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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March 28, 2019

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H.A. v. Travelers Insurance (18-005178)

The claimant sought entitlement to IRBs, removal from the MIG, and three medical benefits. Adjudicator Lake concluded that the claimant had proven entitlement to only three months of IRBs, but that his injuries fell within the MIG. The remainder of the MIG limits was awarded on one of the treatment plans.

March 4, 2019

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L.L. v. Intact Insurance Company (17-003125)

The claimant was injured when a motorist deliberately hit her with the door of his parked car. The motorist then got out of the vehicle and struck the claimant several times. The insurer argued that there were two separate incidents, and that it was not liable to pay for injuries related to the second assault....

February 28, 2019

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Traders General Insurance Company v. Rumball (2019 ONSC 1412)

The insurer appealed the Tribunal's decision that the claimant was not barred by the limitation period from seeking IRBs. The Court held that the appeal to Divisional Court was premature, and that the matter should proceed at the Tribunal regarding the claimant's entitlement to IRBs. If IRBs were awarded, the insurer could then appeal the...

February 27, 2019

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E.K. v. Portage La Prairie Mutual Insurance Company (18-001333)

The claimant sought entitlement to four medical benefits. Adjudicator Ferguson dismissed the claims. He held that the proposed assessments were not reasonable and necessary, and that the proposed treatment was not proven to be related to an accident-related impairment.

February 8, 2019

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Z.A. v. Guarantee Insurance (17-008345)

The claimant sought accident benefits following an injury on a public transit bus. The insurer argued that there was no collision and that the claim was barred by section 268(1.1) of the Insurance Act. Adjudicator Grant concluded that the claimant failed to adduce evidence that there was a collision. No documentation was provided to substantiate...

February 7, 2019

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N.M. v. Aviva General Insurance (17-007986)

The claimant sought entitlement to one medical benefits for physical therapy. Adjudicator Ferguson dismissed the claim. He held that the claimant failed to demonstrate that the claimed benefit was reasonable and necessary.

February 7, 2019

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J.M. v. Certas Home & Auto Insurance Company (18-001153)

The claimant sought entitlement to two medical benefits. The claimant also sought to add a new medical benefits claim as part of a written hearing. Adjudicator Punyarthi permitted the issue to be added, but held that it was not payable because a treatment plan had never been submitted in relation to the incurred treatment. The...

February 7, 2019

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J.V. v. RBC General Insurance Company (17-001981)

The claimant sought entitlement to various medical benefits. Adjudicator John awarded the all of the claimed assessments and treatment. She found that the claimant continued to suffer from chronic pain which affected her activities of daily living. She also suffered psychological injuries that required ongoing treatment. Adjudicator John was not persuaded by surveillance which showed...

February 5, 2019

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G.T. v. The Commonwell Mutual Insurance Group (17-004072)

The claimant sought entitlement to IRBs and two medical benefits. Adjudicator Gosio concluded that the claimant suffered a substantial inability to perform her job as a bartender up to the end of the 104 week period, but she did not meet the "complete inability" test. He accepted that there were other similar employment options available...

February 5, 2019

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S.W. v. Pafco Insurance (17-007716)

The claimant sought IRBs. The insurer argued that the limitation period applied. Adjudicator Ferguson held that the LAT application was made more than two years after the accident, but that the exception at section 7 of the LAT Act should apply. The insurer and the claimant had entered into a settlement agreement of IRBs up...

January 29, 2019

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M.K. v. Wawanesa Mutual Insurance Company (18-001879)

The claimant refused to produce various records sought by the insurer. The insurer brought a motion for production of the records. Adjudicator Ferguson held that all of the requested medical records that were requested by the insurer because they were relevant to the claimant's injuries and his late application for accident benefits. The records showing...

January 24, 2019

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A.J. v. Aviva General Insurance (18-000214)

The claimant sought entitlement to payment of physical therapy. Adjudicator Mather concluded that the treatment was not reasonable and necessary because there was no evidence that such treatment was beneficial and that further treatment was required.

January 24, 2019

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M.B. v. Aviva Insurance Canada (18-002289)

The claimant sought entitlement to a functional abilities evaluation/vocational assessment and a chronic pain assessment. Adjudicator Ferguson held that functional abilities evaluation/vocational assessment was payable up to the Professional Services Guideline limits, but denied entitlement to the chronic pain assessment. The FAE was awarded because the claimant was not able to do his pre-accident work...

January 23, 2019

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M.J. v. TD Home and Auto Insurance Company (18-004395)

The claimant had filed two LAT applications: one addressing NEBs and five treatment plans; the second addressing a catastrophic impairment determination. The claimant had exhausted her medical benefits and would only be entitled to the disputed treatment plans if she suffered a catastrophic impairment. A hearing was scheduled on the first application, while the second...

January 23, 2019

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S.A. v. Aviva Insurance Canada (18-000651)

The claimant sought entitlement to medical benefits for physiotherapy and a chronic pain assessment. Adjudicator Maleki-Yazdi denied both claims. She held that the claimant's right hip pain (which was the basis for the medical benefits) was not caused by the accident, but rather a subsequent slip-and-fall. Further, the claimant did not present evidence that the...

January 23, 2019

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J.R. v. RSA Insurance (18-000770)

The claimant sought removal from the MIG and entitlement to four medical benefits. Adjudicator Hamud concluded that the claimant suffered chronic pain syndrome and that his injuries did not fall within the MIG. The family physician's clinical notes and records supported the conclusion, and the IE physicians failed to fairly consider the claimant's reports of...

January 21, 2019

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Aviva General Insurance Company v. H.H. (17-007805)

The insurer sought repayment of NEBs accidentally paid to the claimant from four weeks after the accident rather than 26 weeks after the accident. Adjudicator Hamud concluded that the insurer was not entitled to repayment. He held that because the first payment of NEBs that was made in error was more than 12 months prior...

January 21, 2019

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T.T. v. Security National Insurance Company (18-002654)

The claimant sought entitlement to NEBs and medical benefits for physical therapy. Adjudicator Ferguson held that the claimant did not meet the "complete inability" test because her pain did not practically prevent her from engaging in her pre-accident activities. She continued to perform self-care, she received accommodations at college, and she had returned to a...

January 21, 2019

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S.P. v. Gore Mutual Insurance Company (17-003686)

The claimant applied for accident benefits one year after an accident. She sought entitlement to a treatment plan for physical therapy. The insurer denied the claim and argued that the claimant was barred from pursuing accident benefits due to her late application. Adjudicator Msosa held that the claimant provided a reasonable explanation for the late...

January 20, 2019

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R.G. v. State Farm Insurance (17-006934)

The claimant sought entitlement to a home modification assessment. The insurer agreed to pay for the assessment up to $2,000. The claimant argued that the cap did not apply to such assessments. Adjudicator Gosio agreed with the insurer and held that home accessibility and housing assessments were subject to the $2,000 cap on assessments.

January 18, 2019

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A.R. v. Aviva Insurance Company (18-000838)

The claimant sought entitlement to medical benefits for psychological services. Adjudicator Johal concluded that the claimant was entitled to the claimed benefits. He concluded that the psychological services assisted the claimant with strategies for coping with pain and physical symptoms. He also concluded that a psychological assessment was reasonable and necessary given that the insurer...

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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