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 22, 2019

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A.E. v. Aviva General Insurance Company (18-006132)

The claimant sought removal from the MIG and entitlement to six treatment plans. Adjudicator Grant concluded that the claimant's accident-related injuries were "minor." The claimant's post-accident complaints were similar to pre-accident complaints; the accident caused only soft tissue injuries; and the claimant returned to work and was engaging in her regular activities of daily living.

July 22, 2019

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N.H. v. Coachman Insurance Company (18-006770)

The claimant sought further IRBs; the insurer argued that the claimant failed to attend an IE. Adjudicator Ferguson held that the subject IE was not reasonably necessary to determine the claimant's entitlement to benefits. The IE was scheduled after the Case Conference; the scheduling of the IE would delay the hearing of the merits of...

July 22, 2019

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F.P. v. Aviva Insurance Company of Canada (18-006800)

The claimant sought entitlement to a treatment plan for chiropractic services. Adjudicator Grant dismissed the claim. He noted there was no supporting evidence that the treatment was reasonable and necessary; the claimant had returned to work immediately after the accident and had not missed any time from work; and that the claimant's pre-accident pain complaints...

July 18, 2019

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S.M. v. Federated Insurance Company of Canada (18-004533)

The claimant sought entitlement to $6,000 per month in ACBs from April 2012 onwards, and the cost of two assessments. Adjudicator Lake considered the time period prior to and after the February 1, 2014 changes to the incurred expense definition for non-professional service providers. She held that the claimant failed to prove that her niece...

July 18, 2019

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N.A. v. Aviva General Insurance (18-006048)

The claimant sought entitlement to a TMJ assessment. The insurer argued that the Tribunal had already determined whether the claimant suffered TMJ injuries in the accident during an earlier proceeding. Adjudicator Grant agreed with the insurer that the causation of the claimant's TMJ symptoms had already been addressed by the Tribunal, and that res judicata...

July 18, 2019

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O.T. v. Allstate Insurance Company of Canada (18-006520)

The claimant sought removal from the MIG and entitlement to various treatment plans. Adjudicator Grant preferred the opinions of the insurer's experts and concluded that the claimant suffered a predominantly minor injury.

July 18, 2019

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E.O. v. BelairDirect (18-006718)

The claimant sought removal from the MIG and entitlement to various treatment plans. Adjudicator Grant concluded that the medical records supported that the claimant suffered a predominantly minor injury as a result of the accident. Furthermore, the claimant's family doctor did not support the need for any further treatment.

July 17, 2019

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N.S. v. Coseco Insurance Company (18-002659)

The claimant sought removal from the MIG and entitlement to two treatment plans. Adjudicator Grant concluded that although the claimant suffered serious physical issues, those issues were not caused by the accident. There was no accident-related issue supporting removal from the MIG or the disputed treatment plans.

July 17, 2019

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E.M. v. Aviva Insurance Company (18-004588)

The claimant sought entitlement to a chronic pain assessment. Adjudicator Grant concluded that the assessment was not reasonable and necessary. The claimant had already participated in a chronic pain assessment, and the proposed assessment was duplicative. The claimant's treatment providers were suggesting treatment rather than assessments to focus on her recovery. Finally, the claimant had...

July 17, 2019

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K.T. v. Aviva Insurance Canada (18-003870)

The claimant sought entitlement to NEBs, removal from the MIG, and two medical benefits. Adjudicator Grant concluded that the claimant suffered a predominantly minor injury as a result of the accident, and did not meet the "complete inability" test. The claimant suffered soft tissue injuries in the accident. His post-accident functionality was similar to his...

July 17, 2019

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L.F. v. Aviva Insurance Canada (18-001243)

The claimant sought entitlement to two treatment plans for physical therapy. The insurer argued that it had already approved and paid for the disputed treatment. Adjudicator Grant held that the insurer was not required to pay any further amounts on the treatment plans because the insurer had paid for all invoiced amounts.

July 17, 2019

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A.L. v. Aviva Insurance Canada (18-001867)

The claimant sought entitlement to ACBs, transportation expenses, and interest. Adjudicator Grant concluded that the claimant was entitled to attendant care benefits from February 22, 2016 to August 11, 2017 in diminishing amounts over that period. He found it unreasonable for the attendant care need to increase over time, and rejected the claimant's Form 1s...

July 12, 2019

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L.R. v. RSA Insurance Company of Canada (18-002989)

This preliminary issue addressed the limitation period in the context of a claim for IRBs and ACBs. The insurer denied the benefits more than two years prior to the LAT application. The claimant was found in June 2016 to lack capacity to instruct counsel and to require the assistance of a litigation guardian. Adjudicator Punyarthi...

July 12, 2019

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S.G. v. Aviva Insurance Company (18-002269)

The claimant sought entitlement to four treatment plans for chiropractic services. Adjudicator Parish dismissed all of the claims. She held that further physical therapy was not reasonable and necessary. The claimant made infrequent complaints of back pain, and the complaints he did made were similar to pre-accident complaints

July 10, 2019

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L.Y.L. v. Aviva Insurance Canada (18-004659)

The claimant sought removal from the MIG and entitlement to further physical therapy. Adjudicator Johal concluded that the claimant suffered predominantly "minor" injuries. Her injuries were soft tissue in nature and there was no evidence of neurological disorder. Furthermore, the claimant did not suffer a pre-existing injury that would prevent maximal recovery under the MIG.

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...

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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