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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July 20, 2018

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Applicant v. Unica Insurance Inc. (17-007052)

The claimant sought a declaration that she sustained a catastrophic impairment, and sought entitlement to ACBs and medical benefits. The insurer denied all of the claims and argued that the claim for ACBs was time barred. Adjudicator Ferguson held that the claimant did not suffer a catastrophic impairment. He preferred the evidence of the IE...

July 19, 2018

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Applicant v. Aviva Insurance Canada (17-006787)

The claimant sought removal from the MIG and various medical benefits. Adjudicator Parish concluded that the claimant's injuries fell within the MIG. The claimant's injuries were clinically associated sequela to the soft tissue injuries she sustained in the accident. Adjudicator Parish preferred the opinion of the IE assessor, who believed that the claimant's soft tissue...

July 19, 2018

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K.T. v. Aviva General Insurance (17-007027)

The claimant sought entitlement to attendant care benefits beyond the termination date despite no amounts being incurred. The claimant asked that the LAT deem the expenses incurred. Adjudicator Mazerolle concluded that he could not deem the expenses incurred. He held that the insurer's termination of attendant care benefits was not unreasonable and that the IE...

July 18, 2018

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Applicant v. Aviva Insurance (17-005631)

The claimant sought entitlement to a chronic pain assessment and assistive devices. Adjudicator Kepman found the claimant credible and granted the chronic pain assessment based on ongoing wrist pain years after the accident. The insurer had paid part of the claims for assistive devices, but denied the remainder based on the cost. Adjudicator Kepman concluded...

July 18, 2018

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Applicant v. Aviva Insurance Canada (17-006159)

The claimant sought removal from the MIG and entitlement to five treatment plans. Adjudicator Boyce concluded that the claimant's injuries were minor. Adjudicator Boyce held that the claimant failed to provide evidence of chronic pain and that pain lasting more than six months was not sufficient proof for removal from the MIG. He also held...

July 18, 2018

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Applicant v. Aviva Insurance Canada (17-006157)

The claimant sought removal from the MIG and entitlement to five treatment plans. Adjudicator Boyce concluded that the claimant's injuries were minor. Adjudicator Boyce held that the claimant failed to provide evidence of chronic pain and that pain lasting more than six months was not sufficient proof for removal from the MIG. He also held...

July 18, 2018

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C.M. v. Aviva General Insurance (17-005910)

The claimant sought entitlement to an additional seven months of IRBs and entitlement to a special award for IRBs that were paid at a lower rate than mandated by the SABS. Adjudicator Grant concluded that no further IRBs were payable for the disputed period because the medical evidence did not suggest an inability to continue...

July 18, 2018

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Applicant v. Aviva Insurance Canada (17-007959)

The claimant sought entitlement to IRBs and the cost of a chronic pain assessment. Adjudicator Watt dismissed both claims. Regarding IRBs, he held that the claimant was able to work. None of the claimant's own physicians said that the claimant was unable to work, and the IE assessors made the same conclusions. Regarding the chronic...

July 17, 2018

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Applicant v. Pembridge Insurance Company (17-005315)

The claimant sought removal from the MIG and entitlement to chronic pain treatment. Adjudicator Grant dismissed the claims. He accepted the opinions of the IE assessors that the claimant had normal physical functional limits and that no diagnosable psychological condition was demonstrated.

July 17, 2018

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Applicant v. The Guarantee Company of North America (17-005360)

The claimant sought entitlement to NEBs. Adjudicator Watt dismissed the claim. He noted that the claimant was still able to be active in most of her pre-accident activities, and that she had recovered by at least 50 percent. Although the claimant suffered pain, the pain was insufficient on its own to meet the "complete inability"...

July 17, 2018

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Applicant v. Wawanesa Mutual Insurance Company (17-005887)

The claimant (who was represented by a litigation guardian due to pre-existing mental disability) sought entitlement to six treatment plans for physical therapy. Adjudicator Watt concluded that the therapy was not reasonable and necessary. The claimant had been receiving similar treatment for four years and there was no evidence that further treatment of a chiropractic...

