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.

February 16, 2023

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Sookbir v. Wawanesa Insurance (20-008613)

The insurer and the claimant disputed at a preliminary issue hearing whether the claimant's IRB claim ought to be barred for a failure to submit a completed OCF-3 to the insurer. The claimant submitted an OCF-3 form which indicated that she was not working in the 26 weeks before the accident and that she did...

February 15, 2023

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Wicks v Intact Insurance Company (20-011457)

The claimant disputed entitlement to vocational/academic training services, a mattress, a massage chair, and a Stairmaster. The Tribunal found that the claimant did not meet the burden of proving that the disputed benefits were reasonable and necessary. Despite recommendations from occupational therapists and physicians, there was a lack of supporting medical evidence to justify the...

February 14, 2023

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Vaillancourt v. The Guarantee Company of North America (21-008125)

The claimant was previously deemed catastrophically impaired. He applied to the LAT to resolve a dispute concerning the quantum of certain benefits, including attendant care and home modifications. Prior to the accident, the claimant managed his own consulting company, was quite active, and regularly enjoyed doing housework. The insurer denied much of the claimant’s attendant...

February 10, 2023

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RBC General Insurance Company v Balasubramaniam (19-008701)

The claimant was involved in a motor vehicle accident in 2005. In 2010, FSCO ordered the insurer to pay the claimant IRBs. On July 22, 2019, the insurer applied to the LAT to have the LAT vary or revoke the 2010 FSCO order. Adjudicator Adamidis found that the LAT cannot vary or revoke an order...

February 8, 2023

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Gibson v. Intact Insurance Company (20-012060)

The claimant applied to the LAT for the approval of multiple treatment plans, including a treatment plan for a tractor. The insurer brought a motion to bar the claimant from disputing the entitlement to the tractor for failing to attend s. 44 IEs. The LAT added the claimant’s non-attendance at the IEs as a preliminary...

February 8, 2023

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Sagastume v. Allstate Insurance Company of Canada (20-014755)

The claimant disputed entitlement to ACBs and medical benefits that were denied because the claimant was within the MIG. The Tribunal found that the claimant failed to demonstrate that his injuries warranted removal from the MIG. The Tribunal rejected the argument that an insurer is required to re-schedule an IE within 10 days of an...

February 7, 2023

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Ciyayi v. Economical Insurance Company (19-005222)

The claimant suffered from a non-catastrophic impairment and applied to the LAT for attendant care and medical benefits. The claimant sought repayment for both non-professional and professional attendant care services. To establish that expenses for non-professional attendant care were “incurred” under s. 3(7)(e) of the SABS, a claimant must prove that a non-professional service provider...

February 7, 2023

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Nichols v. Gore Mutual Insurance Company (21-008322)

The claimant sought reconsideration of the Tribunal's decision that the late OCF-1 barred the application. The Tribunal found that the insurer had not provided the application package, yet found that section 32 applied. Adjudicator Kaur granted the reconsideration, holding that the 30 day deadline to submit the OCF-1 did not start running because the claimant...

February 6, 2023

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Varriano v. Allstate Insurance Company of Canada (2023 ONCA 78)

The insurer appealed the Divisional Court's decision that the limitation period on IRBs did not commence because the denial did not provide any medical reasons. The insurer argued that the only basis for denial was the claimant's return to work (i.e. an "other" reason), and that it was not required to state a medical reason...

February 6, 2023

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Aized v. The Co-operators (20-012300)

The claimant applied to the LAT for post-104 week IRBs and medical benefits, including physiotherapy services and an attendant care assessment. Prior to the accident, the claimant was employed as a student placement coordinator, which required concentration, critical thinking skills and sitting in front of a computer screen for prolonged periods of time. Despite returning...

February 6, 2023

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Suntharalingam v. Chubb Insurance Company of Canada (20-009977)

The insurer argued that the claimant was barred from receiving accident benefits because he was entitled to WSIB and could not opt out to pursue a Court claim. Adjudicator Grant agreed, finding that the claimant had been in a single-vehicle accident, was charged in relation to the accident, and had admitted in an EUO that...

