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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December 8, 2017

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Applicant v. Travelers Insurance (16-003313)

The claimant sought entitlement to a number of medical benefits. Adjudicator Paul Gosio, on review of the medical evidence, determined that the treatment sought was reasonable and necessary.

December 8, 2017

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Applicant v. State Farm Mutual Automobile Insurance Company (16-004375)

This was an amended decision from a previous ruling in which the claimant sought entitlement to a number of medical treatment pans. On review of the medical evidence, Adjudicator Avvy Go determined the treatment plans were reasonable and necessary. Additionally, interest was awarded on the overdue payment of benefits.

December 7, 2017

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G.K. v. Unifund Assurance Company (17-001274)

The claimant sought entitlement to income replacement benefits. The insurer agreed benefits were payable but asserted that a deduction of gross short and long term disability benefits was needed to calculate the appropriate quantum. The claimant stated that the deduction involved the net of short and long term disability payments. Adjudicator Ian Maedel determined that...

December 6, 2017

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M.J. v. Aviva General Insurance (17-002229)

After the commencement of the hearing, the claimant withdrew the application. The Tribunal closed its file and no costs were awarded.

December 6, 2017

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J.C.C. v. Echelon General Insurance Company (17-000848)

The claimant was found entitled to attendant care benefits from a medical standpoint, but was denied payment on the basis that his service provider was not a professional. The service provider had her certification as a PSW, but was not working in the field at the time of the claimant's accident. Adjudicator Go held that...

December 6, 2017

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Applicant v. RBC General Insurance Company (16-004500)

The claimant sought entitlement to non-earner and medical benefits. On review of the evidence, Adjudicator Brian Norris concluded the claimant failed to meet the burden of proof for NEBs. After reviewing each treatment plan, it was held that all but one were not reasonable and necessary. The claims, with the exception of the one treatment...

December 1, 2017

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T.F. v. Intact Insurance Company (17-002703)

The claimant's husband sought reimbursement for mileage incurred while visiting the claimant and transporting the claimant. Adjudicator Reilly held that the husband was, in fact, an aide because he transported the claimant, and that the proper mileage rate for him as an aide was $0.40 per kilometer per the Transportation Expense Guideline.

December 1, 2017

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H.T. v. TD General Insurance Company (16-000608)

The claimant sought reconsideration of a Tribunal decision that dismissed all claims. Executive Chair Linda Lamoureux reviewed the submissions and concluded that no significant error of fact or law took place and noted that it was open to the Tribunal to hold that benefits were suspended due to non-attendance at an EUO. Additionally, no procedural...

December 1, 2017

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G.T. v. Unifund Assurance Company (16-001283)

The insurer appealed a ruling in which the claimant was awarded an orthopaedic assessment. The insurer argued that the assessment was available through OHIP, and therefore not payable under the SABS. Executive Chair Lamoureux rejected the reconsideration. She held that the obligation was on the insurer to advance evidence establishing that a benefit at issue...

December 1, 2017

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G.K. v. Security National Insurance Company (16-001904)

The insurer sought reconsideration of the Tribunal's decision that the claimant was a resident of Ontario at the time of the accident, and therefore an "insured person." Executive Chair Lamoureux rejected the reconsideration. She held that the Tribunal was asked to make a determination that largely turned on the facts of the case, and that...

December 1, 2017

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F.S. v. Aviva Insurance Company (17-002313)

The claimant sought entitlement to various medical benefits. Adjudicator Sewrattan dismissed all of the claims, holding that the claimant had not demonstrated that the proposed treatment was reasonable and necessary. He also noted that the claimant had refused to provide her collateral benefits entitlement information and that he was unable to determine if any of...

December 1, 2017

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Aviva Canada Inc. v. R.R. (16-004445)

The insurer appealed the dismissal of its repayment claim, which had been denied because there was no proof that the claimant was given the notice of repayment. Executive Chair Lamoureux held that there had been a breach of procedural fairness because the issue of whether a notice was provided to the claimant was not addressed...

December 1, 2017

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G.T. v. Unifund Assurance Company (16-001283)

The insurer appealed a ruling in which the claimant was awarded an orthopaedic assessment. The insurer argued that the assessment was available through OHIP, and therefore not payable under the SABS. Executive Chair Lamoureux rejected the reconsideration. She held that the obligation was on the insurer to advance evidence establishing that a benefit at issue...

December 1, 2017

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G.K. v. Security National Insurance Company (16-001904)

The insurer sought reconsideration of the Tribunal's decision that the claimant was a resident of Ontario at the time of the accident, and therefore an "insured person." Executive Chair Lamoureux rejected the reconsideration. She held that the Tribunal was asked to make a determination that largely turned on the facts of the case, and that...

December 1, 2017

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Aviva Canada Inc. v. R.R. (16-004445)

The insurer appealed the dismissal of its repayment claim, which had been denied because there was no proof that the claimant was given the notice of repayment. Executive Chair Lamoureux held that there had been a breach of procedural fairness because the issue of whether a notice was provided to the claimant was not addressed...

November 29, 2017

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D.K.M. v. Motor Vehicle Accident Claims Fund (16-004520)

The claimant sought the remainder of a partially approved home modification treatment plan (which sought the purchase of a new home) in the amount of $119,451.70. The insurer asserted the remaining balance of the treatment plan was not reasonable and necessary and given the claimant's "Indian" status HST would not apply to the figures originally...

November 29, 2017

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Applicant v. Pembridge Insurance Company (17-000162)

The claimant sought entitlement to various medical benefits and assessments. Adjudicator Harmison rejected all of the claims. In general, she preferred the evidence of the IE assessors, and noted that the family doctor's records did not comport with the position put forward by the claimant's assessors. She also wrote that the claimant had approved treatment...

November 28, 2017

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A.D. v. Aviva Insurance Canada (17-001145)

The claimant sought entitlement to one treatment plan for rehabilitation therapy. The claimant argued that the treatment plan was reasonable and necessary, and that as the respondent had failed to respond to the treatment plan within the required ten days under the SABS, it should be deemed paid under section 38(11) of the SABS. The...

November 28, 2017

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Applicant v. State Farm Mutual Automobile Insurance Company (16-000449)

The claimant had an ongoing FSCO arbitration addressing the same benefit in dispute. Adjudicator Watt granted an order on consent dismissing the LAT application.

November 28, 2017

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Applicant v. State Farm Mutual Automobile Insurance Company (16-000448)

The claimant had an ongoing FSCO arbitration addressing the same benefit in dispute. Adjudicator Watt granted an order on consent dismissing the LAT application.

November 28, 2017

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Applicant v. Dominion of Canada General Insurance Company (16-004660)

The claimant sought entitlement to a treatment plan that had not been submitted through HCAI. Adjudicator Watt concluded that the treatment plan was not payable because the claimant had failed to submit the plan in accordance with the Superintendent's Guideline.

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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