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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June 27, 2017

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Applicant v. Cumis General Insurance Company (16-003144)

The claimant sought a catastrophic designation. The insurer requested five IEs. The claimant agreed to attend three, and did not attend two because she felt the remaining assessments were excessive and unreasonable. On the basis of refusing to attend the remaining IEs, the insurer designated the applicant non-CAT. The claimant filed an application for arbitration....

June 22, 2017

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Y.D. v. Aviva Insurance (16-001810)

The claimant sought entitlement to attendant care benefits provided by her husband (a fertility physician) and the cost of an in-home assessment. The insurer denied that the claimant had "incurred" any attendant care services and further denied that any attendant care services were reasonable and necessary beyond June 2016. The claimant responded that the insurer...

June 21, 2017

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Y.C. v. State Farm Mutual Automobile Insurance Company (16-004494)

The insurer sought to exclude a medical report tendered on behalf of the claimant. The insurer asserted the submission was in contravention of a deadline imposed by a case conference adjudicator. The claimant sought to have the report included and argued procedural fairness. Vice Chair Terry Hunter concluded to allow the report as is would...

June 20, 2017

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V.H.T. v. Certas Home and Auto Insurance Company (16-000874)

The claimant sought entitlement to IRBs and further medical benefits. A preliminary motion was first heard to address the admissibility of late documents. Adjudicator Sapin held that the late documents were admissible, that the insurer had sufficient time to review the new documents, and that the insurer should have requested an adjournment if it believed...

June 20, 2017

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K.L. v. Aviva Insurance Company of Canada (16-002397)

The claimant sought removal from the MIG and entitlement to five treatment plans based on a spinal compression fracture identified two years after the accident. The insurer argued that the claimant had not proven that the compression fracture was related to the accident. Adjudicator Shapiro agreed with the insurer and concluded that the claimant had...

June 20, 2017

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Applicant v. The Guarantee Company of Canada (16-001348)

The claimant originally sought attendant care benefits on an ongoing basis. The initial adjudicator's decision only addressed attendant care benefits up to the date of the hearing and held that the claimant was nominally entitled to $666.23 per month, but that no attendant care services had been incurred. The claimant sought reconsideration of that decision...

June 20, 2017

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Applicant v. Echelon (16-003223)

The claimant was involved in a serious accident in which his daughter was fatally injured. The claimant was deemed to have sustained a catastrophic impairment. The claimant sought entitlement to occupational therapy assistance. The insurer denied the treatment plan and stated there was no rehabilitative goal of consuming the treatment. On review of the medical...

June 20, 2017

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Applicant v. Echelon (16-003221)

The claimant had suffered a catastrophic impairment in the accident and sought entitlement to rehabilitation benefits from an OT. The insurer denied the services on the basis of IEs that had concluded that the claimant had recovered from a physical perspective. Adjudicator Mather awarded the claimed benefits, and held that the claimant continued to suffer...

June 20, 2017

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Applicant v. Aviva Insurance Company of Canada (16-004144)

This motion concerned the appointment of a litigation guardian. The claimant's counsel wrote to the LAT stating that the claimant did not have capacity, and was impecunious and unable to afford the cost of proceeding with a guardianship application. The LAT Rules did not provide a process for appointing a guardian. Vice Chair Hunter held...

June 20, 2017

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Applicant v. Aviva Insurance Canada (16-001031)

This is a reconsideration in which the insurer sought to have the LAT overturn the award of various treatment plans. The insurer also argued that the claimant had submitted documents too late, and should not have been considered by the adjudicator. Executive Chair Lamoureux held that there was sufficient evidence for the adjudicator to conclude...

June 19, 2017

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Liu v. The Co-operators General Insurance Company (2017 ONSC 3599)

The claimant sought judicial review of Adjudicator Sewrattan's decision that his injuries were "minor injuries." The Divisional Court held that the standard of review was reasonableness, and concluded that the adjudicator's decision fell within the range of reasonableness. The appeal was dismissed.

June 19, 2017

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J.X. v. TD Insurance Meloche Monnex (16-003179)

The decision dismissed an LAT application, given a settlement was reached during the hearing

June 16, 2017

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G.S. v. Wawanesa Mutual Insurance Company (16-003963)

The claimant sustained injuries when he was assaulted in a parking lot. During the assault, the claimant managed to get into his car and turn the engine on. The claimant applied for accident benefits. The insurer took the position that the incident was not an "accident" as defined in the SABS. Adjudicator Neilson dismissed the...

June 16, 2017

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D.S. v. TD Insurance Meloche Monnex (16-000131)

The claimant suffered catastrophic injuries while running down a street, and tripping headfirst into a parked vehicle. The insurer argued that the evidence did not support the facts of loss as reported by the claimant, and that even if the facts as reported were true, the claimant was not involved in an "accident" for the...

June 16, 2017

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Applicant v. Gore Mutual Insurance Company (16-001305)

The claimant applied for a CAT determination based on GCS. The insurer denied the determination based on a paper review of a neurologist. Adjudicator Bickley reviewed the medical evidence, which included two ambulance call reports both showing GCS scores of 15. However, during the course of hospitalization, the claimant scored GCS scores of 7, 8,...

June 15, 2017

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L.S. v. Royal & Sun Alliance Insurance Company of Canada (16-002381)

The claimant sought entitlement to a medical treatment plan. In addition to the issues outlined in the Case Conference Order, the claimant also sought a lump sum payment of $35,000.00 for 5 years of future medical treatment. Adjudicator Truong noted that issues not codified by the Case Conference Order were not properly before the Tribunal...

June 13, 2017

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C.M. v. The Co-operators General Insurance Company (16-000793)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to one treatment plan for a psychological assessment. Adjudicator Sewrattan found that the claimant's injuries were predominantly minor and that his entitlement was subject to the MIG. In terms of psychological impairments, the adjudicator found that the diagnosis of mixed...

June 13, 2017

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P.W. v. Aviva Canada Inc. (16-001097)

The claimant sought entitlement to a medical treatment plan. The insurer relied on IE reports and denied the benefit. On review, Adjudicator Norris preferred the evidence of the claimant and determined the treatment plan was reasonable and necessary.

June 12, 2017

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G.P. v. Unifund Assurance Company (16-003165)

The claimant sought payment for various clinic balances for medical treatment. Adjudicator Sewrattan ruled that the claimant failed to submit the treatment plans as evidence and therefore the issue as to whether the treatment was reasonable and necessary was not at issue. The claims were dismissed.

June 12, 2017

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Applicant v. Unifund Assurance Company (16-002818)

The claimant sought entitlement to a number of medical benefits. The insurer asserted a MIG defence. On review of the evidence, Adjudicator Sewrattan determined the claimant's psychological injury was as a result of the accident and not predominantly minor. The psychologically-based treatment plans were found payable, and the physically-based treatment plans were denied as not...

June 12, 2017

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Applicant v. Aviva Insurance Company of Canada (16-001985)

The claimant sought and was successful in obtaining a Tribunal Order for a number of treatment plans. In making the determination, the Tribunal also ordered interest payable at 2 percent per month. On reconsideration, however, Executive Chair Lamoureux noted the Tribunal erred by using the interest provisions of the previous SABS; the correct provision is...

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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