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.

March 14, 2018

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W.E. v. Wawanesa Mutual Insurance Company (17-002054)

The claimant sought entitlement to housekeeping expenses, and the cost of obtaining her employment file for the insurer. Adjudicator Gosio held that the claimant had proven that she suffered a substantial inability to perform the housekeeping services she normally performed prior to the accident, but that she did not prove that the expenses were incurred....

March 14, 2018

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Applicant v. Travelers Canada (17-005291)

The insurer requested the claimant's attendance at an IE shortly before the LAT hearing. The claimant refused to attend. The insurer argued that the claimant could not proceed with the hearing. Adjudicator Paluch held that the insurer's request for an IE was not reasonably necessary, and that the claimant could therefore proceed with the hearing....

March 13, 2018

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R.P. v. Wawanesa Insurance Company (16-002947)

The claimant requested reconsideration of the LAT's decision in favour of the insurer's denial of entitlement to certain medical benefits, expenses for prescription medication, and interest. He argued that the LAT violated procedural fairness by failing to either refer to or consider certain medical records in its decision. Executive Chair Lamoureux denied the request for...

March 13, 2018

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Applicant v. Aviva Insurance (16-004312)

The claimant disputed the insurer's termination of income replacement benefits eight months after the accident. Adjudicator Paluch held the claimant was entitled to receive IRBs from the date of termination to the date of the decision and ongoing. The claimant's medical evidence with respect to her chronic pain satisfied the arbitrator on a balance of...

March 12, 2018

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V.A. v. Wawanesa Mutual Insurance Company (17-002948)

The claimant disputed his MIG status; entitlement to payment for treatment; entitlement to payment for examinations and completion of OCF-3s; and entitlement to IRBs. Adjudicator Sewrattan denied all of the claims. The claimant, allegedly suffering from chronic pain, failed to prove that he suffered from an injury not predominantly minor in nature. The expert reports...

March 12, 2018

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Z.A. v. Certas Direct Insurance (17-003297)

The claimant, who was catastrophically impaired in an earlier accident, sought entitlement to NEBs and treatment plans for medical marijuana and osteopathic treatment in relation to a subsequent accident. Adjudicator Go found that the claimant was entitled to the cost of the two disputed treatment plans plus interest, but he was not entitled to NEBs....

March 12, 2018

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W.C.C. v. Allstate Canada (17-001363)

The claimant sought entitlement to non-earner benefits, which had been denied by the respondent on May 22, 2013, and entitlement to two treatment plans. Adjudicator Daoud dismissed all the claims, finding that the claimant was limitation barred from disputing the denial of non-earner benefits and that the claimant had not proven that the disputed treatment...

March 12, 2018

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K.G. v. Certas Direct Insurance Company (16-003633)

The insurer argued that the claimant failed to apply to the LAT within two years of the refusal to pay in accordance with section 56 of the SABS. The claimant argued the insurer's explanation of benefits (EOB) did not constitute a denial in compliance with the SABS. Adjudicator Watt held the EOB did not constitute...

March 12, 2018

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Applicant v. The Guarantee Company of North America (17-003906)

The claimant sought entitlement to two treatment plans. Adjudicator Reilly denied entitlement to both. Regarding the first, she held that the insurer's initial denial was deficient because it failed to provide any medical or other reasons, but that the insurer rectified the notice with a subsequent denial. Because the claimant had not incurred the assessment...

March 12, 2018

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K.G. v. Certas Direct Insurance Company (16-003633)

The insurer argued that the claimant failed to apply to the LAT within two years of the refusal to pay in accordance with section 56 of the SABS. The claimant argued the insurer's explanation of benefits (EOB) did not constitute a denial in compliance with the SABS. Adjudicator Watt held the EOB did not constitute...

March 10, 2018

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Applicant v. Certas Home and Auto Insurance (16-003480)

The claimant, who was working as a PSW at the time of the accident, sought entitlement to pre-104 IRBs and a treatment plan proposing a psychological assessment. Adjudicator Reilly found that the claimant was entitled to the cost of the proposed assessment plus interest, but she was not entitled to IRBs. Adjudicator Reilly concluded that...

