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.

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...

May 23, 2019

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K.B. v. Aviva General Insurance Company (17-009088)

The claimant sought entitlement to NEBs. Adjudicator Punyarthi dismissed the claim. He held that the claimant did not meet the "complete inability" test, and that the evidence submitted did not provide an in-depth assessment of the claimant's pre-accident and post-accident activities or how he was practically prevented from engaging in the activities that were most...

May 23, 2019

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L.K.C. v. Unifund Assurance Company (18-004346)

The insurer sought reconsideration of the Tribunal's order to produce adjusting log notes. Adjudicator Marzinotto dismissed the reconsideration request. She held that the Tribunal did not make a significant error of law, and that the log notes were relevant to the issues in dispute. She also noted that there was no legal requirement that a...

May 17, 2019

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C.D. v. Aviva General Insurance (17-005825)

The Tribunal had awarded the claimant all claimed medical benefits in her application, and a 25 percent special award. The insurer sought reconsideration, arguing that it had paid amounts to the clinics for the medical benefits, so that any payments to the claimant was double recovery. The insurer also argued that the special award was...

May 16, 2019

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T.K. v. Allstate Insurance (18-007113)

The claimant sought an order for interim benefits pending the LAT hearing. The insurer argued that the LAT did not have jurisdiction to award interim benefits. Adjudicator Letourneau agreed with the insurer and held that he did not have jurisdiction to award interim benefits. When read together, none of the Insurance Act, the Statutory Powers...

May 16, 2019

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A.P. v. Coachman Insurance Company (17-004906)

The Tribunal had awarded the claimant IRBs for a specific quantum and specific time period; the Tribunal also awarded interest on medical benefits. The insurer sought reconsideration, arguing that the decision did not accurately reflect the timeframe for payment of IRBs and when interest became payable. Adjudicator Lester partially granted the reconsideration request. She held...

May 16, 2019

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J.L. v. Wawanesa Mutual Insurance Company (18-000766)

The claimant sought reconsideration of the Tribunal's decision that he did not suffer a catastrophic impairment under the Glasgow Coma Scale. He argued that the Tribunal should have admitted video evidence of the paramedic administering the GCS. Adjudicator Boyce agreed with the Tribunal that the video had limited probative value and was unlikely to change...

May 16, 2019

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D.M. v. Wawanesa Mutual Insurance Company (18-003314)

The claimant was catastrophically impaired as a result of a motorcycle accident. He sought entitlement to $6,000 per month in ACBs and entitlement to further physiotherapy. Adjudicator Hines awarded $3,047.29 per month in ACBs. The primary dispute was whether the claimant required 24/7 care. The adjudicator concluded that the claimant did not require 24/7 care....

May 15, 2019

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A.R. v. Certas Direct Insurance Company (18-005035)

The claimant sought entitlement to IRBs; the insurer argued that the claimant failed to attend an IE. Adjudicator Johal concluded that the claimant was barred from proceeding with the LAT dispute until attending an IE. Although the claimant was justified in not attending the initially scheduled IE based on a note from his family doctor,...

May 15, 2019

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F.C. v. Intact Insurance Company (18-005079)

The claimant had applied to the Tribunal for accident benefits, and commenced an action for property damage in the Superior Court. The insurer alleged that the claimant had committed material misrepresentations, and sought a stay of the LAT proceedings until the Superior Court decision was rendered or a preliminary hearing addressing the material misrepresentations. The...

May 14, 2019

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S.M. v. Aviva General Insurance Company (17-008818)

Vice-Chair Helt dismissed the insurer's request for reconsideration. The insurer alleged that the LAT violated the rules of natural justice and procedural fairness and made significant errors of law. The parties had agreed upon a document exchange deadline. The claimant brought a motion following the deadline, requesting an opportunity to file an affidavit. The LAT...

May 14, 2019

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M.K. v. Aviva Insurance Canada (18-001128)

The claimant sought entitlement to the balance of a partially approved psychological assessment. Adjudicator Punyarthi held that the claimant was not entitled to the remaining balance as there was no evidence substantiating the claimant's entitlement. The adjudicator specifically noted that the treatment plan at issue was vague and unparticularized, and there was no justification as...

May 14, 2019

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C.S. v. Certas Home and Auto Insurance (18-003463)

The claimant was injured in an icy parking lot. She was a few feet from her vehicle when she slipped and fell. She applied for accident benefits. The insurer denied coverage on the basis that the incident was not an "accident" under the SABS. Adjudicator Ferguson concluded that the facts of loss were not an...

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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