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.

September 26, 2019

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Applicant v. Certas Direct Insurance Company (18-000563)

The minor claimant sought a catastrophic impairment determination following an accident in which he sustained a concussion and developed behavioural disorders, including post-traumatic stress disorder and obsessive-compulsive disorder. Adjudicator Daoud found that the claimant suffered a Class 4 Marked Impairment in adaptation as a result of his injuries. She accepted the evidence of the claimant's...

September 24, 2019

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B.M. v. Allstate Insurance (18-008410)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to a chronic pain assessment. Adjudicator Maleki-Yazdi concluded that the claimant's injuries fell outside of the MIG due to chronic pain, and that the claimant was entitled to the cost of the chronic pain assessment. The claimant continued to reported...

September 23, 2019

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J.E. v. Intact Insurance Company (18-011314)

The claimant sought entitlement to two treatment plans proposing a psychological assessment and a physiatry assessment. Adjudicator Boyce concluded that neither cost of examination was payable, noting that the claimant had already received approval for a slate of nine catastrophic impairment examinations. As such, the examinations were duplicative, and not reasonable and necessary.

September 23, 2019

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Hedley v. Aviva Insurance Company of Canada (2019 ONSC 5318)

Aviva sought reconsideration of the Tribunal's reconsideration that its section 38 denial did not provide sufficient "medical and any other reasons for the examination," and that the claimant was not required to attend the IE. The Court upheld the reconsideration decision as falling within the range of reasonableness. The Court wrote: "where reasons are required,...

September 18, 2019

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Applicant v. Unica Insurance Inc. (18-009767)

This preliminary issue hearing was brought to determine whether the claimant was precluded from applying for post-104 week income replacement benefits, as the issue had already been dealt with as a result of a prior application to the Tribunal. An extensive hearing had previously been conducted and a final decision dealing with both pre and...

September 17, 2019

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C.G. v. Travelers Insurance (18-001021)

The claimant applied to the Tribunal seeking entitlement to IRBs and medical benefits. The insurer raised a preliminary issue requesting that the Tribunal bar the claimant's dispute over IRBs due to his failure to attend a s. 44 FAE with a kinesiologist. Adjudicator Létourneau concluded that the claimant was entitled to IRBs for the pre-104...

September 17, 2019

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Applicant v. Wawanesa Mutual Insurance Company (18-004984)

The claimant sought entitlement to a medical benefit, interest, and a special award. Adjudicator Chakravarti found that the proposed medical benefit was reasonable and necessary. Adjudicator Chakravarti noted that in a separate and earlier LAT hearing, Adjudicator Gueller removed the claimant from the MIG. Adjudicator Chakravarti held that she was persuaded by the claimant's treating...

September 17, 2019

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Applicant v. Wawanesa Mutual Insurance Company (18-003314)

The claimant sought reconsideration of the Tribunal's decision on narrow issue of the quantum of attendant care awarded. The Tribunal awarded the claimant $3,047.27 in monthly attendant care, despite the claimant's Form 1 listing $6,000 in monthly attendant care and the respondent's Form 1 listing $3,243.95 in monthly attendant care. The claimant argued that the...

September 16, 2019

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S.H.S.K v. Allstate Canada (18-003699)

The claimant applied to the Tribunal disputing his entitlement to four treatment plans and interest. Of the four disputed treatment plans, the claimant disputed his entitlement to an orthopaedic assessment and MRI. Adjudicator Kaur concluded that the claimant did not prove that the orthopaedic assessment and MRI were reasonable and necessary as he failed to...

September 16, 2019

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P.Y. v Aviva General Insurance Company (17-003692)

The claimant sought reconsideration of the Tribunal's decision based on there being new evidence that the claimant could not have reasonably obtained earlier and based on the insurer's concession at the close of the proceedings that the MIG did not apply. Adjudicator Grieves granted the claimant's reconsideration request. Adjudicator Grieves accepted that the new evidence,...

