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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January 30, 2018

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D.M. v. Certas Direct Insurance Company (17-000180)

The insurer requested a preliminary issue hearing as to whether the incident in question was an automobile accident. The claimant had sustained injuries after she slipped and fell next to the passenger door of her parked vehicle. The claimant had sought benefits under the SABS, which the insurer denied as the incident did not qualify...

January 30, 2018

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N.H. v. Aviva Insurance Canada (17-001309)

The claimant sought entitlement to a medical treatment plan for optometrist services. The insurer denied the plan, citing the proposal to not be reasonable and necessary. Adjudicator Gemma Harmison noted that the applicant failed to submit the disputed OCF-18 as evidence and subsequently failed to meet the burden of proof. Additionally, Adjudicator Harmison went further...

January 30, 2018

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D.W. v. Heartland Farm Mutual (17-001508)

The claimant sought entitlement to a number of medical treatment plans. The insurer asserted the claimant was barred from proceeding to the LAT due to a failure to attend IEs scheduled. On review of the Notices provided, Adjudicator Rupinder Hans found the requested IEs to be reasonable. Accordingly, because the claimant failed to attend, the...

January 29, 2018

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C.P. v. Wawanesa Mutual Insurance Company (17-001931)

The claimant sought entitlement to income replacement benefits. The insurer denied the benefits citing a return to work. The claimant sought IRBs for the period not working as well as ongoing. Adjudicator Ruth Gottfried concluded the claimant was entitled to IRBs for the time when the claimant was not working, and should have been paid,...

January 29, 2018

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Applicant v. Wawanesa (17-000565)

The claimant sought entitlement to a number of medical treatment plans. The insurer asserted a MIG position. Adjudicator Billeh Hamud reviewed the medical evidence and found the claimant's injuries to be predominantly minor. Adjudicator Hamud also reviewed surveillance footage and social media evidence and found the credibility of the claimant to be negatively impacted. None...

January 29, 2018

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Applicant v. Aviva Insurance Canada (17-001040)

The claimant sought entitlement to a number of medical treatment plans. The insurer denied each as not being reasonable and necessary. Adjudicator Eleanor White reviewed the medical evidence and found half of the treatment plans reasonable and necessary. Interest, in accordance with section 51, was awarded on the payable benefits.

January 28, 2018

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T. T. v. Aviva Insurance Canada (17-002535)

The claimant sought entitlement to a number of medical treatment plans. The insurer denied the treatment and asserted a MIG position. The insurer also tendered surveillance in support of its position, to which the claimant sought to exclude on the basis of bad faith. Adjudicator Avvy Go determined that the surveillance was in contravention of...

January 26, 2018

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Applicant v. TD Insurance (17-003356)

The claimant sought entitlement to medical benefits, including a number of prescription expenses. The insurer raised a causation argument as the claimant's medical history was littered with previous MVAs and workplace injuries. The claimant countered by noting the insurer previously approved treatment, which would suggest the insurer accepted the subject motor vehicle accident as the...

January 26, 2018

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Applicant v. Certas Home and Auto Insurance (17-001228)

The claimant sought entitlement to a number of medical benefits. The insurer denied the treatment asserting the claims were not reasonable and necessary. On review of the medical evidence, Adjudicator Eleanor White determined that the medical benefits sought were payable, with the exception of a neuropsychological examination. A gym membership and assistive devices were also...

January 26, 2018

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Applicant v. Allstate Insurance Company of Canada (17-001523)

The claimant sought entitlement to a number of medical benefits, as well as attendant care benefits. The insurer denied the medical treatment asserting the claims were not reasonable and necessary. The insurer also denied the claimant's attendant care claim and cited a lower attendant care rate commissioned by an IE assessor. Adjudicator Billeh Hamud reviewed...

