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 29, 2018

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Applicant v. Wawanesa (17-000565)

The claimant sought entitlement to a number of medical treatment plans. The insurer asserted a MIG position. Adjudicator Billeh Hamud reviewed the medical evidence and found the claimant's injuries to be predominantly minor. Adjudicator Hamud also reviewed surveillance footage and social media evidence and found the credibility of the claimant to be negatively impacted. None...

January 29, 2018

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Applicant v. Aviva Insurance Canada (17-001040)

The claimant sought entitlement to a number of medical treatment plans. The insurer denied each as not being reasonable and necessary. Adjudicator Eleanor White reviewed the medical evidence and found half of the treatment plans reasonable and necessary. Interest, in accordance with section 51, was awarded on the payable benefits.

January 28, 2018

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T. T. v. Aviva Insurance Canada (17-002535)

The claimant sought entitlement to a number of medical treatment plans. The insurer denied the treatment and asserted a MIG position. The insurer also tendered surveillance in support of its position, to which the claimant sought to exclude on the basis of bad faith. Adjudicator Avvy Go determined that the surveillance was in contravention of...

January 26, 2018

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Applicant v. TD Insurance (17-003356)

The claimant sought entitlement to medical benefits, including a number of prescription expenses. The insurer raised a causation argument as the claimant's medical history was littered with previous MVAs and workplace injuries. The claimant countered by noting the insurer previously approved treatment, which would suggest the insurer accepted the subject motor vehicle accident as the...

January 26, 2018

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Applicant v. Certas Home and Auto Insurance (17-001228)

The claimant sought entitlement to a number of medical benefits. The insurer denied the treatment asserting the claims were not reasonable and necessary. On review of the medical evidence, Adjudicator Eleanor White determined that the medical benefits sought were payable, with the exception of a neuropsychological examination. A gym membership and assistive devices were also...

January 26, 2018

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Applicant v. Allstate Insurance Company of Canada (17-001523)

The claimant sought entitlement to a number of medical benefits, as well as attendant care benefits. The insurer denied the medical treatment asserting the claims were not reasonable and necessary. The insurer also denied the claimant's attendant care claim and cited a lower attendant care rate commissioned by an IE assessor. Adjudicator Billeh Hamud reviewed...

January 25, 2018

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D.F. v. Gore Mutual Insurance Company (17-002799)

The claimant filed a LAT application on May 4, 2017, seeking entitlement to NEBs. A written preliminary issue hearing was scheduled to determine whether the claimant was precluded from bringing the application to the LAT, pursuant to s. 56 of the SABS, for failure to dispute the denial of benefits within two years. The insurer...

January 25, 2018

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N.J. v. Aviva Insurance Canada (17-002841)

The claimant's mother died in an accident. The claimant sought payment of death benefits. The insurer denied the benefits, arguing that the claimant was not a dependent of her mother. Adjudicator Watt agreed with the insurer. He noted that while the claimant lived with her mother and did not pay rent, the claimant had earned...

January 25, 2018

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S.J. v. Aviva Insurance Canada (17-002899)

The claimant's mother died as a result of an automobile accident. She applied for death benefits. The insurer argued that the claimant was not dependent on her mother at the time of the accident, and therefore not an insured person under the policy. Adjudicator Watt agreed with the insurer. Although the claimant resided with her...

January 25, 2018

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P.I. v. Aviva Insurance Canada (16-001320)

The claimant sought reconsideration of a Tribunal decision which upheld a MIG determination. The claimant asserted the Tribunal violated the rules of natural justice and erred in law when it failed to consider psychological, physical, and pre-existing medical evidence. Executive Chair Linda Lamoureux determined that it is open for a Tribunal adjudicator to prefer one...

January 25, 2018

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K.A. v. Aviva Insurance Company of Canada (17-002023)

The claimant sought entitlement to three treatment plans. Adjudicator Avvy Go reviewed the medical evidence and determined that the claim for assistive devices was reasonable; however, the claim for chiropractic services was not reasonable. It was also noted that the claimant had not exhausted all previously approved treatment plans.

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.

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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