July 17, 2018

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Applicant v State Farm Mutual Automobile Insurance Company (17-008613)

The applicant sought payment for IRBs. The respondent argued that the applicant's claim was time-barred. The applicant submitted an OCF-1 in February 2012. State Farm denied the claim on March 8, 2012. The applicant submitted an OCF-3 in January 2017 after exhausting collateral benefits. State Farm denied the claim and requested additional financial documentation, but...

July 16, 2018

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Applicant v. Aviva Insurance Company (17-006910)

The claimant sought a death benefit in relation to the death of her adult child. Adjudicator Norris concluded that the deceased was principally dependent for care on the claimant due to mental disability and diabetes. The claimant was the principal provider of social and emotional support for the deceased and regularly spoke to the deceased...

July 16, 2018

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Applicant v. Guarantee Company of North America (17-006956)

The claimant sought entitlement to NEBs and funding for catastrophic impairment assessments. The insurer argued that the limitation period barred the claim for NEBs, and that the claimed catastrophic impairment assessments were not reasonable and necessary. Adjudicator Flude agreed with the insurer. He held that the claim for NEBs was barred by the limitation period...

July 16, 2018

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Applicant v. Desjardins General Insurance Group (17-005974)

The claimant sought entitlement to seven treatment plans and a special award. Adjudicator Purdy granted all the claims. She concluded that the medical evidence showed a compression fracture was directly caused by the accident, and that the proposed treatment was appropriate for addressing the injury. She was critical of the IE assessor focusing on standard...

July 16, 2018

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Applicant v. Royal Sun Alliance (RSA) (17-006236)

The claimant sought entitlement to two years of IRBs, removal from the MIG, and six treatment plans. Adjudicator Punyarthi concluded that the claimant sustained a concussion and that his injuries were therefore not minor. All of the disputed treatment plans were awarded because they directly addressed the impairments the claimant was suffering. Finally, Adjudicator Punyarthi...

July 16, 2018

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Applicant v Aviva Insurance Canada (17-006470)

The applicant sought medical benefits for a massage therapy chair and extended warranty. Adjudicator Ferguson held that the applicant was entitled to the benefit claimed as it was reasonable and necessary. The applicant was also entitled to interest on overdue payment of benefits due. The adjudicator preferred the applicant's treatment plan from an occupational therapist...

July 13, 2018

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Applicant v. The Guarantee Company of North America (17-004431)

The claimant sought entitlement to treatment outside of the MIG, and NEBs. Adjudicator Gosio held that the claimant's injuries fell within the MIG. Adjudicator Gosio held that while the claimant had pre-existing back pain, she failed to submit compelling evidence that her pre-existing back pain prevented her from achieving maximal medical recovery within the MIG....

July 12, 2018

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S.K. v. TTC Insurance (17-002561)

The Tribunal found that the claimant sustained a catastrophic impairment due to two marked impairments. The insurer sought reconsideration based on a number of arguments. Vice Chair Trojek rejected the reconsideration. She held that there was no requirements that the adjudicator convert the marked impairment into a WPI. She also wrote that the adjudicator considered...

July 10, 2018

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S.B. v. Wawanesa Mutual Insurance Company (17-004020)

The claimant sought entitlement to the cost of an in-home assessment and chiropractic treatment proposed in one treatment plan. Adjudicator Daoud found that the claimant was not entitled to the benefits in dispute. Adjudicator Daoud held that experiencing some difficulty with housekeeping and home maintenance tasks does not warrant the need for an in-home assessment.

July 6, 2018

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Applicant v. Unifund Assurance Company (17-008769)

The claimant sought disclosure of any surveillance in the insurer's possession, whether it intended on relying upon it or not. Adjudicator Grieves held that while any surveillance in the insurer's possession was relevant, it was not producible if litigation privilege would apply to it (i.e. if it was obtained after the LAT dispute was commenced...

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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