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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April 6, 2017

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J.L.H.C. v. Chubb Insurance (16-004448)

The claimant failed to attend two LAT Cases Conferences, and the insurer sought to have the matter dismissed. Adjudicator Purdy dismissed the matter as abandoned.

April 6, 2017

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Aviva Insurance Company of Canada v. A.M. (16-001014)

The insurer sought repayment of IRBs that were paid while the claimant was allegedly receiving short-term disability benefits. The claimant did not participate in the hearing. Adjudicator Gosio refused to order repayment and held that the insurer had not met its burden in proving that the claimant had received short-term disability benefits. No information was...

April 5, 2017

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M.B. v. RBC General Insurance Company (16-002963)

The claimant sought entitlement to a chronic pain program. The insurer brought a preliminary motion that the claimant had failed to attend an IE. Adjudicator Gottfried concluded that the IE notice was insufficient because it did not provide medical and other reasons for the IE, and that the claimant was not barred from seeking entitlement...

April 4, 2017

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J.M. v. Royal Sun Alliance Insurance (16-000832)

The insurer sought an adjournment of the LAT hearing due to receipt of productions from the claimant late in the process. Adjudicator Hunter granted the adjournment, and also ordered the claimant to produce a record of her passport, which was relevant to her travel activities. No costs were awarded in relation to the late productions.

April 3, 2017

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G.P. v. Cumis General Insurance Company (16-003144)

The claimant sought entitlement to various medical benefits and a catastrophic impairment determination. The insurer argued that the claimant had not attended two of five IEs it had requested. Adjudicator Pay held that section 55 did not apply, and that the multiple IEs requested by the insurer were not reasonable. The claim was allowed to...

March 31, 2017

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Optimum Insurance Company (16-000760)

The claimant sought entitlement to an in-home assessment and assistive devices. After weighing the evidence, Adjudicator Pay found the treatment plans reasonable and necessary. Although the insurer raised objections to the Reply submissions of the claimant, Adjudicator Pay stated: "Because these submissions of the applicant were not relevant to the determination of the dispute, I...

March 31, 2017

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D.D.D. v. RBC Insurance Company (16-000097)

The claimant sought IRBs between August 1, 2015 and March 29, 2016; the period she was off work following a January 4, 2015 accident. Adjudicator Gottfried concluded that the claimant was not entitled to IRBs, as she had not provided evidence that her lack of work was disability related. The evidence from the employer was...

March 31, 2017

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Applicant v. Wawanesa Mutual Insurance Company (16-000324)

The 17 year old claimant sought entitlement to an EEG (brain scan). The insurer sought the exclusion of three reports that were authored and provided after the Case Conference. Adjudicator Mather admitted all three reports, reasoning that if the insurer believed the reports were prejudicial, it should have sought an adjournment. Adjudicator Mather awarded the...

March 31, 2017

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Applicant v. Aviva Insurance Company of Canada (16-001985)

The claimant sought NEBs and three treatment plans. Adjudicator Pay dismissed all claims except for the psychological treatment. She found that the claimant had not presented evidence satisfying the NEB test. In particular, the claimant had extensive issues prior to the accident, and the claimant did not present a clear picture as to how his...

March 31, 2017

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A.A. v. Aviva Insurance (16-002670)

The claim for various medical benefits and MIG removal was dismissed because the claimant did not participate in the written hearing. Adjudicator Marzinotto held that the insurer did not need to bring a formal notice for a dismissal because the parties had agreed to a written hearing to be held March 14, 2017. Rather, the...

March 28, 2017

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S.C.L. v. State Farm Mutual Automobile Insurance Company (16-001683)

The claimant was struck by a golf cart while on the driveway of a private golf course. The insurer denied that an "accident" had occurred because the golf cart did not qualify as an "automobile". Adjudicator Sewrattan agreed with the insurer and concluded that the golf cart was not an "automobile" because it was not...

March 28, 2017

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P.K. v. Cumis General Insurance (16-001809)

The claimant sought entitlement to eight treatment plans, including prescription medication. Adjudicator Sewrattan found five of the treatment plans were not payable as the treatment was incurred before the submission of treatment plans. When interpreting section 38(2), it was noted that there was no "reasonable excuse" exception; therefore, if the claimant did not meet any...

March 28, 2017

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M.P. v. Northbridge Personal Insurance Corporation (16-001394)

The claimant had already previously adjourned two case conferences due to a death in the family and medical reasons. A preliminary issue hearing was scheduled; however, it was subsequently withdrawn by the insurer and the matter was set to proceed to a hearing. The claimant sought to adjourn a written hearing, so she could undergo...

March 28, 2017

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E.F. v. RBC Insurance Company (16-001038)

The claimant sought entitlement to physiotherapy and an FAE. The insurer denied the treatment based on a MIG determination. Adjudicator Anwar considered the medical evidence submitted, including family doctor clinical notes and records, and determined the claimant did not prove entitlement to treatment beyond the MIG.

March 28, 2017

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B.W. v. Royal SunAlliance Insurance (16-001517)

The claimant sought entitlement to five treatment and assessment plans. The insurer denied the treatment based on a MIG determination. Adjudicator Johal dismissed all claims and upheld the MIG determination. Of note, while Adjudicator Johal found the claimant did suffer from issues of anxiety, depression, sleeping problems, and panic attacks prior to the accident, it...

March 27, 2017

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M.F. v. Belair Direct (16-002057

The insurer brought a preliminary issue motion asserting the claimant was not entitled to income replacement since the claimant knowingly drove without a license, pursuant to section 31 of the SABS. Adjudicator Sewrattan reviewed Section 2.2.1 of OAP 1. It was noted that while a broad interpretation favouring the insured was asserted, not even a...

March 27, 2017

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G.T. v. Unifund Assurance Company (16-001283)

The claimant sought entitlement to an orthopaedic assessment. The insurer denied the assessment and informed the claimant that should he wish to obtain an assessment, he should seek one through OHIP and his family doctor. Under section 38, Adjudicator Chris Sewrattan did not identify valid medical and other reasons in the denial letter. Moreover, the...

March 27, 2017

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G.A. v. Co-Operators General Insurance Company (16-001976)

The claimant sought entitlement to income replacement benefits. The insurer asserted a limitations defence. Adjudicator Sewrattan noted that the LAT assumed jurisdiction of accident benefits disputes on April 1, 2016. The parties agreed the 90-day grace period beyond a report of mediator is not applicable to LAT disputes. Adjudicator Sewrattan noted the claimant had ample...

March 24, 2017

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T.E. v. Unifund Assurance Company (16-001326)

A preliminary hearing was held to decide whether the claim for IRBs was barred by the limitation period. Adjudicator Sewrattan concluded that the denials by the insurer were clear and unequivocal, and that the claim for IRBs was therefore barred. No costs were awarded.

March 24, 2017

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P.C. v. Wawanesa Mutual Insurance Inc. (16-000989)

The claimant sought entitlement to three treatment plans. The insurer denied the plans and maintained a MIG position. Adjudicator Truong reviewed the medical reports and found each to have competing views; as a result, a review of the clinical notes was undertaken. On review, the claimant was said to suffer from soft tissue injuries and...

March 24, 2017

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

At this motion, the insurer sought the exclusion of evidence and costs after the claimant's counsel failed to make submissions in accordance with the timelines set out in the Case Conference. Adjudicator Hines granted the claimant an extension to make submissions, and asked the insurer to make further submissions regarding costs to the hearing adjudicator.

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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