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.

May 8, 2019

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M.F.X. v. Certas Home and Auto Insurance Company (18-004282)

The claimant argued that he suffered a non-minor injury due to chronic pain and sought entitlement to further chiropractic treatment. Adjudicator Norris rejected the claims. He reviewed the six factors outlined by the American Medical Association Guides in determining whether the claimant suffered chronic pain syndrome. The claimant failed to submit evidence regarding any of...

May 8, 2019

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L.M. v. Certas Home and Auto Insurance Company (18-002240)

The claimant was involved in an accident in California and sought accident benefits from his father's policy. The insurer argued that the claimant was not an "insured person" because he was not a dependent of his father. Adjudicator Punyarthi agreed with the insurer. There was insufficient financial evidence provided by the claimant to determine whether...

May 7, 2019

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L.F. v. Allstate Insurance Company of Canada (18-004517)

The claimant sought removal from the MIG and entitlement to various medical benefits. Adjudicator Fricot concluded that the claimant sustained a predominantly minor injury, and that there was no exacerbation of pre-accident injuries. Adjudicator Fricot noted that the claimant returned to work on a full time basis after the accident, and that reports of pain...

May 7, 2019

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S.C. v. Aviva Insurance Canada (18-007005)

The claimant sought a request for reconsideration following a denied request to adjourn a hearing on consent. The Tribunal initially denied the adjournment request because there was no evidentiary basis to support the request. Associate Chair Batty granted the reconsideration request because the claimant submitted information that demonstrated compelling personal reasons why counsel could not...

May 7, 2019

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L.S. v. Guarantee Insurance (18-004105)

The claimant brought a motion to exclude the transcripts from the criminal proceeding. Adjudicator Maedel dismissed the motion, holding that admissibility of evidence was to be left to the hearing adjudicator subject to relevance, privilege, or inadmissibility.

May 6, 2019

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J.V. v. Economical Insurance Company (18-001145)

The claimant sought reconsideration of the adjudicator's preliminary decision that IRBs and ACBs were statute barred and would not be addressed in the hearing. It was clear from review of the adjudicator's decision that ACBs were not meant to be statute-barred, and the typographical error in the decision was amended pursuant to Rule 19. The...

May 3, 2019

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J.D.S. v. Aviva Insurance Canada (18-002529)

The claimant sought entitlement to a speech language pathology assessment. He failed to attend an IE scheduled by the insurer; the insurer argued that the claimant was barred from applying to the LAT in accordance with section 55. Adjudicator Johal agreed with the insurer and concluded that section 55 applied. The IE notice provided the...

May 1, 2019

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L.V.D. v. Aviva Insurance Company of Canada (18-001286)

The claimant sought entitlement to three treatment plans and removal from the MIG. Adjudicator Mazerolle concluded that the claimant suffered a minor injury, and was not entitled to further medical benefits. He noted that the claimant had returned to pre-accident activities, and did not suffer from chronic pain or psychological impairment.

May 1, 2019

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E.D. v. Aviva General Insurance Company (18-002597)

The claimant sought entitlement to the remainder of a partially approved treatment plan for physical therapy and gym equipment, and a special award. Adjudicator Lake awarded the remainder of the treatment plan, but declined to grant a special award. She held that the proposed treatment was reasonable for pain reduction, increase in strength and range...

April 30, 2019

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V.D. v. Aviva Insurance Canada (18-007435)

This is a preliminary issue decision addressing the following issues: 1) whether the claimant was statute barred from applying to the LAT for non-earner benefits for failure to attend a s. 44 OT assessment, and 2) whether the claimant was barred from proceeding with her claim for payment of a psychological assessment. Adjudicator Ferguson held...

April 30, 2019

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R.T. v. The Economical Group (17-008069)

The claimant was catastrophically impaired as a result of an accident and sought a determination that she was entitled to receive home modifications and home devices in the amount of $415,334.00. The insurer agree that home renovations were required but disputed the scope and quantum of the proposed benefits. Adjudicator Grieves found that the proposed...

April 29, 2019

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V.K. v. Unica Insurance Inc. (18-007227)

This is a preliminary issue decision on whether the cost of assessments to determine catastrophic impairment falls within the $50,000.00 limit on medical and rehabilitation benefits. Adjudicator Ferguson concurred with previous decisions that CAT assessments are not a benefit, and found that the insurer is obliged to pay the full cost of CAT assessments subject...

April 29, 2019

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D.S. v. The Personal Insurance Company (18-001204)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to a s. 25 psychology assessment. The insurer raised the preliminary issue of whether the claimant was statute barred from applying to the LAT for the psychology assessment because he failed to attend a s. 44 examination. The claimant was...

April 26, 2019

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D.0. v. Primmum Insurance Company (18-001673)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to two treatment plans for physiotherapy. The claimant submitted that the he developed chronic pain as a result of the accident. In support of his position, he relied on three OCF-3s, a s. 25 chronic pain report, and family doctor...

April 26, 2019

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H.K. v. The Commonwealth Mutual Insurance Group (18-005647)

The claimant sought production of log notes from the date of the first FSCO arbitration application up to the date of the LAT application. The insurer argued that these notes were protected by privilege. Adjudicator Fricot concluded that the log notes between the date of the FSCO arbitration application up to the date of the...

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...

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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