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.

December 10, 2018

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M.K. v. Certas Direct (17-008725)

The claimant sought removal from the MIG and entitlement to two treatment plans. Adjudicator Mather dismissed the claim. She held that the claimant suffered predominantly minor injuries, and that the claimant failed to prove that she suffered chronic pain or psychological injuries.

December 10, 2018

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Applicant v. The Guarantee Company of North America (18-002753)

The claimant sought the raw test data from the insurer's psychologist. The request was denied during the Case Conference. On reconsideration, Vice Chair Marzinotto also dismissed the request. She wrote that the claimant failed to provide any basis for reconsideration, and there were no supporting facts for the reconsideration.

December 7, 2018

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D.B. v. Wawanesa Mutual Insurance Company (18-000506)

The claimant sought removal from the MIG and entitlement to five medical benefits. Adjudicator Mather concluded that the claimant suffered minor injuries. There was no evidence of psychological impairment, and the claimant's self-reports of pain did not substantiate a diagnosis of chronic pain syndrome. There was also no evidence of pre-existing conditions.

December 7, 2018

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L.H. v. Aviva Insurance Company of Canada (17-008904)

The claimant failed to make written submissions. The insurer sought the dismissal of the application and costs. Adjudicator Norris concluded that the matter should be dismissed due to the claimant's default. He also awarded costs of $125 because the claimant's behaviour was unreasonable and frivolous (she had failed to comply with the Case Conference Order...

December 6, 2018

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Aviva Insurance Canada v. R.R. (16-004445)

The insurer sought repayment of $9,673.38 in IRBs and accountant fees of $2,353.93. Adjudicator Ferguson concluded there was an overpayment of IRBs because the claimant had misrepresented his pre-accident income and that the insurer's payment of IRBs was therefore made in error. He held that he had no jurisdiction to order the claimant to reimburse...

December 6, 2018

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Applicant v. Aviva Insurance Canada (17-008304)

The claimant sought entitlement to a chronic pain program and a special award. Adjudicator Maleki-Yazdi found the chronic pain program reasonable and necessary. She preferred the evidence of the claimant's treatment providers and noted that the insurer had not put forward evidence from appropriate experts. A special award was not granted because the claimant failed...

December 5, 2018

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V.D. v. United Assurance Canada (17-005656)

The claimant sought entitlement to medical benefits proposed in treatment plans for chronic pain treatment and assistive devices (a self-propelled lawnmower and snow blower). The claimant had a pre-existing health history that included two back surgeries, and causation was an issue when determining whether the proposed benefits were reasonable and necessary as a result of...

December 5, 2018

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J.W.C. v. Certas Direct Insurance Company (17-007593)

The claimant was involved in an accident in British Columbia. He sought accident benefits through a policy held by his sister, argued that he was financially dependent upon her. Adjudicator Ferguson held that the claimant failed to provide evidence supporting financial dependency. The claimant was married, had a daughter, and worked in various jobs in...

December 5, 2018

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F.A. v. Belairdirect Insurance Company (17-007534)

The claimant sought entitlement to five proposed assessments. Adjudicator Norris concluded that the proposed impairment assessment and chronic pain assessment was reasonable and necessary. The psychological, orthopaedic, and physiatry assessments were not awarded.

December 5, 2018

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O.M. v. Aviva Insurance Company of Canada (18-001929)

The claimant applied for accident benefits after suffering injury on a city bus. The insurer denied that he was entitled to accident benefits because there was no collision; rather, the claimant fell when the bus driver accelerated. The claimant suffered from various disabilities prior to the accident and sought a seat in the priority seating...

December 4, 2018

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R.M. v. Unica Insurance Inc. (17-007500)

The claimant exhausted his medical benefits coverage and sought payment of catastrophic impairment assessment outside of the medical benefits limits. He sought a total of $9,718. The insurer argued that it was not required to pay for assessments outside of the medical limits, and in the alternative, that one of the proposed assessments was not...

December 4, 2018

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P.J. v. Aviva Insurance Company (18-001418)

The insurer sought reconsideration of the order that it produce unredacted log notes and that the claimant was not required to provide the particular of the special award claim until after receipt of the log notes. Vice Chair Trojek held that the insurer was to provide the log notes up to the date the LAT...

December 3, 2018

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S.M. v. Certas Home and Auto Insurance Company

The claimant sought entitlement to medical benefits and removal from the MIG. The insurer argued that one of the treatment plans was barred by the limitation period, and should be dismissed. Adjudicator Norris agreed that one of the treatment plans could not be disputed because it was dispute more than two years after the denial....

November 30, 2018

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D.T. v. Aviva General Insurance (17-004698)

The claimant sought entitlement to two treatment plans for physical therapy. Adjudicator Norris awarded the treatment plan for chiropractic services but denied the treatment plan for physiotherapy services. He held that the chiropractic services made the claimant more functional. The claimant failed to provide evidence that physiotherapy was needed.

November 28, 2018

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Applicant v. The Dominion of Canada General Insurance Company (17-006860)

The claimant sought entitlement to NEBs and various medical benefits. Adjudicator Kepman denied all claims. She held that the claimant's post-accident presentation was largely the same as the pre-accident presentation, and that he was receiving disability support payments prior to the accident due to significant impairments and disabilities. The claimant's wife assisted with most activities...

November 27, 2018

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A. AH. v. Royal Sun Alliance Insurance (17-006850)

The claimant sought entitlement to the cost of various prescription medications. Adjudicator Letourneau found that some of the prescriptions in dispute were reasonable and necessary as a result of the accident.

November 27, 2018

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K.B. v. Echelon General Insurance Company (18-000655)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to benefits proposed in two treatment plans. Adjudicator Sewrattan found that the claimant's injuries fell outside of the MIG due to a diagnosis of accident-related concussion and post-concussion symptoms. The claimant was found entitled to the in-dispute driving rehabilitation and...

November 20, 2018

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K.H. v. Unifund Insurance Company (17-007586)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to benefits proposed in three treatment plans. Adjudicator Ferguson found that the claimant's injuries fell within the MIG and that the treatment plans in dispute were not payable as the MIG limits had been exhausted.

November 16, 2018

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H.S. v. Allstate Insurance Company (17-007264)

The claimant was in an accident in August 2016. She argued that the pre-June 1, 2016 definition of catastrophic impairment should apply to her claim because her policy had not renewed. Adjudicator Neilson disagreed with the claimant and held that section 2 of the SABS unambiguously stated that the new catastrophic impairment definition applied to...

November 16, 2018

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H.C. v. Allstate Insurance Company (17-007262)

The claimant was in an accident in August 2016. He argued that the pre-June 1, 2016 definition of catastrophic impairment should apply to his claim because his policy had not renewed. Adjudicator Neilson disagreed with the claimant and held that section 2 of the SABS unambiguously stated that the new catastrophic impairment definition applied to...

November 13, 2018

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Applicant v. Aviva Insurance Canada (17-003957)

The claimant sought entitlement to medical benefits for physical and psychological therapy. Adjudicator Goela awarded all of the claimed benefits. She held that the claimant suffered from chronic pain and psychological injuries. She relied upon the records of the family physician which supported the need for ongoing treatment.

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Contact Us

150 York Street, Suite 1800
Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

© 2020 Thomas Gold Pettingill LLP