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.

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July 23, 2018

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Applicant v. RBC General Insurance Company (17-006369)

The claimant sought entitlement to four treatment plans for physical therapy. As a preliminary issue, the claimant sought to exclude the IE reports because the IE assessor did not file the LAT Acknowledgement of Expert Duties and because no section 44 notice was sent to the claimant regarding an addendum report. Adjudicator Helt permitted the...

July 23, 2018

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Applicant v Aviva Insurance Canada (17-003989)

The claimant sought medical benefits for an orthopaedic assessment and interest on the overdue payment of benefits. Adjudicator Watt held that the claimant was not entitled to the cost of the orthopaedic assessment. The claimant had a pre-accident history of fibromyalgia, anxiety disorder, lower back pain, right knee osteoarthritis, and was considered substantially disabled. Adjudicator...

July 20, 2018

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Applicant v. Aviva Insurance Canada (17-008093)

The claimant sought removal from the MIG and entitlement to various medical benefits. Adjudicator Ferguson concluded that the claimant suffered predominantly minor injuries. The medical records showed the claimant suffered soft tissue injuries. Though medical imaging two years after the accident showed a tear in the shoulder, no evidence connected the tear to the accident....

July 20, 2018

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N.M. v. Western Assurance Company (17-009102)

The insurer denied entitlement to accident benefits based on the facts of loss. The claimant had parked her vehicle at a mechanic's garage in order to have a emissions test performed. She pulled into the service bay, turned offer her engine, left the keys in the vehicle and exited her vehicle. She then spoke with...

July 20, 2018

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Applicant v. Unifund Assurance Company (17-006581)

The claimant sought removal from the MIG, entitlement to attendant care benefits, and various medical benefits. Adjudicator Reilly concluded that the claimant's injuries were predominantly minor. She held that there was no evidence that pre-existing high blood pressure would prevent maximal recovery under the MIG; that the claimant did not suffer a psychological disorder; that...

July 20, 2018

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Applicant v RBC Insurance Company (17-005000)

The claimant argued that her injuries fell outside the MIG and sought medical benefits and the costs of examinations. Adjudicator Lake held that the claimant's injuries fell within the MIG. The adjudicator concluded that there was insufficient documentary evidence, supporting reasons, or analysis to establish that the claimant had cervical radiculopathy. The claimant relied on...

July 20, 2018

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Applicant v. Unica Insurance Inc. (17-007052)

The claimant sought a declaration that she sustained a catastrophic impairment, and sought entitlement to ACBs and medical benefits. The insurer denied all of the claims and argued that the claim for ACBs was time barred. Adjudicator Ferguson held that the claimant did not suffer a catastrophic impairment. He preferred the evidence of the IE...

July 19, 2018

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Applicant v. Aviva Insurance Canada (17-006787)

The claimant sought removal from the MIG and various medical benefits. Adjudicator Parish concluded that the claimant's injuries fell within the MIG. The claimant's injuries were clinically associated sequela to the soft tissue injuries she sustained in the accident. Adjudicator Parish preferred the opinion of the IE assessor, who believed that the claimant's soft tissue...

July 19, 2018

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K.T. v. Aviva General Insurance (17-007027)

The claimant sought entitlement to attendant care benefits beyond the termination date despite no amounts being incurred. The claimant asked that the LAT deem the expenses incurred. Adjudicator Mazerolle concluded that he could not deem the expenses incurred. He held that the insurer's termination of attendant care benefits was not unreasonable and that the IE...

July 18, 2018

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Applicant v. Aviva Insurance (17-005631)

The claimant sought entitlement to a chronic pain assessment and assistive devices. Adjudicator Kepman found the claimant credible and granted the chronic pain assessment based on ongoing wrist pain years after the accident. The insurer had paid part of the claims for assistive devices, but denied the remainder based on the cost. Adjudicator Kepman concluded...