March 9, 2018

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The Applicant v. The Guarantee Company of North America (17-001170)

The claimant sought payment of home renovations. Adjudicator Johal explained that the onus is on the claimant to prove on a balance of probabilities that the renovations were reasonable and necessary. In this case, the renovations would only be reasonable and necessary if they provided the claimant access to areas of the home that were...

March 9, 2018

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M.T.G. v. Aviva General Insurance (formerly RBC General Insurance) (17-002122)

The insurer requested the preliminary hearing to address whether the claimant was limitation barred from pursuing a claim for IRBs because the LAT application was not commenced within two years of the insurer's denial. Adjudicator Gottfried held that the claimant was not precluded from applying for IRBs. The limitations analysis involved a lengthy review of...

March 8, 2018

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F.H. v. Certas Direct Insurance Company (17-003735)

The claimant sought entitlement to treatment outside of the MIG, five treatment plans, and a special award. Adjudicator Sewrattan found that the claimant suffered from Chronic Post Traumatic Pain Syndrome and was entitled to treatment outside of the MIG. Adjudicator Sewrattan preferred the claimant's expert report over the insurer's, as the insurer's report failed to...

March 7, 2018

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R.W. v. The Co-operators (17-005447)

The claimant sought entitlement to IRBs for a four month period of IE non-attendance. Adjudicator Ferguson held that the claimant had a reasonable excuse for not attending the IE - namely, that he suffered anxiety, which was exacerbated at the beginning of the initial IE assessment. The claimant was entitled to receive the four months...

March 7, 2018

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K.W.D. v. Progressive American Insurance Company (17-003705)

The claimant sought entitlement to one treatment plan. Adjudicator Goela found that the treatment plan for physiotherapy was reasonable and necessary. Adjudicator Goela noted that the IE assessor's acknowledgment that the claimant still required daily stretching and range of motion exercises supported the need for the proposed physiotherapy.

March 7, 2018

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Applicant v. Certas Home and Auto Insurance (17-004509)

The claimant sought entitlement to the cost of three assessments. Adjudicator Fricot concluded that the chronic pain assessment was reasonable and necessary based on the medical evidence showing a reasonable possibility that the claimant suffers from chronic pain. The orthopaedic and neurological assessment were denied due to the lack of relevant symptoms supporting impairments in...

March 6, 2018

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N.M. v. Certas Home and Auto Insurance (17-002605)

The claimant sought removal from the MIG and entitlement to various treatment plans. Adjudicator Goela found that the claimant was subject to the $3,500 limit under the MIG. The Adjudicator found that the claimant did not provide evidence of a pre-existing injury that would prevent her from a full recovery if limited by the MIG....

March 6, 2018

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M.S. v. Aviva Insurance Canada (17-002857)

A treatment plan for physiotherapy services was recommended for the claimant, but the respondent denied it. The respondent later advised the License Appeal Tribunal that it had decided to approve the claimant's medical benefit. By the time this dispute was heard by the License Appeal Tribunal, it was not clear whether the respondent had paid...

March 6, 2018

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Tsalikis v. Wawanesa Mutual Insurance Company (2018 ONSC 1581)

The claimant had been denied benefits above the MIG limits and further IRBs. The Tribunal dismissed her application based on the medical evidence and based on a two day teleconference hearing. The claimant argued that a teleconference hearing was a breach of procedural fairness; that she was not aware the MIG would be addressed in...

March 6, 2018

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Applicant v. RBC General Insurance Company (16-002963)

This is a preliminary issue decision on whether the applicant was precluded from proceeding with the LAT application until she attended requested IE assessments. With reference to Augustin v. Unifund, Adjudicator Daoud found that the insurer's Notice of Examination complied with section 44 of the SABS and held that the applicant was precluded from proceeding...

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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