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 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...

October 4, 2018

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Applicant v. Aviva Insurance Company (17-007820)

The claimant sought entitlement to non-earner benefits and the benefits proposed in three treatment plans. Adjudicator Mazerolle found that the claimant was not entitled to NEBs and two treatment plans for physiotherapy. The claimant was found entitled to the cost of a neurobiofeedback assessment.

October 4, 2018

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R.K. v. Aviva Insurance Company (16-003997)

The insurer sought reconsideration of the Tribunal's award of medical benefits, arguing that the claimant had not provided invoices evidencing that services were incurred. Associate Chair Jovanovic denied the reconsideration. He held that the adjudicator had considered and weighed the evidence and accepted that the medical treatment in dispute was reasonable, and that it was...

October 4, 2018

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X.L. v. Unifund Assurance Company (17-008769)

The insurer sought the production of records from all post-accident physicians identified on the OHIP summary. The claimant did not dispute the relevance, but argued that the production of all records would be disproportionate. The Case Conference adjudicator did not make an order for such records, and the insurer sought reconsideration. Associate Chair Jovanovic ordered...

October 3, 2018

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A.H. v. Aviva Insurance Canada (17-006373)

The claimant sought a determination that her impairments were outside of the MIG and entitlement to benefits proposed in one treatment plan. The respondent submitted that the claimant failed to provide any evidence to support her allegations of chronic pain and failed to comply with a case conference order to produce medical documents. The claimant...

October 3, 2018

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Applicant v. Aviva Insurance Canada (17-008086)

The claimant sought entitlement to non-earner benefits. Adjudicator Ferguson found that the claimant was not entitled to NEBs based largely on multidisciplinary IE assessments. Adjudicator Ferguson noted that the claimant's failure to produce ODSP records raised insurmountable doubts as to what her pre-accident level of housekeeping activity actually was. He found that without evidence of...

October 2, 2018

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Applicant v. Certas Home and Auto Insurance Company (17-000513)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to benefits proposed in two treatment plans. Adjudicator Punyarthi found that the claimant's injuries fell within the MIG and that the treatment plans in dispute were not payable as the MIG limits had been exhausted. Adjudicator Punyarthi decided not to...

October 2, 2018

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Applicant v. Certas Home and Auto Insurance Company (17-006892)

The claimant sought a determination that her impairments were outside of the MIG and entitlement to benefits proposed in one treatment plan. Adjudicator Mazerolle found that the claimant's injuries fell within the MIG and that the treatment plan in dispute was not payable as the MIG limits had been exhausted.

October 2, 2018

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S.C. v. Pembridge Insurance Company (17-007017)

The claimant sought entitlement to income replacement benefits for a period of 3 weeks and 4 days (from stoppage to return to work). Adjudicator Hans found that the claimant failed to establish that she was substantially unable to complete the essential tasks of her pre-accident employment, and the claimed benefits were not payable.

October 2, 2018

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Tomec v. Economical Mutual Insurance Company (2018 ONSC 5664)

The claimant was declared catastrophically impaired seven years after the accident. The insurer had denied entitlement to further attendant care benefits and housekeeping expenses at the 104 week anniversary. The claimant sought entitlement to ACBs and HK expenses from the 104 week anniversary onwards following the catastrophic impairment designation. The insurer argued that the claims...

October 2, 2018

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Lefebvre v. Aviva Insurance Company of Canada (2018 ONSC 5676)

The claimant sought judicial review of the Tribunal's decision that she could not pursue specified benefits because she had not completed and returned an election prior to applying to the LAT. The Court dismissed the review. The Court held that the claimant's failure to submit the election, contrary to section 35 of the SABS, meant...

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Contact Us

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

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150 York Street, Suite 1800
Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com