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.

April 25, 2019

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F.D. v. Allstate Canada (17-006372)

The claimant sought a determination that she had sustained a catastrophic impairment as a result of the accident. The parties disputed causation with respect to the claimant's impairments. Adjudicator Daoud confirmed that the "but for" test is the proper test for causation in accident benefits cases. Adjudicator Daoud found that "but for" the accident the...

April 24, 2019

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V.R. v . Aviva Insurance Company (18-0028800)

The claimant sought entitlement to passive chiropractic treatment and a chronic pain assessment. Vice Chair Flude found that the proposed treatment and assessment were not reasonable and necessary. Vice Chair Flude found that the medical records supported the IE assessor's opinion that an active exercise program, rather than passive treatment, was required.

April 24, 2019

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B.E. v. Aviva General Insurance Company (18-005760)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to a various medical benefits. Vice Chair Kershaw found that the claimant established that she had a psychological injury and chronic pain injuries, and was therefore not subject to the $3500 MIG limit. Based on these findings, the adjudicator concluded...

April 23, 2019

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P.M. v. ACE INA Insurance Company (18-002377)

The claimant sought reconsideration of the Tribunal's decision which declined to remove the insurer's counsel of record. The claimant argued that because the firm representing the insurer had also represented one of the defendants in the earlier tort action, a conflict existed. Vice Chair Helt concluded that the Tribunal did not make an error and...

April 18, 2019

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The Applicant by his Guardian, K. R. v. Unifund Assurance Company (18-001975)

The claimant was catastrophically impaired in a motor vehicle accident in August 2017, and remained in a coma until the date of his death on September 11, 2018. The claimant claimed for legal fees incurred in obtaining a guardianship order, arguing that the legal fees were a rehabilitative benefit. The respondent argued that the legal...

April 18, 2019

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S.M. v. Certas Direct Insurance Company (18-000426 and 18-000423)

The claimant requested reconsideration of a Motion Order, in which Vice Chair Hunter granted the respondent's motion to adjourn a written hearing scheduled for December 2018. The claimant submitted that reconsideration was warranted because the Tribunal erred in granting an adjournment in respect of the addition of treatment plans when none were in issue, the...

April 18, 2019

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H.A. v. Intact Insurance Company (18-002501)

The claimant, an Uber driver, was assaulted while waiting in his car to pick up passengers. The claimant sustained injuries as a result of the attack, and applied for accident benefits. The insurer denied coverage on the basis that the incident was not an "accident" under the SABS. Adjudicator Johal agreed. He concluded that the...

April 5, 2019

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P.Z. v. Unifund Claims Inc. (18-004786)

The claimant brought a motion for the production of log notes; the insurer brought a motion for productions of various clinical notes and records. Adjudicator Hines granted both motions. She ordered the log notes up to the date of the IRB denial to be produced subject to redactions for litigation privilege and solicitor-client privilege. She...

April 4, 2019

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A.A. v. Aviva Insurance Company (17-008472 and 17-004680)

The claimant sought reconsideration of the Tribunal's denial of the cost of a chronic pain assessment. Vice Chair Trojek concluded that the Tribunal did not make an error in fact such that it would likely have reached a different result had the error not been made. The reconsideration request was dismissed.

April 3, 2019

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C.L. v. Aviva General Insurance (17-004389)

The insurer sought reconsideration of the Tribunal's award of ongoing IRBs based on psychological impairment. Vice Chair Hunter dismissed the reconsideration request. He concluded that the Tribunal provided careful and detailed reasons for its decision, and that there was no basis to interfere with it. He also wrote that the Tribunal correctly found that the...

March 28, 2019

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H.A. v. Travelers Insurance (18-005178)

The claimant sought entitlement to IRBs, removal from the MIG, and three medical benefits. Adjudicator Lake concluded that the claimant had proven entitlement to only three months of IRBs, but that his injuries fell within the MIG. The remainder of the MIG limits was awarded on one of the treatment plans.

March 4, 2019

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L.L. v. Intact Insurance Company (17-003125)

The claimant was injured when a motorist deliberately hit her with the door of his parked car. The motorist then got out of the vehicle and struck the claimant several times. The insurer argued that there were two separate incidents, and that it was not liable to pay for injuries related to the second assault....

February 28, 2019

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Traders General Insurance Company v. Rumball (2019 ONSC 1412)

The insurer appealed the Tribunal's decision that the claimant was not barred by the limitation period from seeking IRBs. The Court held that the appeal to Divisional Court was premature, and that the matter should proceed at the Tribunal regarding the claimant's entitlement to IRBs. If IRBs were awarded, the insurer could then appeal the...

February 27, 2019

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E.K. v. Portage La Prairie Mutual Insurance Company (18-001333)

The claimant sought entitlement to four medical benefits. Adjudicator Ferguson dismissed the claims. He held that the proposed assessments were not reasonable and necessary, and that the proposed treatment was not proven to be related to an accident-related impairment.

February 8, 2019

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Z.A. v. Guarantee Insurance (17-008345)

The claimant sought accident benefits following an injury on a public transit bus. The insurer argued that there was no collision and that the claim was barred by section 268(1.1) of the Insurance Act. Adjudicator Grant concluded that the claimant failed to adduce evidence that there was a collision. No documentation was provided to substantiate...

February 7, 2019

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N.M. v. Aviva General Insurance (17-007986)

The claimant sought entitlement to one medical benefits for physical therapy. Adjudicator Ferguson dismissed the claim. He held that the claimant failed to demonstrate that the claimed benefit was reasonable and necessary.

February 7, 2019

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J.M. v. Certas Home & Auto Insurance Company (18-001153)

The claimant sought entitlement to two medical benefits. The claimant also sought to add a new medical benefits claim as part of a written hearing. Adjudicator Punyarthi permitted the issue to be added, but held that it was not payable because a treatment plan had never been submitted in relation to the incurred treatment. The...

February 7, 2019

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J.V. v. RBC General Insurance Company (17-001981)

The claimant sought entitlement to various medical benefits. Adjudicator John awarded the all of the claimed assessments and treatment. She found that the claimant continued to suffer from chronic pain which affected her activities of daily living. She also suffered psychological injuries that required ongoing treatment. Adjudicator John was not persuaded by surveillance which showed...

February 5, 2019

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G.T. v. The Commonwell Mutual Insurance Group (17-004072)

The claimant sought entitlement to IRBs and two medical benefits. Adjudicator Gosio concluded that the claimant suffered a substantial inability to perform her job as a bartender up to the end of the 104 week period, but she did not meet the "complete inability" test. He accepted that there were other similar employment options available...

February 5, 2019

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S.W. v. Pafco Insurance (17-007716)

The claimant sought IRBs. The insurer argued that the limitation period applied. Adjudicator Ferguson held that the LAT application was made more than two years after the accident, but that the exception at section 7 of the LAT Act should apply. The insurer and the claimant had entered into a settlement agreement of IRBs up...

January 29, 2019

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M.K. v. Wawanesa Mutual Insurance Company (18-001879)

The claimant refused to produce various records sought by the insurer. The insurer brought a motion for production of the records. Adjudicator Ferguson held that all of the requested medical records that were requested by the insurer because they were relevant to the claimant's injuries and his late application for accident benefits. The records showing...

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416.507.1850

eodonnell@tgplawyers.com

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Toronto, Ontario M5H 3S5

416.507.1850

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