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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April 24, 2018

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Applicant v. Aviva Insurance Company (17-003600)

The claimant sought entitlement to medical benefits outside of the MIG and a special award. Adjudicator Victor found that the claimant was outside of the MIG because of the extent of her psychological symptoms, and she was entitled to the cost of a psychological assessment, plus interest. The claimant was not found entitled to a...

April 24, 2018

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P.R. v. Aviva Canada Insurance (16-002782)

The insurer requested reconsideration of the LAT's decision to deny its request for costs, arguing that the claimant's failure to address serious evidentiary issues throughout he proceeding amounted to frivolous and vexatious conduct warranting a costs award. Associate Chair Batty denied the request. While the LAT did not explicitly apply the definitions of frivolous and...

April 23, 2018

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J.B. v Allstate Canada (17-005951)

The claimant sought medical benefits for driver reintegration sessions and psychotherapy sessions, as well as travel expenses. Adjudicator Maedel held that the claimant failed to establish that the benefits sought were reasonable and necessary. Allstate had partially approved the OCF-18 in dispute for eight one-hour weekly driver reintegration sessions and six one-hour psychotherapy sessions, as...

April 23, 2018

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B.A. v Certas Direct Insurance Company (17-004796 and 17-004801)

The claimant was involved in two motor vehicle accidents and appealed Certas' MIG determination for each accident. The claimant also sought medical benefits for physiotherapy for the first accident and chiropractic services for the second accident. Adjudicator Cavdar held that the claimant's injuries for each accident fell within the MIG. The claimant suffered soft-tissue injuries...

April 23, 2018

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Applicant v. Co-Operators Insurance Company (17-006513)

The claimant sought medical benefits outside of the MIG and interest on the overdue payment of benefits. Adjudicator Ferguson held that the claimant's injuries fell within the MIG and dismissed the claimant's application. Adjudicator Ferguson relied on the claimant's self-reporting to conclude that the claimant did not have a credible psychological injury arising from the...

April 23, 2018

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Applicant v. Royal Sun Alliance Insurance (17-001746)

The minor claimant was injured in an accident when he was six years old. He sought entitlement to NEBs after his sixteenth birthday. The insurer terminated NEBs after obtaining IE reports. Adjudicator Ferguson agreed with the insurer that the claimant did not suffer a complete inability to live a normal life. The evidence showed that...

April 23, 2018

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S.L. v. Aviva Insurance Company of Canada (17-004989)

The claimant sought entitlement to three treatment plans, costs of various examinations, and interest on overdue payments. The insurer denied the first two treatment plans as the claimant had not exhausted MIG limits, but had later removed the claimant from the MIG. The insurer denied the third plan for not being reasonable and necessary, as...

April 23, 2018

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Aviva Insurance Canada v. W.T. (17-004341)

The insurer sought repayment of IE costs, the cost of disability certificate, and various investigation costs based on the claimant not being an occupant in the vehicle at the time of the accident. Adjudicator Ferguson held that the claimant was not an occupant of the vehicle based on inconsistencies in reporting, and that he made...

April 20, 2018

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Applicant v. Aviva Insurance (17-005318)

The claimant sought an adjournment of the hearing because the insurer's IE assessor was unavailable. The insurer opposed the adjournment. Adjudicator Makhamra granted the adjournment, reasoning that the claimant was entitled to cross examine the IE assessor as part of her case.

April 20, 2018

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Applicant v. Aviva Insurance Company (17-005081)

The claimant sought entitlement to three treatment plans, and interest on overdue payments. The insurer brought a preliminary issue concerning whether the applicant was precluded from submitting evidence regarding the benefits in dispute; more specifically, the claimant had failed to submit two of the treatment plans to the Tribunal. Adjudicator Go determined that, it was...