February 6, 2023

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Al Dhoun v Aviva Insurance Company (20-009309)

The claimant disputed entitlement to non-earner benefits, medical assessments, and psychological services. The Tribunal found that the claimant did not meet the requirements for NEBs, as he failed to demonstrate a complete inability to carry on a normal life due to the accident. Despite medical evidence of ongoing impairments, the claimant did not establish the...

February 6, 2023

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Sexsmith v Certas Home and Auto Insurance Company (21-000943)

The claimant disputed the insurers decision that he was precluded from receiving specified benefits pursuant to s. 31 of the SABS. The claimant's uninsured motorcycle, which was involved in the accident, was not listed on any policy despite the claimant owning multiple vehicles and holding separate policies. The Tribunal found that the claimant failed to...

February 6, 2023

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Hassan v. Aviva Insurance Company of Canada (21-000811)

The claimant disputed entitlement to NEBs, ACBs, and a special award. As a preliminary motion, the insurer sought to exclude the claimant's CAT reports because they were not disclosed in accordance with the LAT order timelines. Adjudicator Prowse excluded the CAT reports because the documents were not exchanged in accordance with the order, and because...

February 3, 2023

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Khan v. Allstate Insurance Company of Canada (20-000806)

The claimant sought reconsideration of the Tribunal's decision that he did not suffer a catastrophic impairment. The claimant argued that the hearing was procedurally unfair and that the Tribunal applied the wrong test for causation. Adjudicator Neilson dismissed the reconsideration. She found that the claimant was aware of the insurer's position regarding causation, and as...

February 3, 2023

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Nouracham v. Aviva General Insurance Company (21-000224)

The claimant applied to the LAT for entitlement to IRBs. Prior to the accident, the claimant, who worked as an employee on an “on call” basis, had not been called upon to work for a period of six weeks. The insurer denied IRBs on the basis that the claimant was not eligible for IRBs because...

February 3, 2023

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Gagnon v Belairdirect (20-010307)

The claimant filed a LAT Application seeking a determination of catastrophic impairment under Criteria 8. At the outset of the hearing, the claimant raised a motion to have the insurer's psychology report excluded because the psychologist had passed away and could not be cross-examined. Adjudicator Norris allowed the insurer to rely on the report but...

February 3, 2023

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Stewart v Travelers Canada (21-008891)

This is a preliminary issues decision addressing whether the claimant was barred from applying to the LAT for attendant care benefits under s. 55(3) of the SABS for failure to comply with s. 46.2(1) of the SABS (i.e., the duty of a provider to provide information). The insurer argued that there was non-compliance with s....

February 3, 2023

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Khan v. Aviva Insurance Company of Canada (21-003298)

The claimant disputed entitlement to a catastrophic impairment designation, attendant care benefits of $6,000 per month, and various medical benefits. The insurer argued that the claimant's impairments were a result of subsequent injuries and events in his life. Adjudicator Lester concluded that the accident was not the "but for" cause of the claimant's impairments, and...

February 2, 2023

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Kokulanthan v. TD General Insurance Company (20-011886)

The insurer raised a preliminary issue, arguing that the claimant's entitlement to medical benefits and IRBs was barred for non-attendance at s. 44 examinations. Adjudicator Tavlin Kaur found that the insurer's notices of examination in relation to IRBs did not comply with the SABS as they did not refer at all to the claimant's medical...

February 2, 2023

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Cabral v. Northbridge General Insurance Company (20-013500)

The claimant was involved in a motor vehicle accident on February 9, 2006 (the "2006 accident"). He brought an application seeking a CAT designation due to a mental or behavioral disorder. The insurer argued that the claimant did not suffer from a catastrophic impairment and also that his alleged injuries arose from a previous motor...

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

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Contact Us

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

416.507.1850

eodonnell@tgplawyers.com