January 25, 2018

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D.F. v. Gore Mutual Insurance Company (17-002799)

The claimant filed a LAT application on May 4, 2017, seeking entitlement to NEBs. A written preliminary issue hearing was scheduled to determine whether the claimant was precluded from bringing the application to the LAT, pursuant to s. 56 of the SABS, for failure to dispute the denial of benefits within two years. The insurer...

January 25, 2018

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N.J. v. Aviva Insurance Canada (17-002841)

The claimant's mother died in an accident. The claimant sought payment of death benefits. The insurer denied the benefits, arguing that the claimant was not a dependent of her mother. Adjudicator Watt agreed with the insurer. He noted that while the claimant lived with her mother and did not pay rent, the claimant had earned...

January 25, 2018

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S.J. v. Aviva Insurance Canada (17-002899)

The claimant's mother died as a result of an automobile accident. She applied for death benefits. The insurer argued that the claimant was not dependent on her mother at the time of the accident, and therefore not an insured person under the policy. Adjudicator Watt agreed with the insurer. Although the claimant resided with her...

January 25, 2018

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P.I. v. Aviva Insurance Canada (16-001320)

The claimant sought reconsideration of a Tribunal decision which upheld a MIG determination. The claimant asserted the Tribunal violated the rules of natural justice and erred in law when it failed to consider psychological, physical, and pre-existing medical evidence. Executive Chair Linda Lamoureux determined that it is open for a Tribunal adjudicator to prefer one...

January 25, 2018

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K.A. v. Aviva Insurance Company of Canada (17-002023)

The claimant sought entitlement to three treatment plans. Adjudicator Avvy Go reviewed the medical evidence and determined that the claim for assistive devices was reasonable; however, the claim for chiropractic services was not reasonable. It was also noted that the claimant had not exhausted all previously approved treatment plans.

January 25, 2018

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J.R. v. Coachman Insurance Company (17-001154, 17-001337)

This is a reconsideration decision concerning procedural issues with respect to the submission of supplementary written submissions. Following an oral hearing, the parties were invited to submit supplementary written submissions. Due to a clerical error at the LAT's office, Adjudicator Shapiro ordered that the insurer file its submissions prior to the deadline that was ordered...

January 25, 2018

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A.B-H. v. Travelers (17-001856)

The claimant sought entitlement to one treatment plan. The insurer maintained a MIG position. Adjudicator Gemma Harmison reviewed the evidence of the claimant and determined that it was not enough to warrant removal from the MIG. The claim was dismissed.

January 24, 2018

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I.P. v. Aviva Canada Insurance (17-000465)

The insurer sought reconsideration of the underlying decision based on the adjudicator's failure to make a determination on the applicability of section 37(7) (the provision allowing the insurer to not pay IRBs until the claimant attended an IE); the adjudicator had only made an order regarding section 55 (that the claimant had to attend the...

January 24, 2018

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Applicant v. Brant Mutual Insurance Company (17-003105)

The claimant was injured in an accident in 2005. She applied for accident benefits with the insurer. She was assessed for attendant care benefits shortly after submitting the OCF-1. The insurer subsequently denied entitlement to ACBs in an OCF-9 dated April 6, 2005. In 2017, the claimant applied to the LAT for entitlement to ACBs,...

January 24, 2018

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Applicant v. Allstate Canada (17-004793)

The claimant sought entitlement to one treatment plan. The insurer denied the treatment plan as not being reasonable and necessary. Adjudicator Christopher Ferguson reviewed the evidence of each party and determined that the insurer's IE reports were more credible and the claimant's reports did not have corroborating support from clinical notes and records. The claim...

January 23, 2018

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Pagcaliwagan v. Aviva Insurance Company (17-003500)

The claimant sought to exclude addendum reports completed by the insurer's IE assessors, which were served three days after the ordered due date. Adjudicator Paluch held that the late addendum reports would be admissible at the hearing. He reasoned that the insurer had kept that claimant apprised of its intention to obtain the addendum reports,...

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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