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 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...

March 6, 2018

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Applicant v. Certas Home and Auto Insurance Company (17-005008)

The claimant sought removal from the MIG and one treatment plan. Adjudicator Kepman concluded that the claimant's back spasm were clinically associated sequelae to a soft tissue injury, and that the claimant was therefore restricted to MIG-level benefits.

March 6, 2018

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Applicant v. Aviva Insurance Company (17-004394)

The claimant sought entitlement to four medical benefits. Adjudicator Mazerolle found the proposed physiotherapy and chiropractic therapy to be reasonable and necessary based on the persistent nature of claimant's injuries. An acupuncture treatment plan and a proposed orthotics assessments were denied due to the lack of evidence connecting the claimant's injuries to the proposed benefits.

March 5, 2018

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D.A. v. Aviva Insurance Canada (16-001381)

This is a preliminary issue decision on whether the claimant was statute barred from pursuing a claim for non-earner benefits because the LAT application was filed more than two years after the benefit was denied. This matter involved the transition from FSCO to the LAT. Adjudicator Ferguson found that the LAT application had been filed...

March 5, 2018

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Applicant v. Aviva Insurance Canada (17-003824)

The insurer requested an adjournment of the hearing in order to obtain the claimant's ODSP file, which had not yet been provided by ODSP. Vice Chair Hunter granted the adjournment.

March 4, 2018

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K.R. v. Gore Mutual Insurance Company (17-005722)

This is a preliminary hearing decision on whether the insurer could complete s. 44 addendum reports in a hearing regarding CAT impairment determination. The claimant and the insurer had submitted medicolegal assessments on CAT determination. In addition, the claimant submitted addendum reports which affirmed her assessors' original positions, following a review of the insurer's reports....

March 2, 2018

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Y.M.Y. v. Certas Home and Auto Insurance Company (17-004982)

The claimant sought entitlement to a number of medical treatment plans and income replacement benefits. The insurer asserted the claimant failed to meet the disability test for IRBs and also asserted a MIG designation. Adjudicator Ian Maedel, on review of the medical evidence, concluded the claimant sustained predominately minor injuries. The claims for medical treatment...

March 2, 2018

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Applicant v. Aviva Insurance Canada (17-004258)

The insurer argued that the LAT did not have jurisdiction to determine if the claimant sustained a catastrophic injury because the claimant had not disputed entitlement to any substantive benefits. Adjudicator Ferguson dismissed the insurer's motion. Adjudicator Ferguson held that the provisions of the Insurance Act and the SABS did not preclude the LAT from...

March 2, 2018

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Applicant v. Aviva General Insurance (17-005287)

The claimant requested an adjournment of the LAT hearing because two witnesses were not available, and in order to obtain an addendum report from his expert. Adjudicator Makhamra granted the adjournment, noting that the Tribunal preferred to adjudicate claims on a complete evidentiary basis.

February 28, 2018

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S.G. v. Intact Insurance Company (17-002640)

The claimant was a pedestrian who was struck by an egg thrown at him from the occupant of a moving vehicle. He applied for accident benefits. The insurer argued that the incident was not an "accident" as defined in the SABS. Adjudicator Ferguson dismissed the application and held that the claimant had not been involved...

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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