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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July 30, 2018

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K.H. v Unifund Assurance Company (17-008686)

The claimant appealed Unifund's MIG determination due to a pre-existing condition and sought medical benefits for physiotherapy. Adjudicator Ferguson held that the claimant's pre-existing scoliosis of the upper thoracic spine did not remove her from the MIG because her condition was undetected before the accident, and the claimant provided no evidence that her condition would...

July 30, 2018

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Applicant v Aviva Canada Inc. (17-007626)

The claimant sought medical benefits for assistive devices, chiropractic treatment, and a functionality assessment, as well as a special award. Adjudicator Boyce held that the claimant was entitled to the medical benefits sought, but not a special award. The adjudicator held that the assistive devices sought were reasonable and necessary as Aviva removed the claimant...

July 30, 2018

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Applicant v. Aviva Insurance Canada (17-007825)

The claimant sought removal from the MIG and payment of various medical benefits. Adjudicator Ferguson concluded that the claimant did not suffer chronic pain, and was therefore restricted to MIG-level benefits. The insurer, and the claimant accepted, that the Tribunal should refer to the AMA Guides in determining whether the claimant suffered chronic pain syndrome....

July 27, 2018

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T.S. v. Aviva General Insurance Canada (17-000835)

The claimant sought reconsideration of the Tribunal's decision that his injuries fell under the MIG. The Tribunal had concluded that the claimant suffered chronic pain, but that it was "clinically associated sequelae" of the initial "minor injury." Executive Chair Lamoureux reversed the Tribunal's decision. She held that the Tribunal's finding that the claimant suffered from...

July 26, 2018

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K.J. v Aviva General Insurance (17-006391)

The applicant sought various medical benefits and assessments and argued that his injuries fell outside the MIG. Adjudicator Hamud held that the applicant's injuries fell within the MIG, and the applicant failed to establish that he could not achieve maximal recovery from within the MIG. The applicant sustained sprain and strains of the spine, shoulder,...

July 24, 2018

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S.C. v. Wawanesa Mutual Insurance Company (18-003409)

The claimant filed a Notice of Motion requesting the Tribunal make the following orders: 1) that the insurer could not use any surveillance of the claimant at the hearing or, in the alternative, that the investigator must attend the hearing for cross-examination; 2) that the respondent pay for a s. 25 report or, in the...

July 24, 2018

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C.S. v. Wawanesa Mutual Insurance Company (17-008727)

The claimant sought entitlement to various medical benefits and cost of assessments. Adjudicator Ferguson denied the benefits incurred before the submission of a treatment plan and denied the treatment plan for nutritional counselling. He awarded the cost of approved assistive devices, but ordered that the claimant had to incur the cost of the devices before...

July 24, 2018

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Applicant v Aviva Insurance Canada (17-003450)

The applicant sought the costs of a chronic pain assessment. Based on an IE physiatry paper review, Aviva argued that continuing with psychological treatment alone would suffice. Adjudicator Diplas held that the cost of examination for a chronic pain assessment was reasonable and necessary. The adjudicator relied on clinical notes and records from the applicant's...

July 24, 2018

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E.E. v. Aviva Insurance Company (16-004281)

The insurer sought reconsideration of the Tribunal's decision that the claimant had sustained a catastrophic impairment and was entitled to attendant care benefits. Associate Chair Jovanovic denied the request for reconsideration. He held that the adjudicator did not err in preferring the evidence and opinions of the claimant's experts and treating physicians, and that it...

July 24, 2018

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E.E. v. Aviva Insurance Company (16-004281)

The insurer sought reconsideration of the Tribunal's decision that the claimant had sustained a catastrophic impairment and was entitled to attendant care benefits. Associate Chair Jovanovic denied the request for reconsideration. He held that the adjudicator did not err in preferring the evidence and opinions of the claimant's experts and treating physicians, and that it...

