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.

July 10, 2019

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P.S. v. Certas Home and Auto Insurance Company (18-001199)

The claimant sought removal from the MIG, five medical benefits, and attendant care benefits. Adjudicator Msosa concluded that the claimant's injuries were predominantly "minor". His injuries were soft tissue in nature, he did not suffer a psychological impairment, and there were no pre-existing injuries preventing maximal recovery under the MIG.

July 10, 2019

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B.K. v. Aviva Insurance Canada (18-007095)

The insurer had requested the claimant's attendance at an examination under oath. The claimant refused to attend the examination under oath until the insurer had provided the particular of surveillance. The insurer suspended benefits in accordance with section 33. Adjudicator Ferguson held that there was no obligation on Aviva to disclose surveillance particulars under the...

July 9, 2019

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M.G. v. Aviva Insurance Canada (18-001568)

The claimant sought entitlement to four medical benefits, and argued that the insurer's denials did not comply with section 38. Adjudicator Fricot concluded that the denial complied with section 38 because it explained the basis for the denial with reference to the claimant's medical condition and the IE report. She also held that the insurer...

July 8, 2019

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S.G. v. Aviva General Insurance Company (18-007668)

The claimant sought reconsideration of the decision that his injuries fell within the MIG. Associate Chair Batty dismissed the reconsideration request, writing that the claimant failed to provide sufficient information to meet the criteria for reconsideration. There were no particulars provided as to the grounds for reconsideration.

July 8, 2019

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T.H. v. Aviva Insurance Company of Canada (17-001125)

The Tribunal dismissed the claim for NEBs and the claimant sought reconsideration arguing that he had been denied natural justice because he was not permitted to call additional witnesses at the hearing, despite agreeing to the procedure in the Case Conference. He also argued that the insurer failed to send an appropriate NEB denial. Member...

July 5, 2019

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M.J. v. Economical Mutual Insurance Company (18-005523)

The claimant requested productions from SOMA Medical Assessment. SOMA was a third party who had concluded in its s. 44 assessments that the claimant's injuries were not catastrophic. In the Case Conference for the matter, the adjudicator released an Order dated November 6, 2018 requiring the insurer to produce SOMA's complete file as it pertained...

July 4, 2019

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M.D.H. v. Wawanesa Mutual Insurance Company (17-007887)

The claimant sought reconsideration of the decision that his injuries fell within the MIG. Adjudicator Neilson dismissed the reconsideration request. She was not persuaded that the Tribunal made a significant error of law or fact, or acted outside its jurisdiction or violated the rules of procedural fairness. She wrote that the Tribunal applied the correct...

July 3, 2019

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C.H. v. Aviva Insurance Canada (18-002710)

The claimant sought removal from the MIG and entitlement to medical benefits for psychological treatment. Adjudicator Go concluded that the claimant suffered psychological injuries as a result of the accident. The treatment for psychological therapy was reasonable and necessary.

July 2, 2019

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Certas Direct Insurance Company v. K.P. (18-005710)

The insurer sought repayment of IRBs alleging that the claimant had misrepresented his work status for a period of seven months. Adjudicator Parish accepted that the claimant was working during the seven month period he was receiving IRBs, and that the claimant wilfully misrepresented his work status in signing an OCF-13 which stated he had...

June 21, 2019

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Shuttleworth v. Ontario (Safety, Licensing Appeals and Standards Tribunal) (2019 ONCA 518)

The Tribunal and the insurer appealed the Divisional Court's decision that there was a reasonable apprehension of lack of adjudicative independence. The Court of Appeal dismissed the appeal and held that the Divisional Court had correctly applied the case law regarding adjudicative independence. The dispute was remitted to the Tribunal for a new hearing on...

June 5, 2019

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E.B. v. Aviva Insurance Canada (18-010159)

The claimant sought entitlement to acupuncture, massage, and chiropractic therapy, a social work assessment, an in-home assessment, the cost for the production of a disability certificate, and interest on the overdue payment of benefits. Adjudicator Norris did not find the disputed treatment, assessments, and cost for the production of a disability certificate to be reasonable...

