy services. The claimant had a significant pre-accident medical history that included a workplace accident, two separate motor vehicle accidents in 2013, chronic lumbar radiculopathy, and chronic lower back pain. He was also involved in a subsequent motor vehicle accident in 2016 after...

September 28, 2020

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P.S. v. Allstate Insurance (18-012633)

The claimant was seriously injured in a 2013 accident and sought a determination that he suffered a catastrophic impairment due to a combined WPI of 55 percent. He also sought entitlement to three treatment plans for further physiotherapy and psychotherapy. The claimant suffered from chronic pain and abused opioids as a result of his injuries....

September 24, 2020

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A.J. v. Aviva General Insurance (19-010794)

The claimant disputed entitled to two treatment plans for physiotherapy and chiropractic services. The insurer disputed the claimant's entitlement based upon IE reports, and argued that new evidence was submitted in the claimant's reply submissions were prejudicial. The insurer, by way of motion, requested that the new evidence was improperly submitted and requested it be...

September 24, 2020

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Marca v. Aviva Insurance Company (19-004839)

The claimant sought entitlement to NEBs, a medical benefit for physiotherapy services, interest on overdue payment of benefits, and an award. The claimant argued that she had partially resumed some activities post-accident but not at all. The claimant also argued that even though she had returned partially to her personal care, she experienced pain when...

September 23, 2020

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M.J. v. Dufferin Mutual Insurance Company (19-006241)

The sole issue in dispute was whether the claimant was entitled to a special award under Ontario Regulation 664. All of the substantive issues, including a claim for income replacement benefits, physiotherapy, and several assessments were resolved in advance of the hearing. Adjudicator Boyce agreed with the claimant on two grounds: (1) denying section 25...

September 23, 2020

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A.M. v. Zurich Insurance Company Ltd. (19-009920)

The claimant was being transported by the Ontario Provincial Police in the rear box of a prisoner’s transportation van. During the transport, the van struck a moose and the claimant, handcuffed and shackled, was thrown towards the front of the van, suffering physical and psychological injuries. He applied for and received accident benefits from the...

September 23, 2020

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M.E.R v. Aviva General Insurance Company (17-008924)

The claimant applied to the LAT seeking entitlement to ACBs in the amount of $2,479 per month and various medical benefits for physical treatment, psychological treatment, occupational therapy services, an orthopaedic mattress, the cost of clothing and personal expenses, and transportation expenses. The claimant was a pedestrian injured in a motor vehicle accident in a...

September 23, 2020

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C.N. v. Aviva General Insurance (19-004405)

The retired claimant sought entitlement to NEB. He argued that the accident had exacerbated a previously asymptomatic right shoulder injury. He claimed due to the accident he suffered neck, right shoulder and lumbar spine pain that affected his ability to engage in his activities of daily living. However, he did not make any submissions on...

September 23, 2020

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M.R. v. Allstate Insurance Company of Canada (18-012729)

The claimant was involved in multiple accidents between 1991 and 2003. A preliminary hearing was held in relation to benefits claimed following a September 1996 accident and whether certain disputed benefits were captured by various releases signed by the claimant. The claimant sought entitlement to ACBs, HK expenses, transportation expenses, and home modifications. In addition...

September 22, 2020

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Watters v. Aviva Insurance Company (19-005152)

The sole issue in dispute was whether the claimant was entitled to a special award under Ontario Regulation 664. The insurer changed its decision with respect to all of the treatment plans in dispute shortly prior to the hearing. The claimant alleged that the insurer ought to be liable for an award because the decisions...

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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