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 31, 2019

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M.A.A. v. RBC Insurance (18-004989)

The claimant sought entitlement to two treatment plans. Adjudicator Ferguson held that the treatment plans were not reasonable and necessary. The claimant's family physician did not support the need for further physical therapy and the IE assessor concluded that the claimant had met maximum medical recovery. The psychological assessment also was not reasonable because the...

July 31, 2019

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H.S. v. Aviva Insurance Canada (17-007384)

The claimant sought removal from the MIG and entitlement to four treatment plans for physical therapy. As a preliminary matter, the insurer sought to admit as evidence two addendum report authored after the production deadline. Adjudicator Harper refused to admit the addendum reports, reasoning that they could have been obtained much earlier, since the records...

July 31, 2019

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M.B. v. TD Insurance Meloche Monnex (18-010696)

The claimant sought entitlement to NEBs. Adjudicator Lake concluded that the claimant did not meet the "complete inability" test. The claimant argued that his pre-existing cerebral palsy combined with the accident related injuries satisfied the test. Adjudicator Lake held that the claimant continued to engage in most of his pre-accident activities, including driving, sledge hockey,...

July 30, 2019

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A.R. v. Aviva General Insurance (18-000838)

The insurer sought reconsideration of the Tribunal's award psychological treatment and a psychological assessment, and the calculation of interest. Adjudicator Hines dismissed the reconsideration requests for the treatment plan and assessment, concluding that the Tribunal did not make an error in weighing the evidence. Adjudicator Hines granted the reconsideration in terms of interest, holding that...

July 30, 2019

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R.D. v. Aviva Insurance Company (18-000725)

The claimant sought reconsideration of the Tribunal's decision that he was barred from proceeding with his claim due to IE Non-Attendance. He argued that he was unable to attend due to mental and physical disabilities. Vice Chair Trojek dismissed the reconsideration. She found no support for the claimant's position that the Tribunal did not consider...

July 29, 2019

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P.Y. v. Aviva General Insurance Company (17-003692)

The claimant sought reconsideration of the Tribunal's decision that the claimant's injuries fell within the MIG and the denial of three treatment plans. Following the Tribunal's decision, the insurer removed the claimant from the MIG. The claimant argued that this was new evidence that could not have reasonably been obtained earlier. Adjudicator Grieves granted the...

July 25, 2019

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J.Y. v. Aviva Insurance Canada (17-009034)

The claimant sought reconsideration of the Tribunal's decision to dismiss all of his claims. Adjudicator Watt dismissed the reconsideration request. He held that the claimant had failed to provide written submissions to the Tribunal as ordered by the hearing adjudicator; that the surveillance considered by the Tribunal was not improper; that the Tribunal considered the...

July 24, 2019

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D.M. v. Belair Direct Insurance Company (18-005470)

The claimant sought entitlement to over $22,000 for multidisciplinary catastrophic impairment assessments. The insurer had approved a total of $7,000. The claimant disputed entitlement to the remainder. Adjudicator Parish approved entitlement to an executive summary and the cost of the OCF-19, but denied the remainder. She held that the remaining assessments were duplicative of the...

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...

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Contact Us

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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