June 5, 2019

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A.B. v. Aviva Insurance Company of Canada(18-000935)

At the case conference, the Adjudicator ordered the issues in dispute to be heard by way of a written hearing. After the respondent filed their submissions, in which it requested costs, the claimant withdrew their application from the Tribunal. The Tribunal proceeded to close the file without hearing the request for costs. The respondent sought...

May 31, 2019

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U.P. v. Aviva General Insurance Company (19-007557)

The claimant sought entitlement to two treatment plans, a chronic pain assessment and physiotherapy treatment. Adjudicator Kaur found that the claimant was entitled to both benefits. The evidence supported that the claimant continued to suffer from ongoing pain and impairment. With respect to the chronic pain assessment, the Adjudicator preferred the claimant's evidence and held...

May 30, 2019

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G.C. v. Aviva Insurance Canada (17-003450)

The insurer sought reconsideration of the Tribunal's decision that the claimant was entitled to a chronic pain assessment, arguing that the Tribunal failed to consider if the proposed assessor was properly qualified and failed to apply significant weight to the respondent's paper review IE report. Adjudicator Grieves dismissed the request for reconsideration. She held that...

May 30, 2019

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M.H. v. Aviva Insurance Canada (17-006910)

The insurer sought reconsideration of the Tribunal's decision to award death benefits, on the basis that the deceased was a dependent for care on the claimant. Associate Chair Jovanovic granted the reconsideration and ordered a new hearing. He wrote that the Tribunal failed to consider whether the deceased was "principally" dependent on the claimant and...

May 28, 2019

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A.O. v. Unifund Assurance Company (18-003798)

This preliminary issue hearing was brought to determine whether the claimant was statute barred from proceeding with her claim for IRBs because she failed to apply within the two year limitation period after its refusal to pay IRBs. The claimant conceded that she did not file her application within the two year limitation period, and...

May 27, 2019

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M.R. v. Aviva Insurance Canada (17-008917)

The claimant sought entitlement to two treatment plans, a chronic pain assessment and a neurological assessment. Adjudicator Makhamra found that the claimant was entitled to both benefits. In terms of the chronic pain assessment, the claimant's family doctor records contained persistent complaints of pain resulting from the accident-related injuries. The Adjudicator assigned little weight to...

May 27, 2019

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S.G. v. Aviva General Insurance (18-007668)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to two treatment plans, one for psychological treatment and another for an orthopaedic assessment. Adjudicator Braun concluded that the claimant's physical injuries were minor, but that he had sustained a psychological injury which exempted him from the MIG limit. The...

May 27, 2019

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P.D. v. Western Assurance Company (17-005066)

The insurer sought reconsideration of the Tribunal's decision that the limitation period did not bar the claims for attendant care benefits and medical benefits. Associate Chair Batty granted the reconsideration, reasoning that the denials were "clear and unequivocal." The denials were based on the claimant having exhausted her non-catastrophic medical benefits limits.

May 24, 2019

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D.M. v. Aviva Insurance (17-003463)

The insurer sought reconsideration of the Tribunal's decision to award ACBs beyond the 104 week mark despite the claimant not being designated catastrophically impaired, and the decision to deem the attendant care services incurred. Adjudicator Boyce granted the reconsideration. He held that the Tribunal made a significant error of law in awarding ACBs beyond the...

May 23, 2019

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T.C. v. Aviva Insurance Canada (17-008107)

The claimant sought reconsideration of the Tribunal's decision that she was not entitled to IRBs. Adjudicator Boyce dismissed the reconsideration request. He held that the claimant's arguments amounted to an attempt to re-argue the case and reweigh the evidence and credibility, which was not the purpose of a reconsideration. He also held that a new...

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Contact Us

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

416.507.1850

eodonnell@tgplawyers.com

© 2020 Thomas Gold Pettingill LLP