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.

January 19, 2023

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Shaikh v. Economical Insurance Company (20-009837/AABS)

The claimant brought a LAT application to dispute NEBs and his MIG designation. Adjudicator Flude found that the claimant was not entitled to NEBs because he had failed to submit a signed application for NEBs until June 8, 2020, approximately a year after the accident of July 16, 2019. Adjudicator Flude confirmed that an application...

January 19, 2023

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Han v. Wawanesa Mutual Insurance Company (21-014475)

The claimant disputed entitlement to a physiatry assessment proposed three years after the accident but which was never incurred. Because the LAT dispute would not be determined until after the expiry of the five year policy period, the insurer brought a motion arguing that the disputed assessment could not be awarded because it was not...

January 18, 2023

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Mbarak v. Wawanesa Mutual Insurance Company (20-014858/AABS)

The claimant was involved in an accident in 2016 and applied to the LAT seeking a CAT designation. The Tribunal found that the claimant had a CAT impairment as a result of one marked impairment in Adaptation. The adjudicator noted that the claimant could not return to work, had poor memory and recall, and was...

January 18, 2023

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Prillo v. Coseco Insurance Company (20-014401/AABS-R)

The claimant filed a request for reconsideration arising from an October 14, 2022 decision, in which Adjudicator Pahuta ruled that the claimant sustained "minor injuries" and was not entitled to further treatment outside of the MIG. The claimant filed for reconsideration under Rule 18.2 (b), alleging that Adjudicator Pahuta made an error of law or...

January 17, 2023

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Chavez v. Unifund Assurance Company (20-011594/AABS)

The insurer raised a preliminary issue and argued that the claimant's claim for NEBs was statute barred. The claimant had failed to submit an OCF-3 with her application pursuant to s. 36 and had failed to apply to the LAT within two years of its refusal to pay NEBs pursuant to s. 56 of the...

January 16, 2023

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Jeffery v. Travelers Insurance Company of Canada (20-013979/AABS)

The claimant was denied IRBs and medical benefits and sought entitlements to the benefits along with a Special Award from the Tribunal. The Tribunal held that the claimant was not entitled to IRBs or medical benefits for physiotherapy treatment. The adjudicator held that since no benefits were owed to the claimant, a s. 10 award...

January 16, 2023

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Adjetey v. Economical Insurance (22-000712)

This is a preliminary decision regarding late notice to the insurer. The claimant applied for accident benefits two years after the accident. Section 32(1) of the SABS provides that the insured must give notice of the intention to claim benefits within 7 days of the loss date. The claimant conceded that they were two years...

January 13, 2023

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Hordo v CAA Insurance Company (20-012761/AABS0

The claimants were involved in an accident. They filed an application, and the LAT found that they were not entitled to non-earner benefits, housekeeping/home maintenance benefits, interest, a special award, or costs. The claimants filed for reconsideration. Their request for reconsideration was denied. Vice-Chair Moore did not find a violation of procedural fairness, as the...

January 13, 2023

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Stoppard v. Economical Insurance, (21-006374/AABS-PI)

The claimant was involved in an accident. She incurred transportation expenses in relation to her hip replacement surgery, and submitted these expenses to her insurer. The insurer denied payment of the transportation expenses as the records did not support that the surgery was required as a result of the accident. The claimant submitted an additional...

January 13, 2023

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Delena v. Aviva Insurance Company (19-007957/AABS)

The claimant filed an Application disputing entitlement to NEBs, interest and sought costs under Rule 19. The claimant relied on limited medical evidence, including some diagnostic reports, an OT functional assessment, and doctors' records. The claimant argued that his accident-related injuries resulted in a complete inability to carry on a normal life. The insurer argued...

January 13, 2023

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Steele v. Aviva General Insurance (21-007268/AABS)

The claimant filed a LAT Application disputing entitlement to NEBs, interest, and a special award. The claimant testified that although she was able to do things, she was not able to totally engage in all of her pre-accident activities due to pain. For example, the claimant noted that she had "some" limitations with respect to...

