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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February 21, 2017

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S.L. v. Pembridge Insurance Company (16-000393)

The claimant sought entitlement to medical treatment plans. The claimant asserted a chronic pain diagnosis to justify the treatment plans. The insurer asserted that the chronic pain diagnosis was as a result of a pre-existing injury and not the MVA. Adjudicator Derek Grant ruled that although "but for" is the default test for causation, "material...

February 14, 2017

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M.M. v. Northbridge Personal Insurance Corporation (16-000682)

The claimant sought entitlement to ongoing IRBs. Adjudicator Sewrattan applied a three-part test: (1) Was the claimant employed at the time of the accident, (2) Causation; did the claimant sustain an impairment preventing him/her from returning to work, and (3) Does the claimant suffer a substantial inability to perform the essential tasks of his/her employment,...

February 13, 2017

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T.D. v. The Dominion of Canada General Insurance Company (16-002640)

The claimant sought to combine the hearing of his case with the hearing of another applicant's claim, as both claims arose from the same accident. The insurer opposed combining the files. Adjudicator Trojek denied the request to combine the hearings, reasoning that the claims dealt with two different claims by two difference people. Each claim...

February 13, 2017

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M.Y.Y. v. Dominion of Canada General Insurance Company (16-002636)

The accident involved two people, each with claims. The insurer requested that the matter be combined. The claimants did not consent. The two hearings shared only one common witness. Vice Chair Trojek denied the request for the combination of hearings. Under Rule 20.5 Vice Chair Trojek did not find any value in terms of "fairness,...

February 13, 2017

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L.Y.C. v. The Co-operators General Insurance Company (16-000881)

The claimant did not attend the hearing. Accordingly, the claims were dismissed.

February 13, 2017

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L.C. v. Aviva Insurance Company of Canada (16-001387)

The claimant sought removal from the MIG and entitlement to a series of treatment plans.Â Adjudicator Flude concluded that the applicant had suffered a predominantly minor injury. A post-accident MRI identified degenerative changes and nerve root compression. The applicant argued that the condition was pre-existing and entitled him to removal from the MIG. Adjudicator Flude...

February 13, 2017

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G.P. v. Northbridge Personal Insurance Company (16-001066)

The LAT was asked to consider the effect of a WSIAT decision finding that the applicant could pursue a claim under the WSIA. The applicant filed at LAT and argued that the insurer had to pay benefits notwithstanding the WSIAT decision, arguing that he had made an election to receive accident benefits. Adjudicator Grant held...

February 13, 2017

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G.P. v. Aviva Insurance Company of Canada (16-000726)

This preliminary motion addressed when the limitation clock began in relation to IRBs which were stopped in 2006, based on the timelines set out in the Pre-Approved Framework. The claimant subsequently notified the insurer that she was totally disabled from work in 2015. The insurer denied that request for IRBs. The insurer argued that the...

February 9, 2017

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Applicant v. Aviva Insurance Canada (16-000098)

This was a reconsideration request by the insurer following a decision that the claimant sustained psychological injuries that fell outside of the MIG. Executive Chair Lamoureux held that the adjudicator had weighed all of the evidence and made clear findings. There was therefore no basis to overturn the initial decision.

February 7, 2017

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A.W. v. Cooperators General Insurance Company (16-000283)

The claimant sought entitlement to non-earner benefits as well as a number of treatment plans. The insurer took a MIG position and also noted that the initial OCF-3 did not support an NEB claim. Although a subsequent disability certificate was submitted supporting NEBs, no further medical evidence was provided. On review, Adjudicator Pay concluded that...

February 6, 2017

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H.C. v. Certas Direct Insurance Company (16-001285)

The claimant sought entitlement to income replacement benefits along with two treatment plans, costs, and a special award. Adjudicator Bass reviewed the medical evidence, along with surveillance submitted by the insurer. It was found that the claimant's reports were "overly pessimistic in light of the surveillance evidence from only a few months later." As a...

February 3, 2017

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K.T. v. Allstate Insurance Company of Canada (16-000151)

The claimant was a pedestrian knockdown in Ontario. She applied for and received accident benefits, including IRBs, under Quebec's Quebec Societe de l'assurance automobile. Her IRBs were terminated 11 months post-accident and she did not appeal the decision. She then applied for IRBs in Ontario. The insurer paid IRBs and terminated benefits up to and...

February 3, 2017

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Applicant v. TD Home and Auto Insurance Company (16-000929)

The claimant sought entitlement to income replacement benefits. Adjudicator Sewrattan stated that a claim must be broken into three steps: (i) was the claimant employed at the date of loss, (ii) causation [do the injuries suffered prevent working within the first 104 weeks], and (iii) does the claimant suffer a substantial inability to perform the...

February 2, 2017

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J.S. v. RBC Insurance Company (16-000576)

The claimant sought entitlement to eight treatment plans. The insurer maintained a MIG position. Adjudicator Makhamra found the claimant failed to meet the burden of proof to warrant removal from the MIG. The claimant holds the onus to prove removal from the MIG is justified. In doing so, Adjudicator Makhamra distilled the analysis to three...

February 1, 2017

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Applicant v. Aviva (16-001144)

The claimant sought entitlement to income replacement benefits and an orthopaedic assessment. The insurer paid IRBs for four months and terminated them after a number of IE reports. The orthopaedic assessment was denied based on a MIG position. As a preliminary issue, the insurer sought to add the claimant's LinkedIn page to show the claimant...

January 31, 2017

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J.V. v. Wawanesa Mutual Insurance Company (16-000722)

The claimant sought an order for IRBs in the amount of $280 per week. Adjudicator An concluded that the claimant suffered a substantial inability to engage in the essential tasks of her employment up to the date of her return to work.

January 31, 2017

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J.M. v. Wawanesa Mutual Insurance Company (16-000258)

This decision addressed procedural issues in the awarding of a neurocognitive assessment. Adjudicator Sewrattan wrote that an assessment requested by the claimant was reasonable for the purpose of determining causation in relation to a catastrophic impairment claim. In terms of LAT process, the adjudicator held that both the parties had exceeded the 10 page limit...

January 30, 2017

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S.C.W.H. v. The Dominion of Canada General Insurance Company (16-000677)

The claimant sought entitlement to two chiropractic treatment plans and removal from the MIG. Adjudicator Makhamra concluded the claimant's injuries fell within the MIG and therefore the treatment plans were not payable. The claimant did not submit medical evidence in support of the non-MIG injuries. It was noted that the pre-existing medical condition to warrant...

January 30, 2017

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M.M.S. v. Wawanesa Mutual Insurance Company (16-000435)

The claimant sought costs in the amount of $1,000 for the insurer's failure to produce documents in accordance with the Case Conference Order. Adjudicator Lester awarded costs of $250, reasoning that the insurer had been disrespectful of the Tribunal's process.

January 30, 2017

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F.V. v. Wawanesa Mutual Insurance Company (16-001811)

The claimant had sustained a catastrophic impairment and sought entitlement to rehabilitation benefits funding a trip to Florida and Disney World. Adjudicator Lester held that the proposed treatment did not fall within the scope of activities set out in section 16 of the SABS, and dismissed the claim.

January 30, 2017

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B.F. v. Wawanesa Mutual Insurance Company (16-000433)

The claimant sought costs in the amount of $1,000 for the insurer's failure to produce documents in accordance with the Case Conference Order. Adjudicator Lester awarded costs of $250, reasoning that the insurer had been disrespectful of the Tribunal's process.

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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