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 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,...

January 23, 2018

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P.K. v. Unica Insurance Inc. (17-005397)

The insurer sought an order for a number of documents (which the claimant undertook to provide during the Case Conference) and the particulars of the special award claim. Adjudicator Ferguson granted the insurer's motion, and ordered the claimant to produce the requested documentation within seven days, and to provide the particulars of the special award...

January 22, 2018

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J.T. v. Aviva Canada Inc. (16-003674)

The claimant sought reconsideration of the underlying Tribunal decision, in which the adjudicator concluded that the ATV the claimant was occupying at the time of the accident was not an "automobile," and that the claimant was therefore not entitled to accident benefits. Executive Chair Lamoureux allowed the reconsideration and remitted the matter to a new...

January 22, 2018

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D.W. v. The Co-operators (17-000388)

The claimant sought reconsideration of the Tribunal's denial of IRBs. The crux of the issue was whether the claimant could claim IRBs after the first 104 weeks without first receiving IRBs during the first 104 weeks. The Tribunal initially ruled that the claimant could not seek IRBs. Executive Chair Lamoureux confirmed the result, but on...

January 22, 2018

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Applicant v. Unica Insurance Company (17-002059)

The insurer sought to have the application dismissed on the basis of the claimant's failure to attend the hearing. Adjudicator Maedel held that the claimant had abandoned his application, and had failed to substantiate his claims. The matter was dismissed.

January 22, 2018

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J.T. v. Aviva Canada Inc. (16-003674)

The claimant sought reconsideration of the underlying Tribunal decision, in which the adjudicator concluded that the ATV the claimant was occupying at the time of the accident was not an "automobile," and that the claimant was therefore not entitled to accident benefits. Executive Chair Lamoureux allowed the reconsideration and remitted the matter to a new...

January 22, 2018

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D.W. v. The Co-operators (17-000388)

The claimant sought reconsideration of the Tribunal's denial of IRBs. The crux of the issue was whether the claimant could claim IRBs after the first 104 weeks without first receiving IRBs during the first 104 weeks. The Tribunal initially ruled that the claimant could not seek IRBs. Executive Chair Lamoureux confirmed the result, but on...

January 19, 2018

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Applicant v. TTC Insurance Company Limited (17-002561)

The claimant sought a declaration that she suffered a catastrophic impairment as a result of the accident, and entitlement to a psychological paper review. The claimant had submitted two OCF-19s - the first alleged a catastrophic impairment due to a 55 percent Whole Person Impairment; the second alleged a catastrophic impairment due to a Class...

January 18, 2018

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Applicant v. Aviva Insurance Company (17-001007)

The claimant sought removal from the MIG and entitlement to two treatment plans for physical therapy. Adjudicator Watt held that the claimant's injuries fell within the MIG and wrote that the claimant had not explained why her pre-existing obesity, hypertension, and sciatic nerve problems would prevent maximal recovery under the MIG. He favoured the opinions...

January 17, 2018

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K.S.Y. v. Aviva Insurance Canada (16-003903)

The claimant sought a determination that her impairments were outside of the MIG and entitlement to benefits proposed in two treatment plans for physical rehabilitation and one treatment plan for a psychological assessment. The insurer raised a preliminary issue, submitting that the claimant was precluded from adjudicating the issues in dispute for failure to attend...

January 17, 2018

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T.H. v. Aviva Insurance (17-001125)

The claimant sought entitlement to non-earner benefits. The insurer argued the claimant had not suffered a complete inability to carry on a normal life. Adjudicator Robert Watt applied the factors found in the Ontario Court of Appeal decision of Heath v. Economical and determined that the claimant failed to meet the burden of proof. The...

January 16, 2018

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Applicant v The Guarantee Company of North America (17-002558)

The applicant sought medical benefits for physiotherapy services. The respondent brought a motion to strike the applicant's reply. The applicant filed a response to the motion to strike a day after the deadline. Adjudicator Goela held that despite being late, she would consider the applicant's response as it did not prejudice the respondent. Adjudicator Goela...

January 16, 2018

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Unifund Assurance Company (17-001773)

The insurer sought repayment of income replacement benefits. Adjudicator Robert Watt reviewed the jurisprudence of section 52 and noted that a proper repayment notice should include: (i) identification of the type of benefit that was overpaid, (ii) the payment period for which repayment is sought, (iii) the amount of repayment sought, and (iv) the amount...

January 16, 2018

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C.W. v. Unifund Assurance Company (16-003336)

The insurer sought reconsideration of the Tribunal's decision that the claimant's injuries were non-minor due to a partial shoulder tear and pre-existing back pain. Executive Chair Lamoureux dismissed the reconsideration. She held that the Tribunal's decision was based on the evidence before it and that the Tribunal was entitled to weight the contradicting evidence as...

January 16, 2018

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Applicant v. Aviva Insurance Canada (16-003323)

The claimant sought entitlement to non-earner benefits, as well as a number of medical treatment plans. The insurer denied entitlement to all claims. Adjudicator Rebecca Hines reviewed the medical evidence and determined the claimant failed to prove the treatment plans were reasonable and necessary, and also failed to establish a complete inability to carry on...

January 16, 2018

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A.R. v. Wawanesa Mutual Insurance Company (17-000149)

The claimant sought entitlement to two proposed orthopaedic assessments. Adjudicator Msosa denied both assessments. He first wrote that without the treatment plans before him, he could not determine whether they were reasonable. He also accepted the opinion of the insurer's expert that the claimant had not sustained orthopaedic injury in the accident and there was...

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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