January 13, 2023

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Intact Insurance Company v. Hashemi (20-011873)

The insurer applied to the LAT seeking repayment of benefits after concluding that the claimant was involved in a staged accident. The insurer sought repayment of accident benefits, examination costs, and other expenses (including EUO expenses and engineering expert expenses). Adjudicator Kepman accepted that the claimant made wilful material misrepresentations regarding the accident. However, only...

January 12, 2023

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Russell v. Dumfries Mutual Insurance Company (20-004264/AABS)

The claimant applied to the LAT for a CAT designation, ACBs, and medication. The adjudicator found that the claimant did have a CAT impairment under Category 8 and was entitled to receive ACBs and medication. The Tribunal rejected the insurer's argument that the pre-accident family death was the cause of the claimant's psychological impairment. The...

January 12, 2023

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Ding v. Wawanesa Insurance (20-008236/AABS)

The LAT was asked to determine whether the claimant was entitled to IRBs in the amount of $400 per week. The claimant relied on the submission of medical evidence to demonstrate that he suffered a substantial inability to perform the essential tasks of his self-employment as a result of the accident. The claimant also argued...

January 11, 2023

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Nassan v. Intact Insurance Company (20-010691/AABS)

The claimant applied to the LAT disputing his CAT denial under Criterion 8. The Tribunal held that the claimant did not sustain a CAT impairment under the SABS. The claimants had an unfortunate series of prior events before the MVA including being subject to torture and having to flee to Canada. The adjudicator determined that...

January 10, 2023

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Zhang v. Aviva Insurance Company (21-004454/AABS)

The claimant was denied benefits for non-compliance with s. 44 of the SABS after failing to attend psychological and physical insurer’s examinations . The claimant appealed to the LAT and was found statute-barred based on the two-year limitation period and non-compliance with s. 44. The limitation period was paused under O.Reg 73/20 due to COVID-19....

January 9, 2023

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Liu v. Certas Direct Insurance Company (20-012975/AABS)

The claimant disputed entitlement to NEBs, several treatment plans, and whether her injuries fell under the MIG. Adjudicator Maedel found that the claimant's injuries fell outside of the MIG due to psychological impairments. Despite the insurer's arguments that the claimant's psychological report was based entirely on subjective reporting and not on contemporaneous medical records, Adjudicator...

January 9, 2023

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Smith v. Intact Insurance, (21-005342/AABS – PI)

The claimant submitted an application for determination of catastrophic impairment. The insurer scheduled two IEs (psychological and occupational therapy), which the claimant attended. However, Dr. Kiss (psychologist) passed away before he could complete his report, and the insurer determined that the claimant had not meaningfully participated in the situational portion of the OT IE. The...

January 9, 2023

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Bennett v. The Co-operators (20-014453/AABS)

The claimant filed a LAT Application disputing several OCF-18s with interest. A special award was also claimed. The claimant argued that her worsening pre-accident fibromyalgia had resulted in numerous falls prior to the accident which required physical treatment. The main issue was payment of an OCF-18 for an attendant care assessment. The assessment had been...

January 9, 2023

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Katsiashvili v. Economical Mutual Insurance (21-015596)

The insurer argued that the claimant was not involved in a legitimate accident, pointing to inconsistencies is the material facts leading up to the accident, the description of the accident, and the injuries sustained. Adjudicator Kaur rejected the insurer's position, holding that the inconsistencies were minor, or were immaterial, or were not in fact inconsistencies...

January 9, 2023

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Elkhidir v. Intact Insurance Company (20-011803/AABS)

The claimant was injured in a motor vehicle accident and applied to the LAT for IRBs. Section 36(2) of the Schedule mandates that an applicant seeking IRBs shall submit a completed OCF-3 with their application for benefits, and that there can be no entitlement to IRBs for any period before the OCF-3 is submitted. A...

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com