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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August 4, 2017

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B.H. v. Belair Direct Insurance (16-002779)

Shortly before the hearing, the insurer accepted that the claimant suffered a catastrophic impairment, and was entitled to IRBs. The only remaining issues were the claimant's entitlement to attendant care benefits, and a special award. In terms of the attendant care claim, the insurer accepted that the claimant was medically entitled to assistance; the dispute...

August 3, 2017

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K.S. v. The Dominion of Canada General Insurance Company (16-002099)

The claimant sought entitlement to attendant care benefits and multiple treatment plans. A preliminary issue was whether late submitted medical records should be excluded from the hearing. Regarding the late records, Adjudicator Treksler admitted the records reasoning that third parties had control over the records and that the claimant could not control the date of...

August 1, 2017

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S.U. v. Wawanesa Mutual Insurance Company (16-003333)

The claimant sought entitlement to medical benefits; the insurer argued that the claimant had not complied with section 33 requests and that the claimed benefits were not reasonable and necessary. Regarding the section 33 argument, Adjudicator Ferguson held that the information requested by the insurer was not "reasonably necessary" to determine entitlement as the insurer...

August 1, 2017

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H.A. v. Aviva General Insurance (16-003279)

The claimant sought entitlement to the form fee and HST associated with an assessment plan. The insurer indicated that the treatment plan was subject to the monetary cap under section 25(5). The claimant asserted the form fee was a separate cost, not subject to the cap. Adjudicator Christopher Ferguson referred to Superintendent's Guideline No. 03/14...

July 31, 2017

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C.J. v. The Personal Insurance Company of Canada (16-002815)

The insurer sought an order for costs given the claimant twice failed to meet the filing deadlines prescribed by the case conference adjudicator. The representative of the claimant indicated that the deadlines were missed due to workload and illness. A doctor's note was produced but did not provide an explanation as to why the claimant's...

July 31, 2017

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C.J. v. The Personal Insurance Company of Canada (16-002815)

The claimant sought entitlement to medical treatment plans. The insurer denied payment and maintained a MIG defense. On review of the evidence, Adjudicator Rebecca Hines determined the claimant did not provide compelling evidence to warrant removal from the MIG. It was also noted the claimant did not consume treatment previously approved. Accordingly, the treatment plans...

July 31, 2017

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Applicant v. Aviva Insurance (16-000218)

This preliminary issue hearing was held to address whether the claimant was involved in an "accident" as defined in the SABS. The claimant (a minor with developmental disabilities) was inadvertently locked on a school bus for two hours, causing the claimant to become anxious and frightened. She applied for accident benefits to treat psychological injuries....

July 31, 2017

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C.J. v. The Personal Insurance Company of Canada (16-002815)

The insurer sought an order for costs given the claimant twice failed to meet the filing deadlines prescribed by the case conference adjudicator. The representative of the claimant indicated that the deadlines were missed due to workload and illness. A doctor's note was produced but did not provide an explanation as to why the claimant's...

July 31, 2017

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C.J. v. The Personal Insurance Company of Canada (16-002815)

The claimant sought entitlement to medical treatment plans. The insurer denied payment and maintained a MIG defense. On review of the evidence, Adjudicator Rebecca Hines determined the claimant did not provide compelling evidence to warrant removal from the MIG. It was also noted the claimant did not consume treatment previously approved. Accordingly, the treatment plans...

July 31, 2017

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C.J. v. The Personal Insurance Company of Canada (16-002815)

The insurer sought an order for costs given the claimant twice failed to meet the filing deadlines prescribed by the case conference adjudicator. The representative of the claimant indicated that the deadlines were missed due to workload and illness. A doctor's note was produced but did not provide an explanation as to why the claimant's...

July 25, 2017

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K.R. v. TD Insurance Company (16-004073)

The claimant sought attendant care benefits up to the 104 week mark. Adjudicator Treksler found that the claimant suffered injuries that entitled her to attendant care of $873.30 per month. The second issue was whether the claimant's attendant care expenses were incurred. For a period of five months, the claimant used a professional service provider...

