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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May 28, 2018

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Applicant v. Aviva General Insurance (17-005176)

The claimant sought entitlement to various medical benefits and cost of examinations related to an alleged knee injury. Adjudicator Ferguson held that the knee impairment was not caused by the accident, and the disputed treatment plans were not payable. However, he also concluded that one of the examinations was not properly denied by the insurer,...

May 28, 2018

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Applicant v. Northbridge Insurance Company (17-002232)

The claimant sought entitlement to IRBs and to the cost of his US hospital bill. Adjudicator Shapiro denied both claim. In terms of the IRBs, Adjudicator Shapiro held that the claimant did not suffer a substantial inability to return to work as a truck driver based on IE opinion and surveillance evidence of the claimant...

May 28, 2018

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Applicant v. Certas Direct Insurance Company (17-003553)

The claimant sought entitlement to IRBs and a special award. The insurer sought repayment for an overpayment of IRBs. Adjudicator Anwar found that the claimant was not entitled to IRBs because she did not suffer a substantial inability to perform the essential tasks of her pre-accident job; a special award was also denied. The insurer...

May 25, 2018

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N.F. v. Aviva Insurance Canada (17-000456)

The insurer sought reconsideration of the Tribunal's decision that the claimant's failure to include a police report was not fatal to his application to the Motor Vehicle Accident Claims Fund. Executive Chair Lamoureux upheld the Tribunal's decision. Despite an application being incomplete, section 32 triggered the insurer's responsibility to determine whether a benefit was payable....

May 25, 2018

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Aviva Insurance Canada v G.P. (16-004349)

The claimant sought reconsideration of the Tribunal's decision ordering him to repay IRBs to the insurer. The insurer had voided the claimant's insurance policy after he had failed to notify the insurer of a change in a risk material to that policy. The claimant argued that a third party was at fault for the failure...

May 25, 2018

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Applicant v. Aviva General Insurance (17-004389)

The claimant sought entitlement to IRBs for the pre- and post-104 week period. Adjudicator Ferguson held that the claimant did not suffer a physical inability to engage in his job as a realtor, but did suffer a psychological impairment preventing him from returning to work. Adjudicator Ferguson accepted that there were other stressors in the...

May 24, 2018

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Applicant v. Aviva Insurance Canada (17-007683)

The claimant sought payment for IRBs. The respondent brought a preliminary issue motion seeking to bar the claimant from commencing her application because she failed to attend IE assessments. Adjudicator Ferguson concluded that the insurer's IE notices were compliant with s. 44 of the SABS. Adjudicator Ferguson concluded that the claimant's application was not allowed...

May 24, 2018

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Applicant v. Unifund Assurance Company (17-004690)

The claimant first applied for accident benefits five and a half years after the accident. The insurer did not indicate that the claim was being denied due to its lateness. Once a LAT application was filed, the insurer argued that the claimant was not entitled to claim accident benefits because of the delay in application....

May 23, 2018

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N.A. v. RBC Insurance Company (17-005380)

The claimant sought payment for a TMJ assessments and oral orthotics. The insurer argued that the claimant's dental impairments were not accident-related. The Adjudicator concluded that on either the "but for" test or the "material contribution" test the claimant's dental impairments were not caused by the accident. In reaching her conclusion, the Adjudicator relied on...

May 23, 2018

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V.S. v. Economical Mutual Insurance Company (17-000751)

The central issue in this dispute was the quantum of IRBs payable. The insurer sought repayment for IRBs in the amount of $6,535.62 due overpayment based on the claimant's post-accident income. The dispute proceeded to an oral hearing. At the hearing, a timetable was set for written submissions. The claimant filed reply submissions 40 days...

May 23, 2018

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Applicant v. Aviva Insurance Company (17-004828 )

The claimant and insurer disagreed over the payment of seven disputed medical and rehabilitation benefits, including the cost of IV injections, the cost of an EEG assessment, the cost of a functional abilities evaluation and the cost of a dietician assessment. The insurer submitted that the disputed benefits were not reasonable and necessary and relied...

May 23, 2018

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N.P. v. Motor Vehicle Accident Claims Fund (17-005135)

The claimant was roller blading along a sidewalk when a van allegedly cut in front of him, causing the claimant to fall to the ground. The claimant did not impact the van. The insurer argued that the incident did not occur as reported, and that if it did, it did not qualify as an accident....

May 18, 2018

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Applicant v. Wawanesa Mutual Insurance Company (17-005611)

The claimant had an ongoing FSCO arbitration regarding entitlement to attendant care benefits in the first 104 weeks of her claim. She filed an application with the LAT for entitlement to attendant care benefits beyond the 104 week date. The insurer brought a motion to stay the LAT application under the FSCO matter was resolved,...

May 18, 2018

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A.H. v. TD Home and Auto Insurance Company (17-006678)

The claimant sought an order that she be entitled to record two IEs. Adjudicator Sewrattan held that the LAT did not have jurisdiction to make such an order and dismissed the motion.

May 17, 2018

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R.T. v. Aviva Insurance Canada (17-004564)

The claimant sought a entitlement to income replacement benefits. At the outset of the hearing, the insurer sought an order dismissing the application as abandoned because the claimant had not submitted written submission prior to the oral hearing, as ordered at the case conference. In the alternative, the insurer sought to have any further evidence...

May 17, 2018

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Applicant v. Northbridge Insurance Company (17-005435)

The claimant sought entitlement to NEBs. Adjudicator Mather was satisfied that the claimant suffered an aggravation of pre-existing neck and back pain, but concluded that the claimant had not proven that she met the complete inability test. The claimant remained independent in all aspects of personal care. She continued to provide childcare to her granddaughter....

May 17, 2018

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L.Y.T. v. RBC Insurance Company (17-007019)

The claimant sought entitlement to attendant care benefits and a special award. The claimant claimed that her son resigned from his employment to provide her with attendant care. Adjudicator Sewrattan found that the claimant was not entitled to payment for attendant care as she had not proven that she received attendant care services from her...

May 16, 2018

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Applicant v. Coachman Insurance Company (16-003306)

The claimant sought entitlement to removal from the MIG, IRBs, ACBs, medical benefits, and special award. He argued that he sustained a fractured sternum, a concussion, and major depressive disorder as a result of the accident. Despite an IE assessor concluding that the fractured sternum was related to the accident, the insurer concluded otherwise based...

May 15, 2018

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Applicant v. Pembridge (17-005544)

The claimant sought removal from the MIG and entitlement to four medical benefits. Adjudicator Purdy concluded that the claimant did not suffer chronic pain or psychological impairments as a result of the accident, and that such injuries arose from an unrelated workplace incident.

May 15, 2018

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Applicant v. Aviva Insurance Canada (17-004001)

The claimant sought entitlement to one treatment plan for chiropractic services. The claimant was being treated outside of the MIG as a result of a psychological impairment. Adjudicator Fircot found that the claimant had not proven on a balance of probabilities that the proposed treatment was reasonable and necessary. The claimant's claim was denied.

May 11, 2018

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Applicant v. Aviva Insurance Canada (17-006480)

The claimant sought entitlement to an OCF-18 proposing psychological treatment. Adjudicator Boyce found the proposed psychological treatment to be reasonable and necessary because he found the the claimant's self-reporting of cycling-specific fear to be consistent and compelling, and he preferred the s. 25 psychology report to the s. 44 psychology report. Adjudicator Boyce rejected the...

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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