July 23, 2018

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Applicant v. Aviva Insurance Canada (17-006252)

The claimant sought entitlement to NEBs, physical therapy, and various assistive devices. Adjudicator Kershaw awarded NEBs and the assistive devices but denied further physical therapy. NEBs were awarded because the claimant had gone from an independent retiree to one dependent on others to assist with activities of daily living. She no longer drove and was...

July 23, 2018

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Applicant v. RBC General Insurance Company (17-006369)

The claimant sought entitlement to four treatment plans for physical therapy. As a preliminary issue, the claimant sought to exclude the IE reports because the IE assessor did not file the LAT Acknowledgement of Expert Duties and because no section 44 notice was sent to the claimant regarding an addendum report. Adjudicator Helt permitted the...

July 23, 2018

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Applicant v Aviva Insurance Canada (17-003989)

The claimant sought medical benefits for an orthopaedic assessment and interest on the overdue payment of benefits. Adjudicator Watt held that the claimant was not entitled to the cost of the orthopaedic assessment. The claimant had a pre-accident history of fibromyalgia, anxiety disorder, lower back pain, right knee osteoarthritis, and was considered substantially disabled. Adjudicator...

July 20, 2018

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Applicant v. Aviva Insurance Canada (17-008093)

The claimant sought removal from the MIG and entitlement to various medical benefits. Adjudicator Ferguson concluded that the claimant suffered predominantly minor injuries. The medical records showed the claimant suffered soft tissue injuries. Though medical imaging two years after the accident showed a tear in the shoulder, no evidence connected the tear to the accident....

July 20, 2018

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N.M. v. Western Assurance Company (17-009102)

The insurer denied entitlement to accident benefits based on the facts of loss. The claimant had parked her vehicle at a mechanic's garage in order to have a emissions test performed. She pulled into the service bay, turned offer her engine, left the keys in the vehicle and exited her vehicle. She then spoke with...

July 20, 2018

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Applicant v. Unifund Assurance Company (17-006581)

The claimant sought removal from the MIG, entitlement to attendant care benefits, and various medical benefits. Adjudicator Reilly concluded that the claimant's injuries were predominantly minor. She held that there was no evidence that pre-existing high blood pressure would prevent maximal recovery under the MIG; that the claimant did not suffer a psychological disorder; that...

July 20, 2018

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Applicant v RBC Insurance Company (17-005000)

The claimant argued that her injuries fell outside the MIG and sought medical benefits and the costs of examinations. Adjudicator Lake held that the claimant's injuries fell within the MIG. The adjudicator concluded that there was insufficient documentary evidence, supporting reasons, or analysis to establish that the claimant had cervical radiculopathy. The claimant relied on...

July 20, 2018

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Applicant v. Unica Insurance Inc. (17-007052)

The claimant sought a declaration that she sustained a catastrophic impairment, and sought entitlement to ACBs and medical benefits. The insurer denied all of the claims and argued that the claim for ACBs was time barred. Adjudicator Ferguson held that the claimant did not suffer a catastrophic impairment. He preferred the evidence of the IE...

July 19, 2018

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Applicant v. Aviva Insurance Canada (17-006787)

The claimant sought removal from the MIG and various medical benefits. Adjudicator Parish concluded that the claimant's injuries fell within the MIG. The claimant's injuries were clinically associated sequela to the soft tissue injuries she sustained in the accident. Adjudicator Parish preferred the opinion of the IE assessor, who believed that the claimant's soft tissue...

July 19, 2018

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K.T. v. Aviva General Insurance (17-007027)

The claimant sought entitlement to attendant care benefits beyond the termination date despite no amounts being incurred. The claimant asked that the LAT deem the expenses incurred. Adjudicator Mazerolle concluded that he could not deem the expenses incurred. He held that the insurer's termination of attendant care benefits was not unreasonable and that the IE...

July 18, 2018

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Applicant v. Aviva Insurance (17-005631)

The claimant sought entitlement to a chronic pain assessment and assistive devices. Adjudicator Kepman found the claimant credible and granted the chronic pain assessment based on ongoing wrist pain years after the accident. The insurer had paid part of the claims for assistive devices, but denied the remainder based on the cost. Adjudicator Kepman concluded...

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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