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 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...

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...

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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