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.

January 9, 2023

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Liu v. Certas Direct Insurance Company (20-012975/AABS)

The claimant disputed entitlement to NEBs, several treatment plans, and whether her injuries fell under the MIG. Adjudicator Maedel found that the claimant's injuries fell outside of the MIG due to psychological impairments. Despite the insurer's arguments that the claimant's psychological report was based entirely on subjective reporting and not on contemporaneous medical records, Adjudicator...

January 9, 2023

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Smith v. Intact Insurance, (21-005342/AABS – PI)

The claimant submitted an application for determination of catastrophic impairment. The insurer scheduled two IEs (psychological and occupational therapy), which the claimant attended. However, Dr. Kiss (psychologist) passed away before he could complete his report, and the insurer determined that the claimant had not meaningfully participated in the situational portion of the OT IE. The...

January 9, 2023

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Bennett v. The Co-operators (20-014453/AABS)

The claimant filed a LAT Application disputing several OCF-18s with interest. A special award was also claimed. The claimant argued that her worsening pre-accident fibromyalgia had resulted in numerous falls prior to the accident which required physical treatment. The main issue was payment of an OCF-18 for an attendant care assessment. The assessment had been...

January 9, 2023

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Katsiashvili v. Economical Mutual Insurance (21-015596)

The insurer argued that the claimant was not involved in a legitimate accident, pointing to inconsistencies is the material facts leading up to the accident, the description of the accident, and the injuries sustained. Adjudicator Kaur rejected the insurer's position, holding that the inconsistencies were minor, or were immaterial, or were not in fact inconsistencies...

January 9, 2023

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Elkhidir v. Intact Insurance Company (20-011803/AABS)

The claimant was injured in a motor vehicle accident and applied to the LAT for IRBs. Section 36(2) of the Schedule mandates that an applicant seeking IRBs shall submit a completed OCF-3 with their application for benefits, and that there can be no entitlement to IRBs for any period before the OCF-3 is submitted. A...

January 9, 2023

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Chen v. The Co-operators (20-012408/AABS)

The claimant applied to the LAT seeking entitlement to various benefits, including the ongoing payment of IRBs. The insurer denied IRBs on the basis that the claimant had provided insufficient medical evidence to prove that she suffered a substantial inability to perform the essential tasks of her employment as a manicurist. The claimant's productions lacked...

January 5, 2023

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Berardinelli v. Aviva Insurance Company, (21-007728/AABS)

The insurer requested that the claimant attend insurer examinations (IE) to assess her claims for various benefits. The claimant only attended one IE, and the insurer sought to bar the claimant’s application for attendant care, non-earner benefits, and treatment plans for her failure to attend IEs. The insurer sent 4 notices of examination to assess...

January 5, 2023

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Gray v. Intact Insurance (21-008634)

This is a preliminary issue decision. The claimant applied for accident benefits following an incident in August 2019. The applicant was in her home when a vehicle struck a house a few doors down. A large natural gas explosion occurred at the impacted house. The claimant alleged she sustained psychological impairments as a result of...

January 4, 2023

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Del Grosso v. Intact Insurance Company (20-013318)

The claimant was involved in an accident in Michigan and elected to receive Michigan no-fault benefits, including Work Loss Benefits (the Michigan equivalent of IRBs). The insurer later learned that the claimant misrepresented his driving history and insurance history when applying for his auto policy. The insurer terminated the claimant's entitlement to Work Loss Benefits...

January 4, 2023

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Howes v, CAA Insurance Company (21-012279)

This is a preliminary issue decision. The claimant applied for accident benefits following an incident in February 2019. She was asleep at home when a truck drove into her house, destroying her dining room and kitchen. She alleged that she was injured when a large mirror fell down on her as a result of the...

January 3, 2023

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Madore v. Intact Insurance Company (2023 ONSC 11)

The claimant appealed the Tribunal's decision that he was not involved in an "accident" as defined in the SABS. The claimant had been inspecting and cleaning the roof of his camper trailer, which was hitched to his pickup truck. In the course of cleaning the trailer, the claimant fell to the ground, suffering serious injuries...

