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.

October 29, 2018

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E.S. v Aviva Insurance Canada (18-000456)

The claimant sought entitlement to the balance of a partially approved chronic pain assessment treatment plan and interest. Adjudicator Victor awarded the balance of the treatment plan, less transportation expenses, and interest on the overdue payment of benefits. Adjudicator Victor noted that she arrived at her decision largely in part due to the claimant's credibility...

October 29, 2018

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J.T. v Western Assurance Company (17-008140)

The claimant sought entitlement to treatment outside of the MIG and various medical benefits. Adjudicator Victor held that the claimant's injuries fell within the MIG and that the disputed medical benefits were not payable. With respect to the claimant's submissions that she suffered from chronic pain, Adjudicator Victor held that as the claimant's pain did...

October 25, 2018

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F.F. v. Aviva Insurance (17-005772)

The claimant sought entitlement to NEBs. Adjudicator Ferguson held that the claimant did not meet the "complete inability" test. He found the IE reports persuasive and noted that the claimant did not make any substantive criticism of the IE reports with respect to methodology or the characterization of his self-reporting. Furthermore, assertions in the claimant's...

October 25, 2018

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G.L. v. Security National Insurance Company (18-002099 and 18-004400)

The Case Conference adjudicator listed repayment of non-earner benefits as an issue in dispute. The claimant brought a motion seeking to remove repayment as an issue. Vice Chair Hunter concluded that he did not have jurisdiction to alter the Case Conference Order, and that the claimant should have sought reconsideration. However, he did order the...

October 24, 2018

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Applicant v. Aviva General Insurance (17-008268)

The claimant sought entitlement to a chronic pain assessment. Adjudicator Ferguson held that the claimant failed to prove entitlement. He noted that the claimant was not diagnosed with chronic pain by any independent medical assessors, nor had the risk of chronic pain been raised with any independent assessors. The claimant also failed to explain why...

October 19, 2018

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M.K. v. Certas Direct (17-006932)

The claimant sought removal from the MIG and entitlement to two treatment plans for psychological therapy. Adjudicator Grant concluded that the claimant did not suffer a psychological injury related to the accident. He further noted that the claimant indicated that he was unlikely to find psychological treatment helpful.

October 18, 2018

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R.A. v. The Guarantee Company of North America (17-006363)

The claimant sought removal from the MIG and entitlement to two treatment plans for physical therapy. Adjudicator Ferguson held that the claimant's injuries fell within the MIG. He held that the claimant's lower back pain was not caused by the accident, but rather after lifting something heavy. He also noted that the claimant did not...

October 17, 2018

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P.F. v. Aviva General Insurance Company (formerly RBC Insurance) (17-006863)

The claimant sought entitlement to IRBs. The insurer argued that the limitation period applied. Adjudicator Harmison concluded that the claimant was time-barred from seeking IRBs. She held that the insurer clearly told the claimant that he did not qualify for IRBs in its response to his OCF-1. The insurer also set out the two year...

October 17, 2018

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M.B. v. Travellers Insurance Company (17-006174)

The claimant was injured while driving an off-road vehicle (a dirt bike) at a closed course competition. The insurer denied that an "accident" had occurred because the off-road vehicle was not an "automobile." Adjudicator Kowal agreed with the insurer and held that because the dirt bike was exempt from the requirement to be insured under...

October 12, 2018

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A.S. v. Aviva Canada Inc. (18-001273)

The claimant sought entitlement to a special award. The insurer had requested an OCF-10 Election based on the Disability Certificate supporting both IRBs and NEBs. The claimant argued that it was unnecessary, but later submitted an Election. The insurer agreed to pay IRBs from the date of the Disability Certificate. The claimant argued that she...

October 12, 2018

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W.W. v. Aviva Insurance Canada (18-001127)

The claimant sought entitlement to three assessments. Adjudicator Reilly dismissed all three claims. She held that the claimant failed to provide evidence supporting the need for the assessments. The claimant had not sought treatment for years since the accident, and had experienced subsequent injuries in unrelated incidents. She also noted that the evidence suggested that...