April 18, 2018

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Applicant v. CAA Insurance (17-001138)

The Tribunal was asked to determine whether the claimant was barred from proceeding with his appeal of the insurer's denial of medical benefits owing to his failure to attend scheduled examinations, in contravention of section 44. The claimant had sought a determination of catastrophic impairment. The insurer indicated that further IEs were required to make...

April 18, 2018

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Applicant v. Aviva Insurance Canada (17-003597)

The claimant sought entitlement to medical benefits outside of the MIG, costs of a psychological examination, a special award, and interest. On the basis of the evidence presented by both parties, Adjudicator Hans held that the claimant's injuries fell within the MIG. The claimant also failed to prove that an earlier motor vehicle accidents and...

April 13, 2018

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M.S. v. Unifund Assurance Company (17-003419)

A preliminary issue hearing was held to determine whether the claimant was precluded from proceeding with a claim for income replacement benefits for her failure to dispute the denial of the benefit within the two year limitation period. The claimant argued that the limitation period did not run from the date of the insurer's purported...

April 13, 2018

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Applicant v. RBC Insurance (17-005761)

The claimant sought entitlement to treatment outside of the MIG, various medical benefits, and a special award. The claimant argued that her psychological impairments took her outside of the MIG. Adjudicator Ferguson weighed the medical evidence and determined that the claimant did not suffer a psychological injury that would warrant removal from the MIG. As...

April 13, 2018

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Valerio v. Security National (2018 ONSC 2395)

The claimant sought judicial review of the LAT's decision that his injuries fell within the MIG, and that two treatment plans were not payable. The Court upheld the Tribunal's decision, concluding that it fell within the range of possible acceptable outcomes, and was therefore reasonable. The Court also held that the Tribunal's decision regarding the...

April 10, 2018

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Applicant v. Economical Mutual Insurance Company (17-004358)

The claimant sought entitlement to NEBs, ACBs, and medical benefits. The insurer argued that the claimant failed to attend IEs; the claimant responded that the IEs were not reasonably required and several were requested after the LAT application. Adjudicator Mazerolle agreed with the insurer. He held that the IE notices provided the medical reason for...

April 10, 2018

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Applicant v. Certas Home and Auto Insurance Company (17-005145)

The claimant disputed his MIG status; entitlement to a medical benefit for physiotherapy treatment; and interest on overdue payment of benefits. Adjudicator Norris rejected that the claimant suffered a psychological injury as a result of the accident, finding that the evidence of psychological injury relied upon by the claimant was inconsistent with the entire rest...

April 6, 2018

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J.T. v RBC Insurance (17-005328)

The claimant sought entitlement to NEBs and interest. The insurer relied on the opinions of two IE assessors when concluding that the claimant did not qualify for NEBs. The claimant argued that the denial was invalid, as the assessors did not have an opportunity to review the claimant's disability certificate. Adjudicator Watt disagreed with the...

April 6, 2018

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J.B. v. Coseco Insurance Company (17-005803)

The claimant sought removal from the MIG and entitlement to medical benefits. Adjudicator Ferguson held that the claimant suffered minor injuries and was restricted to MIG level benefits. He concluded that the claimant's rheumatoid arthritis was not caused by the accident, but was instead an unrelated degenerative disease. He also rejected the position that the...

April 6, 2018

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Applicant v. Aviva General (17-005134)

The claimant disputed his MIG status and entitlement to medical benefits for payment of chiropractic treatment. Adjudicator Driesel denied all of the claims. The claimant failed to provide compelling medical evidence to establish that maximal medical recovery could not be reached within the MIG limit. He sustained sprain and strain injuries as a result of...

April 5, 2018

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M.B. v. Travelers (17-003671)

The claimant sought removal from the MIG and entitlement to psychological and physical assessments and treatment. The claimant had a pre-accident medical history relevant for depression and anxiety stemming from infertility issues. Adjudicator Hines concluded that based on the medical records and the evidence of the s. 44 and s. 25 assessors, the claimant’s pre-existing...

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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