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 18, 2018

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The Applicant v. Aviva Insurance Canada (17-006136)

The claimant sought a determination that his impairments were outside of the MIG as well as entitlement to medical benefits proposed in ten treatment plans. The claimant argued that he should be removed from the MIG due to chronic pain. When assessing the claim of chronic pain, Adjudicator Ferguson applied the following criteria: i) Does...

June 18, 2018

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Applicant v. Aviva General Insurance (17-005091)

The insurer denied a treatment plan for chiropractic treatment and the cost of an examination based on its finding that the claimant's injuries fell within the MIG. The claimant disputed the insurer's denials. Adjudicator Driesel found that the claimant's injuries fell within the MIG. Specifically, Adjudicator Driesel rejected the claimant's assertion that pre-existing conditions precluded...

June 14, 2018

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Applicant v. Aviva Insurance Company of Canada (17-004147)

The claimant sought removal from the MIG and entitlement to IRBs and various medical benefits. The insurer argued that the claimant failed to attend an IE, which barred payment of further IRBs. Adjudicator Norris concluded that the claimant did not suffer pre-existing conditions that would prevent recovery under the MIG and that the claimant did...

June 13, 2018

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M.R. v Aviva Insurance Canada (17-005284)

The insurer denied payment for non-earner benefits. The applicant appealed and sought payment of NEBs. Adjudicator Sewrattan held that the applicant was not entitled to NEBs as she did not prove she was continuously prevented from engaging in substantially all of her pre-accident activities. The adjudicator relied on the applicant's statements to IE assessors that...

June 13, 2018

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Applicant v. Allstate Insurance Company of Canada (17-006563)

The claimant had purchased optional benefits set out at section 28(1) 5 of the SABS and sought entitlement to payment of case management services, despite not suffering a catastrophic impairment. The insurer argued that case management services were only available if the claimant suffered a catastrophic impairment. Adjudicator Parish agreed with the insurer. She held...

June 7, 2018

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D.M. v Aviva Insurance (17-003463)

The claimant sought entitlement to NEBs, attendant care, two medical benefits, interest, and costs. Adjudicator Johal found the claimant's complaints of pain to be credible, but did not find that his pain-related restrictions equated to a complete inability to carry on a normal life; as such, the claimant's entitlement to NEBs was denied. However, Adjudicator...

June 7, 2018

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I.K. v. Coseco Insurance Company (17-004897)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to medical benefits proposed in five treatment plans. The claimant argued that he should be removed from the MIG due to psychological impairments, chronic pain, and pre-existing migraines and left wrist/arm pain. Adjudicator Boyce found that pursuant to s. 55(1)2...

June 7, 2018

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Applicant v. Aviva Insurance Canada (17-007036)

The claimant sought entitlement to IRBs, occupational therapy treatment, the cost of an in-home occupational therapy assessment, and a special award. The respondent submitted that the claimant was barred from filing a LAT application due to failure to attend a s. 44 assessment, pursuant to s. 55 of the SABS. The s. 44 assessment had...

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...

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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