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.

October 10, 2019

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I.M.N. v. Intact Insurance Company (18-005359)

The claimant sought reconsideration of the Tribunal's decision that he was not entitled to accident benefits. The claimant had applied for benefits under Quebec's SAAQ. He later filed an application for SABS benefits when he was unhappy with the SAAQ benefits. The Tribunal rejected the claimant's arguments, stating that he was simply re-arguing the same...

October 9, 2019

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A.B. v. Guarantee Insurance (18-010371)

The claimant sought entitlement to medical benefits for physical and psychological treatment. Adjudicator Braun found all three medical benefits reasonable and necessary. In terms of physical therapy, the claimant showed consistent improvement with same. In terms of psychological therapy, Adjudicator Braun accepted that 1.5 hour sessions were appropriate for the claimant.

October 9, 2019

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J.A.A. v. Aviva General Insurance Company (18-008671)

The claimant sought entitlement to one treatment plan for chiropractic treatment. Adjudicator Boyce held that it was not reasonable and necessary. He found the denial complied with section 38, and found that clinic based treatment was not helping the claimant's function improve.

October 9, 2019

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S.B. v. Aviva Insurance Company (17-001414)

The claimant sought reconsideration of the Tribunal's decision that his injuries fell within the MIG and that he was not entitled to claimed medical benefits. The issue of the MIG was accidentally included in the LAT application, and the claimant had been removed from the MIG prior to the hearing based on an IE. Adjudicator...

October 8, 2019

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D.R. v. Aviva Insurance Canada (18-007848)

The claimant sought entitlement to NEBs. Adjudicator Watt dismissed the claim. He found the claimant's testimony to conflict with the medical records. He also wrote that the surveillance of the claimant contradicted his reported abilities. The medical reports from the claimant's experts relied on the claimant's self-reporting, which was held not to be accurate.

October 8, 2019

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I.D.C. v. Aviva Insurance Canada (17-004536)

The claimant sought entitlement to NEBs, removal from the MIG, and various medical benefits. She alleged that the accident aggravated injuries from an earlier accident. Adjudicator Sharda held that the claimant suffered from pre-existing psychological impairments and chronic pain, which were worsened by the accident, and entitled to her treatment outside of the MIG; further...

October 8, 2019

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Motor Vehicle Accident Claims Fund v. I.G. (18-000798)

The Fund sought repayment of IRBs and medical benefits, arguing that the claimant was not employed at the time of the accident and was not involved in a motor vehicle accident as claimed. Adjudicator Makhamra accepted that the claimant had committed a wilful misrepresentation. A few years after initially making the accident benefits claim, the...

October 7, 2019

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D.M. v. Aviva General Insurance Company (18-003850)

The claimant sought entitlement to three medical benefits. The insurer approved the treatment plans shortly after written submissions were due. Adjudicator Norris held that interest was also payable on the treatment plans from the date of the LAT application onwards.

October 7, 2019

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B.H. v. Certas Home and Auto Insurance Company (17-006967)

The insurer sought reconsideration of the Tribunal's decision that the denial letter for a psychological assessment was deficient and that the insurer was barred from applying the MIG; the assessment was also found reasonable and necessary. Vice Chair Lester dismissed the reconsideration. She held that the Tribunal had not violated the rules of procedural fairness...

October 4, 2019

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E.G. v. Wawanesa Insurance (18-010183)

The claimant sought removal from the MIG and entitlement to two medical benefits. Adjudicator Grant concluded that the claimant suffered minor injuries. There was no evidence of pre-existing conditions, psychological impairments, or chronic pain syndrome.

October 4, 2019

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W.P. v. Travelers Insurance (18-010458)

The claimant sought removal from the MIG and entitlement to two medical benefits. Adjudicator Grant concluded that the claimant suffered minor injuries. There was no evidence of impairments falling outside of the MIG definition.

October 3, 2019

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P.V. v. Aviva Insurance Company (18-009130)

The claimant sought entitlement to nine assessments in relation to a catastrophic impairment determination. The insurer approved four (an orthopaedic assessment, an occupational therapy assessment, a psychiatry assessment, and a WPI rating); it denied five other assessments. Adjudicator Boyce accepted that each assessment had to be reasonable and necessary for the completion of the OCF-19...

October 2, 2019

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D.T. v. Wawanesa Mutual Insurance Company (18-005613)

The claimant sought entitlement to IRBs, the MIG, and various medical benefits. The insurer argued that the claimant's entitlement to IRBs had already been decided and was res judicata. The Tribunal had already adjudicated an application for IRBs (among other things), which was upheld on reconsideration and at the Divisional Court. There was no new...

October 2, 2019

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K.P. v. Security National Insurance Company (18-007561)

The claimant sought removal from the MIG and entitlement to various medical benefits. Adjudicator Sharda found that the claimant failed to prove that her injuries fell outside of the MIG. There was little evidence of psychological impairment causing a loss of functional ability.

October 2, 2019

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J.A. v. Aviva Insurance Company (18-005595)

The claimant sought removal from the MIG and entitlement to three treatment plans and two assessments. Adjudicator Grant concluded that the claimant suffered from psychological injuries which was not a minor injury. He awarded the proposed psychological assessment, but rejected the proposed treatment plans for physical therapy and the proposed attendant care assessment.

October 2, 2019

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J.A. v. Aviva General Insurance Company (18-008207)

The claimant sought removal from the MIG and entitlement to two medical benefits. Adjudicator Grant found that the claimant suffered from minor injuries. He rejected the argument that the claimant suffered from chronic pain syndrome because there was no evidence of the claimant having impaired functionality.

October 2, 2019

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J.V. v. TD Insurance Meloche Monnex (18-008337)

The claimant disputed his entitlement to IRBs, but had not submitted a Disability Certificate. The insurer argued that the failure to submit an OCF-3 barred the claim from proceeding. Adjudicator Ferguson agreed with the insurer and barred the dispute from proceeding. He held that section 36 created a strict requirement to provide an OCF-3. Section...

October 2, 2019

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

The claimant sought entitlement to NEBs. The insurer argued that the limitation period barred the dispute. Adjudicator Boyce agreed with the insurer. He concluded that while the denial of NEBs could be considered "pre-emptive" it was still a valid denial, following the Court of Appeal's decisions in Bonaccorso and Sietzema. The insurer's post-denial conduct in...

October 2, 2019

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Applicant v. Certas Direct Insurance Company (17-008853)

The claimant sought removal from the MIG, and entitlement to ACBs and various medical benefits. The insurer argued that the claimant was barred from proceeding to a hearing due to his failure to attend an IE addressing attendant care benefits. Vice Chair Helt concluded that the claimant was not barred from proceeding with his claim...

September 30, 2019

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G.J. v. Aviva General Insurance Company (18-006663)

This preliminary issue hearing was brought to determine whether the claimant was statute barred from proceeding with his appeal of a number of medical benefits and expenses because he did not submit treatment plans before incurring the expenses, and because he did not attend an IE that the respondent had determined was necessary for it...

September 30, 2019

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G.M.K. v. Aviva Insurance Company of Canada(18-009487)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to a psychological assessment. Adjudicator Manigat concluded that the claimant's injuries fell within the MIG. The claimant relied on a section 25 psychological report, in which he was diagnosed with PTSD and Major Depressive Disorder. The respondent relied on a...

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Contact Us

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

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Toronto, Ontario M5H 3S5

416.507.1850

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