July 24, 2017

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Applicant v The Personal Insurance Company (16-000653)

The claimant sought entitlement to a treatment plan in which the claimant and her attendant care provider would fly to Iran to visit family. The insurer denied the benefit as not being reasonable as contemplated under section 16. Adjudicator Chris Sewrattan agreed with the insurer. A two-person trip to Iran was considered outside the scope...

July 21, 2017

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O.D. v. Economical Mutual Insurance Company (17-000801)

The claimant brought a motion to combine the insurer's appeal for repayment of income replacement benefits with the claimant's case for IRBs, attendant care, and medical benefits. The insurer resisted the motion as a hearing date and preparation for said date had already been established - to allow the combination would result in a delay....

July 21, 2017

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A.D. v. Economical Mutual Insurance Company (17-000775)

The claimant brought a motion to combine the insurer's appeal for repayment of income replacement benefits with the claimant's case for IRBs, attendant care, and medical benefits. The insurer resisted the motion as a hearing date and preparation for said date had already been established - to allow the combination would result in a delay....

July 17, 2017

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R.S. v. Aviva Insurance Canada (16-003141)

The claimant sought entitlement to NEBs. As a preliminary issue, the claimant argued that the insurer's late surveillance and IE reports should not be considered by the LAT. Adjudicator Sewrattan allowed the materials to be admitted. In terms of the NEB claim, Adjudicator Sewrattan concluded that the claimant had not proven entitlement because he led...

July 14, 2017

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Applicant v. Wawanesa Mutual Insurance Company (16-000004)

The claimant sought a declaration of catastrophic impairment due to a Class 4 marked impairment. She had sustained soft tissue injuries and a mild concussion in the accident. Adjudicator Sapin concluded that the claimant suffered a Class 4 marked impairment in the functional category of "adaptation". Adjudicator Sapin heard extensive evidence on the claimant's pre-accident...

July 13, 2017

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J.H. v. The Personal Insurance Company (17-000208)

The claimant suffered a non-minor injury and sought entitlement to one treatment plan for physiotherapy. The insurer argued that the treatment was not reasonable and necessary. As a preliminary issue, the insurer argued that the claimant submitted her materials to the LAT four days late, and that the materials should be excluded. Adjudicator Hines allowed...

July 12, 2017

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M.S. v. Primmum Insurance Company (16-000546)

Following an earlier decision, in which the claimant's case was dismissed, the insurer sought costs. Adjudicator Sewrattan reviewed the reasoning for the dismissal of the claimant's case, which largely turned upon the claimant's counsel failing to submit materials and evidence to the LAT. He concluded that the applicant had not acted unreasonably, but rather, that...

July 12, 2017

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M.M. v. Certas Direct Insurance Company (16-004675)

In this preliminary motion, the insurer sought to have the claimant's reply submissions excluded due to late filing. Adjudicator Markovits allowed the late submissions to be filed on the basis that the insurer did not suffer any prejudice, no new issues were raised in the reply submissions, and the Case Conference Order pertaining to late...

July 12, 2017

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M.S. v. Primmum Insurance Company (16-000546)

Following an earlier decision, in which the claimant's case was dismissed, the insurer sought costs. Adjudicator Sewrattan reviewed the reasoning for the dismissal of the claimant's case, which largely turned upon the claimant's counsel failing to submit materials and evidence to the LAT. He concluded that the applicant had not acted unreasonably, but rather, that...

July 6, 2017

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H.W. v. Intact Insurance Company (16-000347)

The claimant sought entitlement to non-earner benefits. Adjudicator Theoharis dismissed the claim, reasoning that the claimant failed to demonstrate that the accident had resulted in the claimant being continuously prevented from engaging in substantially all of the activities in which she ordinarily engaged in before the accident. Of particular note was the claimant's extensive pre-accident...

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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