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 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...

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...

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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