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.

February 27, 2023

/

tgp-admin

Khalaf v The Dominion of Canada General Insurance Company (20-000264)

The claimant was involved in an accident on October 19, 2016, and applied for accident benefits. The dispute involved the insurer denying catastrophic impairment under criterion 8, based on the s. 44 psychiatry IE of Dr. Sivasubramanian, and involved a 7-day videoconference hearing. Initially, Dr. Sivasubramanian had opined that the claimant suffered 2 Class 4...

February 27, 2023

/

tgp-admin

Ali v The Co-operators General Insurance Company (20-006796)

The claimant applied to the LAT seeking entitlement to NEBs and interest. During the written hearing, the claimant sought to add a claim for a special award. The Co-operators sought to strike 2 pages of the claimant's submissions as they were over the 10 page limit ordered at the Case Conference. Furthermore, they sought to...

February 27, 2023

/

tgp-admin

Boni v CAA Insurance Company (20-007645)

The claimant applied for CAT designation for injuries arising from a 2017 accident. The insurer acknowledged that the claimant was catastrophically impaired, but argued that he had already been impaired before the accident occurred. The insurer argued that the claimant had been taking prescription medications for depression and sleep difficulties before the accident. The claimant...

February 24, 2023

/

tgp-admin

Kumar v. Aviva Insurance Company (21-002087)

The claimant applied to the LAT for entitlement to post-104 week IRBs. Prior to the accident, the claimant was employed as a manual labourer and had prior experience working as a retail salesclerk. The claimant argued that he was entitled to post-104 week IRBs based on his various accident-related physical and psychological impairments, including a...

February 24, 2023

/

tgp-admin

Thiyagarajah v Economical Insurance (21-001866)

The claimant was entitled to WSIB benefits. The issue in dispute at the LAT hearing was whether his election to claim benefits under the SABS was primarily to receive those benefits or to pursue a tort action against the at-fault driver. The insurer argued that the claimant's election was primarily for claiming benefits, as he...

February 23, 2023

/

tgp-admin

Amadiegwu v. Aviva General Insurance Company (2023 ONSC 1256)

The claimant appealed the Tribunal's decision dismissing her claim for IRBs. The Court dismissed the appeal holding that there was no extricable question of law. The Court also rejected the arguments that the Tribunal process lacked procedural fairness or that the Tribunal did not apply the correct test for causation.

February 22, 2023

/

tgp-admin

Shahin v. Intact Insurance Company (21-002418)

The claimant applied to the LAT for a determination that she was catastrophically impaired under Criterion 8. The claimant struggled with anxiety due to pre-existing health issues, for which she received treatment prior to the accident. It was thus incumbent upon the claimant to demonstrate on a balance of probabilities that, but for the accident,...

February 21, 2023

/

tgp-admin

Jin v Certas Home and Auto Insurance Company (20-011392)

The claimant was involved in an accident on July 16, 2019 and sought accident benefits. Certas had initially kept the claimant within the MIG and denied various medical benefits. The claimant filed a LAT Application in response to the MIG designation and denials. Following various s. 44 IEs, Certas removed the claimant from the MIG...

February 17, 2023

/

tgp-admin

C.S. v Travelers Insurance (20-014495)

The claimant was injured in an accident in 2014. She applied to the LAT seeking a catastrophic impairment determination under Criteria 8. Adjudicator Lake found that a failure to return to one's pre-accident employment is not on its own evidence of a Class 4 "marked" impairment in the domain of Adaptation and determined that the...

February 16, 2023

/

tgp-admin

Pec v Certas Direct Insurance (21-009610)

The claimant claimed accident benefits in relation to injuries sustained in a confrontation after an alleged road rage incident. The insurer argued that this did not constitute an "accident" under the SABS. The adjudicator, applying a two-part test, found that while the incident arose from the use of the vehicle, the injuries were not directly...

February 16, 2023

/

tgp-admin

Sookbir v. Wawanesa Insurance (20-008613)

The insurer and the claimant disputed at a preliminary issue hearing whether the claimant's IRB claim ought to be barred for a failure to submit a completed OCF-3 to the insurer. The claimant submitted an OCF-3 form which indicated that she was not working in the 26 weeks before the accident and that she did...

