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.

November 8, 2019

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S.K. v. Aviva Insurance Company of Canada (18-011027)

The claimant sought entitlement to four treatment plans - two for psychological services (which were partially approved), and two for physiotherapy services. Adjudicator Boyce awarded one treatment plan for physiotherapy, but denied the remainder of the claims. Regarding the partial psychological treatment plan amounts, the adjudicator held that the claimant failed to prove that the...

November 8, 2019

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Tomec v. Economical Mutual Insurance Company (2019 ONCA 882)

The claimant was declared catastrophically impaired seven years after the accident. The insurer had denied entitlement to further attendant care benefits and housekeeping expenses at the 104 week anniversary. The claimant sought entitlement to ACBs and HK expenses from the 104 week anniversary onwards following the catastrophic impairment designation. The insurer argued that the claims...

November 6, 2019

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O.M. v. Aviva Insurance Canada (16-003552)

The claimant sought entitlement to IRBs. The claimant failed to attend the scheduled hearing and did not submit any evidence in support of the claim. Vice Chair Shapiro dismissed the claim.

November 6, 2019

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T.S. v. Unifund Assurance Company (19-000666)

The claimant sought entitlement to a chronic pain programme. The insurer argued that the claimant failed to attend IEs, barring the claim from proceeding due to section 55. Adjudicator Boyce agreed with the insurer. He found the requested IEs to be reasonable and the IE notices to be compliant with section 44.

November 5, 2019

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V.L. v. Pafco Insurance Company (18-003802)

The claimant sought entitlement to chiropractic treatment and the denied portion of catastrophic impairment assessments. Adjudicator Boyce denied the claims for further chiropractic treatment because the claimant failed to prove the treatment was reasonable and necessary. He awarded the FAE component of the catastrophic impairment assessments, as well as the cost of the OCF-19 completion,...

November 5, 2019

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G.A. v. The Personal Insurance Company (18-003420)

The claimant sought removal from the MIG and entitlement to various medical benefits. Adjudicator Watt held that the claimant's injuries fell within the MIG. He rejected the opinion of the claimant's neurologist because it was not based on accurate facts.

November 5, 2019

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O.I. v. RBC General Insurance Company (18-005774)

The claimant sought entitlement to IRBs for a six months period. Adjudicator Maedel dismissed the claim. He found that the claimant did not suffer job-limiting chronic pain; rather, the claimant suffered some pain in his right shoulder and lower back, but maintained normal range of motion. These impairments did not render him substantially unable to...

November 5, 2019

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C.G. v. Aviva Insurance (18-008957)

The claimant sought removal from the MIG and entitlement to an attendant care assessment and assistive devices. Adjudicator Grant dismissed the claims. He held that the claimant's physical and psychological injuries met the definition of "minor injury". He also rejected the argument that the claimant suffered chronic pain as a result of the accident.

November 1, 2019

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M.R. v. Allstate Insurance Company (17-008969)

The claimant sought reconsideration of the Tribunal's denial of ACBs and order barring the claim for medical benefits based on IE Non-Attendance; the Tribunal had awarded IRBs. Adjudicator Mazerolle held that the Tribunal denials did not meet the criteria in Rule 18 for reconsideration. However, Adjudicator Mazerolle found that the award of IRBs beyond the...

November 1, 2019

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D.M. v. Aviva Insurance Canada (18-008708)

The claimant sought entitlement to a treatment plan for physiotherapy. Adjudicator Grant held that the treatment plan was not reasonable and necessary. The claimant's evidence did not show that physiotherapy was anticipated to provide any benefit. Further, the claimant stated to IE assessors that physiotherapy was not providing long-term benefit.

October 31, 2019

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S.K. v. Aviva Insurance Company (18-007679)

The claimant sought entitlement to NEBs. Adjudicator Grieves dismissed the claim. She held that the claimant failed to provide evidence regarding the change in his pre-accident versus post-accident daily activities. The claimant remained independent with personal care, continued to drive, prepare meals, and completed most household chores.

October 30, 2019

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S.A. v. Aviva Insurance Company (18-006278)

The claimant sought reconsideration of the Tribunal's denial of part of a chronic pain program, a bone growth stimulator, and an MRI. Adjudicator Lake dismissed the reconsideration. She held that the claimant failed to prove that the Tribunal made an error of law or fact. In essence, the claimant was seeking a re-weighing of the...

October 30, 2019

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H.S.H. v. Aviva Insurance Company (18-002204)

The claimant sought entitlement to two medical benefits, and a series of catastrophic impairment assessments. Adjudicator Reilly rejected all of the claims. She held that the proposed benefits were not reasonable and necessary. The medical records from the family physician shows no ongoing accident-related impairments.

October 30, 2019

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Allstate Insurance Company v. Billard (2019 ONSC 6256)

The insurer sought judicial review of the Tribunal's decision that the limitation period should be extended based on section 7 of the LAT Act. The Divisional Court dismissed the review on the basis that the LAT proceeding needed to first be completed in its entirety before seeking judicial review.

October 29, 2019

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P.M. v. Aviva Insurance Canada (17-005419)

The claimant sought entitlement to IRBs and medical benefits. She also sought entitlement to an accounting report. Adjudicator Watt denied the claim for IRBs, as the claimant had been paid IRBs up to the date she returned to work on a modified basis. He found the treatment plans not reasonable and necessary. Finally, he held...

October 29, 2019

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M.D. v. The Co-operators General Insurance Company (18-009426)

The claimant sought removal from the MIG and entitlement to three medical benefits for physical therapy. Adjudicator Victor held that the claimant's injuries were predominantly minor. She preferred the opinions of the IE assessors. She also noted that the claimant had returned to work a few days after the accident.

October 28, 2019

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J.G. v. The Co-operators General Insurance Company (18-012430)

The claimant sought reconsideration of the Tribunal's decision that the claim for NEBs was barred by the limitation period. The claimant also sought further benefits, which were not addressed in the preliminary hearing. Associate Chair Batty dismissed the reconsideration request because it was not a final order disposing of the entire dispute.

October 28, 2019

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M.H. v. Western Assurance Company (18-009498)

The claimant sought reconsideration of the Tribunal's decision that the claim for IRBs was barred by the limitation period. The claimant also sought further benefits, which were not addressed in the preliminary hearing. Associate Chair Batty dismissed the reconsideration request because it was not a final order disposing of the entire dispute.

October 28, 2019

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P.M. v. Aviva Insurance Company (19-002717)

The claimant sought reconsideration of the Tribunal's motion order that permitted the insurer to cross-examine the claimant on her affidavit. Associate Chair Batty dismissed the reconsideration request because it was not a final order disposing of the dispute.

October 28, 2019

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J.B.W. v. Aviva General Insurance (18-008128)

The claimant sought removal from the MIG and entitlement to a treatment plan for chiropractic therapy. The insurer had requested the claimant's attendance at an IE to address the MIG and the medical benefits. The claimant failed to attend, and the insurer argued that claim was barred by section 55. Adjudicator Goela held that the...

October 28, 2019

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Fordjour v. Royal and Sun Alliance Insurance Company of Canada (2019 ONSC 6268)

The claimant judicial review of the dismissal of her claim on two grounds: that she her family physician should be entitled to give opinion evidence, and that the adjudicator did not properly address causation. The Divisional Court agreed with the claimant and remitted the matter for a new hearing. It held that the Tribunal erred...

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

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416.507.1850

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