September 16, 2019

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F.J.H. v. Unica Insurance Inc. (18-008249)

The claimant disputed his entitlement to a medical benefit and the MIG. Adjudicator Lester held that the claimant's injuries fell within the MIG and that he was not entitled to the disputed medical benefit. Adjudicator Lester held that while the claimant suffered from pain and poor sleep pre-accident, the claimant had not submitted compelling evidence...

September 16, 2019

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L. Y. v Aviva Insurance Company (17-008847)

The insurer sought reconsideration of the Tribunal's decision, arguing that it had made a significant error of law or fact by referring to evidence not before it, placed the onus on the insurer, and failing to adhere to case law. On reconsideration, Adjudicator Norris held that he did not err in law in his decision....

September 13, 2019

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H.M. v. Aviva Insurance Canada (18-004734)

The claimant sought reconsideration of the Tribunal's decision finding that he was not entitlement to Non-Earner Benefits. Upon receipt of the reconsideration request, the Tribunal invited both parties to submit supplementary submissions. Neither party delivered supplementary submissions. Adjudicator Lake dismissed the claimant's request for reconsideration. Adjudicator Lake found that the claimant's request for reconsideration was...

September 11, 2019

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Travelers Insurance v. C.B. (18-007878)

The insurer sought repayment of IRBs paid to the claimant for a period she was working in a job with similar job duties to her pre-accident employment. Adjudicator Paluch granted repayment of $13,134.06 in IRBs. He held that the claimant's return to work suggested that she did not suffer a substantial inability to engage in...

September 3, 2019

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C.A. v. Intact Insurance Company (18-000579)

The claimant sought reconsideration of the Tribunal's denial of the cost of catastrophic impairment assessments. Adjudicator Lester held that section 25(1)(5) only obligates an insurer to pay the reasonable fees charged in connection with filling out the application for the catastrophic determination rather than the assessments themselves. She also agreed that the reasonable and necessary...

September 3, 2019

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V.D. v. Unifund Assurance Company (17-005656)

The claimant sought reconsideration of the Tribunal's decision to reject her claims for a chronic pain program and a self-propelled lawn mower and snow blower. Adjudicator Paluch dismissed the reconsideration request. He concluded that the Tribunal had not misapprehended the evidence or erred in its legal analysis. The Tribunal was permitted to weigh the evidence...

September 3, 2019

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C.A. v. Intact Insurance Company (18-000579)

The claimant sought reconsideration of the Tribunal's denial of the cost of catastrophic impairment assessments. Adjudicator Lester held that section 25(1)(5) only obligates an insurer to pay the reasonable fees charged in connection with filling out the application for the catastrophic determination rather than the assessments themselves. She also agreed that the reasonable and necessary...

August 29, 2019

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K.A. v. TD Insurance Company (18-009613)

The insurer sought reconsideration of a motion order denying the request to adjourn the scheduled hearing. Associate Chair Batty dismissed the reconsideration because it was not related to a final order.

August 29, 2019

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C.S. v. Aviva Insurance Company (18-007039)

The claimant sought reconsideration of a motion order denying the request to strike the insurer's evidence. Associate Chair Batty dismissed the reconsideration because it was not related to a final order.

August 27, 2019

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Applicant v. Toronto Transit Commission (18-009821)

The claimant sought a determination that he suffered a catastrophic impairment as a result of the accident. Adjudicator Boyce agreed with the claimant and concluded that he suffered a Class 4 marked impairment in adaptation, as well as a WPI in excess of 55 percent. Although the claimant presented with multiple credibility issues, Adjudicator Boyce...

August 27, 2019

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M.F. v. The Personal Insurance Company (18-007929)

The insurer alleged that the claimant was not a passenger in the vehicle when the accident occurred and sought repayment of medical benefits paid on her behalf. Vice Chair Flude concluded that the insurer had the burden to prove that the claimant had made a wilful misrepresentation, and that the insurer failed to meet its...

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

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

416.507.1850

eodonnell@tgplawyers.com