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.

April 3, 2018

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Applicant v. CUMIS General Insurance (17-002592)

The claimant sustained serious injuries and required 24 hour care. She moved homes to receive care from her father. The claimant and insurer disputed how much money the claimant was entitled to for the cost of rent (as a rehabilitation benefit). The claimant argued that she was entitled to the full cost. The insurer argued...

April 3, 2018

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Applicant v. TD Insurance (17-005449)

The insurer brought a motion arguing that the LAT could not adjudicate a catastrophic impairment dispute without some other benefits also being in dispute. Adjudicator Ferguson rejected the insurer's position and held that the LAT does have jurisdiction to determine whether a claimant is catastrophically impaired regardless of any entitlement to benefits being disputed.

March 29, 2018

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Applicant v. Certas Direct Insurance Company (17-005290)

The claimant sought removal from the MIG and entitlement to three medical benefits. Adjudicator Parish concluded that the claimant's injuries fell within the MIG. She held that the claimant did not suffer psychological injuries or chronic pain. She noted that the claimant's assessors did not adequately consider objective findings and relied upon subjective reporting without...

March 29, 2018

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N.K. v. Certas Home and Auto Insurance (17-004337 and 17-004343)

The claimant, represented by counsel, entered into a settlement agreement with respect to LAT applications for disputed entitlement to various benefits. The claimant executed a full and final release and a settlement disclosure notice, and the LAT was notified that the claimant was withdrawing his applications. The claimant subsequently informed the LAT that he wished...

March 29, 2018

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T.H. v. The Personal Insurance Company (17-000121)

The insurer sought to rely on section 38(2) of the Schedule as a defence, asserting that the claimant incurred the expense of an assessment in dispute prior to submitting the OCF-18 to the insurer for approval. The claimant brought a motion for a declaration precluding the insurer from relying on the defence for a number...

March 29, 2018

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Applicant v. Aviva Insurance Canada (17-004325)

The claimant sought a declaration that her injuries were not predominantly minor injuries to be treated within the MIG, as well as entitlement to medical benefits for treatment. Adjudicator Watt held that the claimant was not entitled to any of the relief sought. The applicant failed to adduce any medical evidence to indicate that her...

March 27, 2018

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Applicant v. Aviva General (17-004847)

The claimant sought entitlement to various medical benefits, the costs of a chronic pain assessment, treatment outside of the MIG, and interest. Upon weighing the medical evidence, Adjudicator Boyce determined that the claimant's chronic pain warranted treatment outside of the MIG. Moreover, Adjudicator Boyce found the requested chronic pain assessment was reasonable and necessary. Adjudicator...

March 27, 2018

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V.K. v. Allstate Insurance Company (16-004273)

The claimant sought entitlement to attendant care benefits and medical benefits for vision-related expenses and transportation expenses. Adjudicator Truong held that the claimant was not entitled to any of the benefits or expenses at issue. The claimant's mother provided her with attendant care; however on the limited and unreliable evidence before the adjudicator, the claimant...

March 27, 2018

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Applicant v. Certas Home and Auto Insurance Company (17-003172)

The claimant sought entitlement to further income replacement benefits and the insurer sought repayment of IRBs it paid to the claimant calculated on the understanding that he was an employee rather than self-employed. The claimant did not return to work after the accident citing his daily use of marijuana to control his anxiety, depression, stress,...

March 27, 2018

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Applicant v. Aviva Insurance Canada (17-003724)

The claimant sought removal from the MIG and entitlement to psychological treatment. Adjudicator Grant concluded that the insurer failed to respond to the treatment plan within 10 days. Even though the treatment plan was denied on HCAI, no letter with the medical and other reasons for the denial was sent to the claimant until two...

March 26, 2018

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Applicant v RBC General Insurance Company (17-005285)

The claimant argued that his injuries fell outside the MIG and sought medical benefits. Adjudicator Mazerolle held that the claimant's injuries fell within the MIG. Adjudicator Mazerolle preferred the insurer's psychological assessment that noted the claimant exhibited adjustment reactions which were mild symptoms and treatable within the MIG. The insurer's report relied on seven psychometric...

March 26, 2018

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Applicant v. Certas Home and Auto Insurance Company (17-004519)

The claimant sought removal from the MIG and entitlement to seven disputed medical benefits. He argued that he suffered psychological injuries and chronic pain. Adjudicator Ferguson rejected the claims. He held that the claimant failed to provide evidence of psychological impairment. He also held that claimant failed to prove that his pain symptoms were not...

March 23, 2018

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Applicant v. Aviva Insurance (17-006160)

The claimant sought entitlement to various medical benefits, a special award, and interest. The claimant raised a procedural issue, and asked the Tribunal to disregard attachments appended to the insurer's written submissions, as they had not been transmitted properly via facsimile to the claimant; the attachments had been provided via mail several days later. Adjudicator...

March 21, 2018

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I.A. v. Allstate Insurance (17-006850)

The claimant sought entitlement to attendant care benefits as well as the benefits proposed in four treatment plans. Adjudicator Watt found that none of the benefits in dispute were reasonable and necessary as a result of the accident. Adjudicator Watt further noted that the claimant had not submitted a Form 1 or attendant care assessment...

March 20, 2018

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F.A. v. Aviva General Insurance (17-006302)

Seven days prior to an in-person hearing, the claimant brought a motion requesting an Order to add a special award to the issues in dispute and an Order for leave to examine the insurer's claims adjuster. Adjudicator Maedel granted both requests.

March 19, 2018

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Applicant v. Western Assurance (17-005066)

The insurer raised two preliminary issues in advance of a hearing. The first issue was whether the claimant was prevented from appealing the insurer's refusal to pay a number of claims because she failed to commence her appeal within two years of the date her claims for benefits was denied. Adjudicator Ferguson held that the...

March 16, 2018

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Applicant v. Royal and Sun Alliance (17-003732)

The minor claimant sought entitlement to NEBs, and four treatment plans. The insurer argued that the claim for NEBs was time barred, and that the claimant's injuries fell within the MIG. Adjudicator Hines held that the two year limitation period did not apply to the minor claimant until she hit the age of majority. She...

March 16, 2018

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Applicant v. Allstate Canada (16-004348)

The claimant sought entitlement to two treatment plans for chiropractic services. Adjudicator White held that the claimant was not entitled to the recommendations proposed in the treatment plans in dispute. The claimant did not meet her onus in establishing the reasonableness or necessity of the plans. There was no evidence that the claimant had benefitted...

March 15, 2018

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Applicant v. Primmum Insurance Company (18-000727)

The claimant's son sought an order appointing him as administrator of the estate and requested that the matter continue with him acting as administrator. Adjudicator Hunter ruled that the Tribunal did not have jurisdiction to appoint an administrator. She ruled that the son could represent the estate if he obtained the consent of all beneficiaries...

March 15, 2018

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Applicant v. Aviva Insurance Canada (17-002957)

The claimant sought entitlement to treatment outside of the MIG, attendant care benefits, medical benefits, the costs of three examinations, and a special award. After a review of the medical evidence, Adjudicator Anwar preferred the reports of the claimant's specialists and held that the claimant's injuries warranted treatment outside of the MIG. Adjudicator Anwar further...

March 15, 2018

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S.H. and H.S. v. Northbridge Personal Insurance Corporation (2018 ONSC 1801)

The insurer sought judicial review of the Tribunal's decision in which the two claimants were permitted to opt out of WSIB and seek accident benefits. The Court upheld the Tribunal's decision. The Court held that the standard of review is reasonableness, and that an appeal could only be made on a point of law. The...

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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