October 11, 2018

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Unifund Assurance Company v. R.O. (17-001773)

The claimant sought reconsideration of the Tribunal's order for her to repay IRBs of $17,200. She argued that the insurer still owed her IRBs for a period prior to her return to work, which should be offset against the repayment. The hearing adjudicator did not address her argument. Associate Chair Jovanovic ordered a new hearing...

October 10, 2018

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Applicant v. Aviva General Insurance (17-008498)

The claimant sought entitlement to IRBs from the date of denial until her return to work and various medical benefits, including a chronic pain assessment, and a two-part physiatrist assessment. Adjudicator Lake held that the claimant did not meet the IRBs test and both the chronic pain assessment and two-part physiatry assessment were not reasonable...

October 10, 2018

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D.M. v. RBC Insurance (17-006781)

The claimant sought entitlement to an ADL assessment and orthopedic assessment. The insurer argued that the claimant was statute-barred from disputing the denials. Adjudicator Norris held that the claimant was not entitled to the ADL assessment, but was entitled to the cost of the orthopedic assessment plus interest. The claimant claimed to have not received...

October 10, 2018

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R.A. v. Allstate Canada (17-005616)

The claimant sought entitlement to IRBs and various medical benefits for chiropractic services. Adjudicator Watt held that the claimant was not entitled to IRBs or the medical benefits in dispute. The claimant suffered soft-tissue injuries and claimed he could not complete computer work for more than 30 minutes and his headaches caused dizziness and poor...

October 10, 2018

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S.T. v. Certas Direct Insurance Company (17-005871)

The claimant applied to the LAT seeking a finding that his injuries fell outside the MIG, and seeking entitlement to physiotherapy and a chronic pain assessment. Adjudicator Kepman held that the claimant's diagnosis of chronic pain fell outside of the MIG. The claimant suffered from pre-existing shoulder pain 2 months pre-accident, which was exacerbated by...

October 10, 2018

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Applicant v. Aviva General Insurance (17-006537)

The claimant sought entitlement to various treatment plans, IRBs and dental treatment. The insurer raised section 33 and 55 defences due to the claimant's failure to provide requested information and attend IEs. Adjudicator Ferguson held that the claimant was barred from seeking IRBs and dental treatment for failing to provide dental records, invoices, an OCF-10,...

October 10, 2018

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E.S. v. Aviva General Insurance (17-008413)

The claimant sought removal from the MIG and entitlement to three treatment plans for physical therapy and assistive devices. Adjudicator Kepman concluded that the claimant suffered minor injuries and dismissed the claims for medical benefits. She accepted that the claimant suffered from chronic pain in 2014 (one year after the accident), but held that there...

October 9, 2018

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Applicant v. The Personal Insurance Company (17-007961)

The claimant applied to the LAT seeking a finding that his injuries fell outside the MIG, and seeking entitlement to various treatment plans. Adjudicator Driesel held that the claimant's injuries fell within the MIG and he was therefore not entitled to the various treatment plans. The claimant sustained soft-tissue injuries to his back, shoulders, and...

October 9, 2018

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Applicant v. Aviva Insurance (17-006632)

The claimant sought entitlement to IRBs from October 24, 2015 to April 1, 2017. Adjudicator Norris held that the claimant was not entitled to any IRBs beyond October 23, 2015 as the medical records did not contain any information confirming his disability as a result of the accident and the claimant's psychological assessment did little...

October 4, 2018

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Applicant v. TD Home & Auto Insurance Company (17-006571)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to benefits proposed in 12 treatment plans. The claimant relied on a chiropractor's diagnosis of depressive symptoms, PTSD, and a chronic pain condition. Adjudicator Grant placed very little weight on the chiropractor's findings as the psychological diagnosis was beyond the...

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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