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.

August 20, 2018

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R.H. v. Wawanesa Mutual Insurance Company (17-005570)

The insurer alleged that the accident was staged and refused to pay accident benefits. The claimant sought disclosure of the insurer's unredacted log notes, the property damage file, and the notes for the related BI claims. Adjudicator Maedel ordered that the insurer produce redacted log notes pertaining to the accident investigation and denial of benefits...

August 17, 2018

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M.R. v Aviva Insurance Canada (17-007428)

The claimant sought entitlement to various medical benefits and the costs of a chronic pain examination. The Tribunal was also asked to determine whether the claimant was statute-barred from disputing one of the denied benefits, as he failed to commence his application within the two year time frame. Adjudicator Kepman concluded that the application for...

August 17, 2018

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Applicant v RBC General Insurance Company (17-007471)

The claimant argued that his injuries fell outside the MIG due to a pre-existing condition that prevented him from achieving maximal recovery under the MIG and due to a psychological injury that was not mere sequelae of his soft tissue injuries. The claimant sought medical benefits for a psychological assessment and chiropractic services, as well...

August 15, 2018

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Applicant v. Aviva Insurance Canada (17-007527)

The claimant sought a determination that her impairments were outside of the MIG and entitlement to medical benefits proposed in three treatment plans. Adjudicator Maleki-Yasdi found that the claimant's psychological impairment took her outside of the MIG, based on evidence that pre-existing psychological issues were exacerbated by the accident. The claimant was found entitled to...

August 15, 2018

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K.D. v. Wawanesa Mutual Insurance Company (18-001020)

The claimant's mother was involved in an accident while an occupant of a friend's vehicle. The mother did not have insurance of her own. The claimant applied for accident benefits under the friend's policy. The insurer argued that the claimant was not an insured person under the policy and not entitled to accident benefits. Adjudicator...

August 14, 2018

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Applicant v Aviva Insurance Canada (17-008107)

The claimant sought entitlement to IRBs and interest on the overdue payment of benefits. Adjudicator Ferguson held that the claimant was not entitled to IRBs or interest as she did not prove that she suffered a substantial inability to perform the essential tasks of her pre-accident employment. The claimant failed to disclose the availability of...

August 13, 2018

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J.R. v. CAA Insurance (17-008693)

Following a full and final settlement of the claim, the claimant sought further payment for a treatment plan that had been in dispute as part of the initial LAT application. She had not rescinded the settlement within the two day cooling off period. Vice Chair Flude concluded that the settlement amount included the payment of...

August 13, 2018

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Applicant v. Unifund Assurance Company (17-006691)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to medical benefits proposed in five treatment plans. Adjudicator Kepman found that the claimant's injuries fell outside of the MIG and that he was entitled to payment for two treatment plans for chiropractic services as well as the cost of...

August 13, 2018

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Applicant v. Economical Mutual Insurance Company (17-004874)

The claimant was a minor at the time of the accident. The insurer denied NEBs around the six months mark. The claimant applied to the LAT to dispute NEBs more than two years after turning 18 years old. The insurer argued that the limitation period barred the claim. Adjudicator Johal agreed that the claim was...

August 10, 2018

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Applicant v. Motor Vehicle Accident Claims Fund (17-001681)

The claimant suffered a catastrophic impairment following a motorcycle accident which caused a traumatic brain injury. He sought entitlement to NEBs, ACBs, a rehab support worker, home modifications, and a special award. The Fund denied his entitlement to the claimed benefits. It also argued that the claimant did not have a valid licence and was...

August 10, 2018

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S.S. v. Economical Mutual Insurance Company (17-002867)

The claimant sought entitlement to attendant care benefits and housekeeping expenses after a catastrophic impairment application. The insurer argued that those benefits had been denied more than two years prior, and were therefore statute barred. Adjudicator Johal agreed with the insurer. He held that the denials of HK expenses and ACBs were clear and unequivocal...

August 10, 2018

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S.S. v. Economical Mutual Insurance Company (17-002867)

The claimant sought entitlement to attendant care benefits and housekeeping expenses after a catastrophic impairment application. The insurer argued that those benefits had been denied more than two years prior, and were therefore statute barred. Adjudicator Johal agreed with the insurer. He held that the denials of HK expenses and ACBs were clear and unequivocal...

August 9, 2018

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Applicant v. Liberty Insurance (17-006380)

The claimant was struck on the head by an unidentified cyclist travelling on the sidewalk while she was taking something out of her work vehicle. She sought accident benefits. The insurer argued that the facts of loss did not qualify as an accident. Adjudicator Hans concluded that the incident was an accident for the purposes...

August 7, 2018

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Applicant v. Allstate Canada (17-005189)

The claimant sought entitlement to two treatment plans for physical and psychological treatment. Adjudicator Grieves denied the claims. She held that the claimant's physical complaints were not supported by prescriptions or referrals to specialists, and no objective evidence of injury was submitted. Similarly, the adjudicator denied entitlement to the psychological treatment based on the insurer's...

August 3, 2018

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O.G. v. RSA Insurance (17-007972)

The claimant sought entitlement to seven medical benefits. Adjudicator Ferguson held that the claimant failed to provide evidence that the disputed treatment plans would provide pain relief or the goals and efficacy of the treatment.

August 1, 2018

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Applicant v. Aviva General Insurance (17-007215)

The claimant sought entitlement to over $20,000 for multidisciplinary catastrophic impairment assessments. The insurer argued that the claimant had exhausted her medical benefits limits, that the proposed assessments were not reasonable and necessary, and that the assessment costs were in excess of the $2,000 limit. Adjudicator Grant held that the medical benefits limits did not...

August 1, 2018

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Applicant v. The Guarantee Company of North America (17-003860)

The claimant sought entitlement to IRBs and three treatment plans. Adjudicator Anwar awarded IRBs but denied the treatment plans. He concluded that the claimant's injuries prevented him from working as a drywaller and steel framer. The medical benefits were denied because the claimant failed to provide the disputed treatment plans as evidence and the Tribunal...

August 1, 2018

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Applicant v. Aviva General Insurance Company (17-007475)

The claimant sought entitlement to a psychological assessment. Adjudicator Punyarthi denied the claim. He held that the claimant failed to explain why the proposed assessment was necessary and that the fees were reasonable. He was also critical of the contents of the Pilowsky report because the diagnoses did not correspond to the evidence that was...

August 1, 2018

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J.B. v. The Guarantee Company of North America (17-003860)

The claimant sought entitlement to ongoing IRBs, and various medical benefits. Adjudicator Anwar found the claimant to be credible, and concluded that he was unable to perform the essential tasks of his pre-accident employment in home construction. IRBs were awarded up to the date of the 104 week anniversary, with IRBs beyond that date to...

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...

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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