February 15, 2023

/

tgp-admin

Wicks v Intact Insurance Company (20-011457)

The claimant disputed entitlement to vocational/academic training services, a mattress, a massage chair, and a Stairmaster. The Tribunal found that the claimant did not meet the burden of proving that the disputed benefits were reasonable and necessary. Despite recommendations from occupational therapists and physicians, there was a lack of supporting medical evidence to justify the...

February 14, 2023

/

tgp-admin

Vaillancourt v. The Guarantee Company of North America (21-008125)

The claimant was previously deemed catastrophically impaired. He applied to the LAT to resolve a dispute concerning the quantum of certain benefits, including attendant care and home modifications. Prior to the accident, the claimant managed his own consulting company, was quite active, and regularly enjoyed doing housework. The insurer denied much of the claimant’s attendant...

February 10, 2023

/

tgp-admin

RBC General Insurance Company v Balasubramaniam (19-008701)

The claimant was involved in a motor vehicle accident in 2005. In 2010, FSCO ordered the insurer to pay the claimant IRBs. On July 22, 2019, the insurer applied to the LAT to have the LAT vary or revoke the 2010 FSCO order. Adjudicator Adamidis found that the LAT cannot vary or revoke an order...

February 8, 2023

/

tgp-admin

Gibson v. Intact Insurance Company (20-012060)

The claimant applied to the LAT for the approval of multiple treatment plans, including a treatment plan for a tractor. The insurer brought a motion to bar the claimant from disputing the entitlement to the tractor for failing to attend s. 44 IEs. The LAT added the claimant’s non-attendance at the IEs as a preliminary...

February 8, 2023

/

tgp-admin

Sagastume v. Allstate Insurance Company of Canada (20-014755)

The claimant disputed entitlement to ACBs and medical benefits that were denied because the claimant was within the MIG. The Tribunal found that the claimant failed to demonstrate that his injuries warranted removal from the MIG. The Tribunal rejected the argument that an insurer is required to re-schedule an IE within 10 days of an...

February 7, 2023

/

tgp-admin

Ciyayi v. Economical Insurance Company (19-005222)

The claimant suffered from a non-catastrophic impairment and applied to the LAT for attendant care and medical benefits. The claimant sought repayment for both non-professional and professional attendant care services. To establish that expenses for non-professional attendant care were “incurred” under s. 3(7)(e) of the SABS, a claimant must prove that a non-professional service provider...

February 7, 2023

/

tgp-admin

Nichols v. Gore Mutual Insurance Company (21-008322)

The claimant sought reconsideration of the Tribunal's decision that the late OCF-1 barred the application. The Tribunal found that the insurer had not provided the application package, yet found that section 32 applied. Adjudicator Kaur granted the reconsideration, holding that the 30 day deadline to submit the OCF-1 did not start running because the claimant...

February 6, 2023

/

tgp-admin

Varriano v. Allstate Insurance Company of Canada (2023 ONCA 78)

The insurer appealed the Divisional Court's decision that the limitation period on IRBs did not commence because the denial did not provide any medical reasons. The insurer argued that the only basis for denial was the claimant's return to work (i.e. an "other" reason), and that it was not required to state a medical reason...

February 6, 2023

/

tgp-admin

Aized v. The Co-operators (20-012300)

The claimant applied to the LAT for post-104 week IRBs and medical benefits, including physiotherapy services and an attendant care assessment. Prior to the accident, the claimant was employed as a student placement coordinator, which required concentration, critical thinking skills and sitting in front of a computer screen for prolonged periods of time. Despite returning...

February 6, 2023

/

tgp-admin

Suntharalingam v. Chubb Insurance Company of Canada (20-009977)

The insurer argued that the claimant was barred from receiving accident benefits because he was entitled to WSIB and could not opt out to pursue a Court claim. Adjudicator Grant agreed, finding that the claimant had been in a single-vehicle accident, was charged in relation to the accident, and had admitted in an EUO that...

Contact Us

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

416.507.1850

eodonnell@tgplawyers.com

Contact Us

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

416.507.1850

eodonnell@tgplawyers.com

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

Powered by Crow & Pitcher

Contact Us

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

416.507.1850

eodonnell@tgplawyers.com