December 29, 2022

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Nagalingam v. Economical Insurance Company (20-006884)

The claimant sought entitlement to pre-104 week and post-104 week IRBs. The insurer denied the claimant's entitlement and argued that section 33 barred the claim as the claimant failed to provide information relating to his place of residence, which was relevant to a potential section 31 exclusion. Adjudicator Maleki-Yazdi found that the claimant did not...

December 28, 2022

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Thompson v. Aviva Insurance Company (20-005734)

The claimant's spouse was involved in an accident in 2015. In 2019, the claimant applied for accident benefits, including IRBs. The insurer denied the claim on the grounds that the application was submitted late. The claimant applied to the LAT seeking entitlement to IRBs, and two treatment plans related to psychological treatment. Adjudicator Norris granted...

December 23, 2022

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Ni v. Aviva Insurance Company of Canada (20-008774)

The claimant requested a special award for IRBs due to an unreasonable delay by the insurer. As of January 16, 2020, the claimant had provided her OCF-1, OCF-2, OCF-3 and OCF-10 to the insurer. On January 30, 2020, the insurer sent a section 33 request for further income-related documents. The insured made repeated section 33...

December 21, 2022

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Balachandran v. Economical Insurance (21-014940)

The claimant applied to the LAT in order to dispute the hourly rates for ACBs being prescribed by his insurer. Adjudicator Kaur found that the LAT did not have jurisdiction to rule on the matter because there was no dispute regarding the claimant's eligibility to a benefit under the SABS. The amount being claimed in...

December 21, 2022

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Fu v. Pembridge Insurance Company (21-012902)

The claimant applied to the LAT seeking entitlement to NEBs and medical benefits. The insurer argued that the claimant was barred from seeking entitlement to the benefits because he did not dispute the denials within the two-year limitation period. The accident occurred in December 2018, the insurer denied entitlement to NEBs and medical benefits between...

December 21, 2022

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Traders General Insurance Company v. Rumball (2022 ONSC 7215)

Both the insurer and the claimant appealed the Tribunal's decision that the claimant was entitled to IRBs up to the 104 week mark. The insurer appealed the finding that the limitation period did not bar the IRB claim because the denial was not clear and unequivocal. The claimant appealed the finding that she was not...

December 19, 2022

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Sgambelluri v. Aviva Insurance Company (20-009937)

The claimant applied to the LAT seeking entitlement to IRBs and HK expenses. Vice Chair Johal dismissed the claims. Regarding HK expenses, the claimant did not put contemporaneous evidence before the Tribunal proving an impairment with housekeeping activities. The reports the claimant relied upon were all from three years or more post-accident, and did not...

December 6, 2022

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Shalto v. Intact Insurance Company (19-014473)

The claimant was involved in a motor vehicle accident in May 2016. She applied to the LAT seeking CAT determination under Criteria 8 and entitlement to NEBs, ACBs, and numerous medical benefits. Adjudicator Grant applied the "but for" test to the issue of causation and found that although the evidence supported some level of psychological...

December 5, 2022

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Wilmot v. Aviva Insurance Company of Canada (21-002048)

The claimant applied for accident benefits arising out of an accident. There was conflicting information regarding his employment and education. In his OCF-1 , the claimant indicated he was in school, and employed. However, his OCF-3 noted that he had not worked at least 26 of the previous 52 weeks. His OCF-3 also indicated that...

December 1, 2022

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Degazio v. Bertie and Clinton Mutual Insurance Company (21-008359)

The claimant applied for accident benefits arising out of an incident. While the claimant was sleeping in his living room, another vehicle collided with the claimant’s vehicle and struck a corner of the claimant’s home. He did not see the accident occur. The claimant alleged that he sustained psychological and emotional injuries as a result...

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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