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.

June 7, 2018

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G.V. v. Northbridge General Insurance (16-001698)

The insurer sought reconsideration of the Tribunal's decision to issue a special award on medical benefits after the insurer removed the claimant from the MIG. Associate Chair Batty allowed granted the reconsideration and cancelled the special award. He held that the insurer's approval of benefits in advance of a hearing was insufficient to warrant a...

June 6, 2018

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A.C. v. Economical Mutual Insurance Company (17-005685)

The claimant sought entitlement to NEBs. The insurer argued that the claimant failed to dispute entitlement within two years of the denial. The claimant conceded that he had not disputed entitlement within two years, but argued that his claim was not discoverable during the period. Adjudicator Go held that the principles of discoverability did not...

June 6, 2018

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Applicant v. Aviva General Insurance (17-005010)

The insurer denied the claimant's entitlement to certain attendant care benefits. The claimant disputed the insurer's denial and argued that the payments were unreasonably withheld or delayed. With respect to the period of time from when the first Form 1 was provided by the claimant to the time when the claimant started to incur attendant...

June 6, 2018

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Applicant v. Wawanesa Mutual Insurance (17-002589)

The claimant sought entitlement to various medical benefits outside of the MIG. Adjudicator Sohal found that the claimant was outside of the MIG due to a pre-existing back injury that would prevent her from achieving maximal recovery if she were subjected to the MIG limits. The claimant had had three back surgeries prior to the...

June 5, 2018

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Applicant v. Aviva Insurance Canada (17-005667)

The insurer denied a number of treatment plans and costs of three assessments based on its finding that the claimant's injuries fell within the MIG. Adjudicator Boyce found that the claimant suffered from chronic pain which entitled him to treatment beyond the MIG. All of the medical benefits for physiotherapy were found reasonable and necessary....

June 4, 2018

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S.S. v. Aviva Insurance Canada (17-005998)

The insurer denied the claimant's entitlement to medical benefits for chiropractic treatment based on its finding that her injuries fell within the MIG. Arbitrator Grant held that the claimant's injuries fell within the MIG. As such, the claimant was not entitled to the medical benefits in dispute. Arbitrator Grant noted that while the clinical notes...

June 4, 2018

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Applicant v. Aviva Insurance Company of Canada (17-005179)

The insurer denied medical benefits for physiotherapy, the cost of an orthopedic assessment, and the cost of a chronic pain assessment based on its finding that the claimant's injuries fell within the MIG. The insurer also terminated the claimant's income replacement benefit approximately nine months after the accident on the recommendations made in three IE...

June 1, 2018

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Applicant v. Aviva Insurance Canada (17-005672)

The insurer denied entitlement to medical benefits for chiropractic services and the cost of a psychological assessment based on its finding that the claimant's injuries fell within the MIG. Adjudicator Kepman held that the claimant's injuries fell within the MIG and therefore the treatment plans at issue were not payable. The claimant argued that a...

June 1, 2018

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Applicant v. Wawanesa Mutual Insurance Company (17-005427)

The claimant sought entitlement to an income replacement benefit from the time the benefit was terminated approximately one year and one month following the accident onward, and entitlement to medical benefits for chiropractic services, psychological services, and custom orthotics. Adjudicator Sewrattan held that the claimant was not entitled to any of the benefits in dispute....

June 1, 2018

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Applicant v Coachman Insurance Company (17-004906)

The self-employed claimant and insurer disagreed about the quantum of IRBs; the claimant also sought interest on medical benefits approved shortly before the hearing, and a special award. Adjudicator Victor held that it was reasonable to base IRB calculations on the year prior's gross business income as contemplated in s.4(3) of the SABS, and as...

June 1, 2018

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Applicant v. Aviva Insurance Canada (17-006757)

The insurer approved and paid NEBs and medical benefits shortly before a hearing. The claimant argued that he was still entitled to a special award. The insurer argued that the Tribunal had no jurisdiction to make the award since all benefits had been paid. Adjudicator Paluch agreed with the claimant that the Tribunal had jurisdiction...

May 31, 2018

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Applicant v Aviva Insurance Canada (17-007873)

The claimant sought medical benefits for chiropractic treatment. Adjudicator Kershaw held that the claimant was not entitled to the treatment because she did not prove that the treatment plan was reasonable and necessary. The claimant's treating physician only recommended a splint and possible surgery for her left hand and stated that additional massage therapy could...

May 30, 2018

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Applicant v Peel Mutual Insurance Company (17-003087)

The claimant sought various medical and rehabilitation benefits, costs of moving, and interest on the overdue payment of benefits. Adjudicator Parish held that the claimant did not demonstrate that the medical/rehabilitation benefits in dispute for physical therapy and online classes were reasonable and necessary. The treatment plans for online courses were premature at the time...

May 30, 2018

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Applicant v Aviva Insurance Canada (17-004824)

The claimant argued that she was diagnosed with a psychological impairment and chronic pain syndrome which did not fall within the MIG and appealed the insurer's denial of physiotherapy treatment, costs of examinations, out of pocket expenses, and interest on overdue amounts. Adjudicator Létourneau held that the claimant had chronic neck pain which fell within...

May 29, 2018

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Applicant v. Aviva Insurance Company (17-004497)

The claimant sought entitlement to an orthopaedic assessment. Adjudicator Kershaw concluded that it was payable because at the time it was proposed, the claimant was experiencing ongoing pain which might have related to an orthopaedic injury.

May 29, 2018

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C.L. v. State Farm Insurance Company (16-003195)

The insurer sought reconsideration of the Tribunal's award of ongoing NEBs. The Tribunal had found that despite the claimant's ability to participate in most of her pre-accident activities, the claimant was so restricted that she could not be seen as engaging in those activities. The insurer argued that the Tribunal had failed to consider relevant...

May 28, 2018

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Applicant v. RBC General Insurance (17-005218)

The claimant sought medical benefits for a psychological assessment and psychological treatment and interest. The insurer maintained that the claimant's injuries fell within the MIG and the disputed medical benefits were not payable. Adjudicator Sharma concluded that the claimant's injuries fell within the MIG and dismissed the claimant's application. Adjudicator Sharma preferred the evidence of...

May 28, 2018

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Applicant v Aviva General Insurance (17-006243)

The claimant sought medical benefits for chiropractic services and interest on overdue amounts. Adjudicator Punyarthi held that the treatment plan was neither reasonable nor necessary and that the claimant was not entitled to interest. In support of her claim, the claimant relied on a physician's report that made a number of treatment recommendations. However, the...

May 28, 2018

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Applicant v RBC General Insurance (17-005218)

The claimant sought medical benefits for psychological issues, interest on the overdue payment of benefits, and a special award. The insurer argued that the claimant's injuries fell within the MIG. Adjudicator Reilly held that the claimant was entitled to medical benefits for a psychological examination and psychological treatment as both were reasonable and necessary. The...

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...

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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