July 18, 2018

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Applicant v. Aviva Insurance Canada (17-006159)

The claimant sought removal from the MIG and entitlement to five treatment plans. Adjudicator Boyce concluded that the claimant's injuries were minor. Adjudicator Boyce held that the claimant failed to provide evidence of chronic pain and that pain lasting more than six months was not sufficient proof for removal from the MIG. He also held...

July 18, 2018

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Applicant v. Aviva Insurance Canada (17-006157)

The claimant sought removal from the MIG and entitlement to five treatment plans. Adjudicator Boyce concluded that the claimant's injuries were minor. Adjudicator Boyce held that the claimant failed to provide evidence of chronic pain and that pain lasting more than six months was not sufficient proof for removal from the MIG. He also held...

July 18, 2018

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C.M. v. Aviva General Insurance (17-005910)

The claimant sought entitlement to an additional seven months of IRBs and entitlement to a special award for IRBs that were paid at a lower rate than mandated by the SABS. Adjudicator Grant concluded that no further IRBs were payable for the disputed period because the medical evidence did not suggest an inability to continue...

July 18, 2018

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Applicant v. Aviva Insurance Canada (17-007959)

The claimant sought entitlement to IRBs and the cost of a chronic pain assessment. Adjudicator Watt dismissed both claims. Regarding IRBs, he held that the claimant was able to work. None of the claimant's own physicians said that the claimant was unable to work, and the IE assessors made the same conclusions. Regarding the chronic...

July 17, 2018

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Applicant v. Pembridge Insurance Company (17-005315)

The claimant sought removal from the MIG and entitlement to chronic pain treatment. Adjudicator Grant dismissed the claims. He accepted the opinions of the IE assessors that the claimant had normal physical functional limits and that no diagnosable psychological condition was demonstrated.

July 17, 2018

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Applicant v. The Guarantee Company of North America (17-005360)

The claimant sought entitlement to NEBs. Adjudicator Watt dismissed the claim. He noted that the claimant was still able to be active in most of her pre-accident activities, and that she had recovered by at least 50 percent. Although the claimant suffered pain, the pain was insufficient on its own to meet the "complete inability"...

July 17, 2018

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Applicant v. Wawanesa Mutual Insurance Company (17-005887)

The claimant (who was represented by a litigation guardian due to pre-existing mental disability) sought entitlement to six treatment plans for physical therapy. Adjudicator Watt concluded that the therapy was not reasonable and necessary. The claimant had been receiving similar treatment for four years and there was no evidence that further treatment of a chiropractic...

July 17, 2018

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Applicant v State Farm Mutual Automobile Insurance Company (17-008613)

The applicant sought payment for IRBs. The respondent argued that the applicant's claim was time-barred. The applicant submitted an OCF-1 in February 2012. State Farm denied the claim on March 8, 2012. The applicant submitted an OCF-3 in January 2017 after exhausting collateral benefits. State Farm denied the claim and requested additional financial documentation, but...

July 16, 2018

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Applicant v. Aviva Insurance Company (17-006910)

The claimant sought a death benefit in relation to the death of her adult child. Adjudicator Norris concluded that the deceased was principally dependent for care on the claimant due to mental disability and diabetes. The claimant was the principal provider of social and emotional support for the deceased and regularly spoke to the deceased...

July 16, 2018

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Applicant v. Guarantee Company of North America (17-006956)

The claimant sought entitlement to NEBs and funding for catastrophic impairment assessments. The insurer argued that the limitation period barred the claim for NEBs, and that the claimed catastrophic impairment assessments were not reasonable and necessary. Adjudicator Flude agreed with the insurer. He held that the claim for NEBs was barred by the limitation period...

July 16, 2018

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Applicant v. Desjardins General Insurance Group (17-005974)

The claimant sought entitlement to seven treatment plans and a special award. Adjudicator Purdy granted all the claims. She concluded that the medical evidence showed a compression fracture was directly caused by the accident, and that the proposed treatment was appropriate for addressing the injury. She was critical of the IE assessor focusing on standard...

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Contact Us

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

416.507.1850

smilne@tgplawyers.com

© 2020 Thomas Gold Pettingill LLP