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.

May 9, 2018

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M.A. v. Aviva Insurance Canada (17-0038892)

The claimant sought entitlement to IRBs for the period of June 23, 2015, to December 1, 2016. The insurer sought repayment of IRBs in the amount of $1,600.00. The parties agree that the claimant was self-employed as the owner/operator of a gas station and convenience store for 26 out of the 52 weeks prior to...

May 9, 2018

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A.S. v. Pafco Insurance (16-003683)

The claimant sought reconsideration of the Tribunal's decision to deny the claim for ongoing IRBs. The claimant requested reconsideration on the basis that the Tribunal denied him natural justice and procedural fairness. Associate Chair Batty agreed with the claimant that the Tribunal had overlooked or mischaracterized parts of the claimant's evidence at the LAT hearing....

May 9, 2018

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S.M. v. Aviva Insurance Canada (17-003731)

The claimant sought entitlement to NEBs and medical benefits. Adjudicator Grant denied all of the claims. He concluded that the claimant's evidence lacked specificity, and that her medical assessor's opinions were not credible. He preferred the conclusions of the IE assessors, including the claimant's self-reporting to the IE assessors that she was improving and returned...

May 8, 2018

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Helmer v. Belair Direct Insurance Company (2018 ONSC 2888)

The insurer sought judicial review of the Tribunal's decision that a PSW who was not working before the accident, met the requirements of the professional service provider branch of the "incurred expense" definition. The Court held that the Tribunal's decision was both reasonable and correct. The Court held that the critical question was whether the...

May 7, 2018

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R.P. v Aviva Insurance Canada (17-003500)

The claimant appealed Aviva's MIG determination and sought medical benefits for chiropractic services, the completion of numerous OCF-3s, a social work assessment, and an orthopaedic assessment. The claimant also sought IRBs. Aviva opposed the claimant's request to have a treating chiropractor qualified as an expert. Adjudicator Hines held that the claimant's injuries were within the...

May 7, 2018

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Applicant v. Unifund Claims Inc. (17-005698)

The claimant sought removal from the MIG, entitlement to ACBs, and entitlement to various medical benefits. Adjudicator Watt concluded that the claimant's injuries fell within the MIG. He noted that the claimant had essentially returned to his pre-accident life shortly after the accident. He also held that the claimant's self-reporting contradicted the statements in the...

May 7, 2018

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M.C. v. Aviva Insurance Company of Canada (17-002614)

The claimant sought entitlement to treatment outside of the MIG, attendant care benefits, six treatment plans, and a special award. Adjudicator Truong found that the claimant was entitled to treatment outside of the MIG, the cost of an attendant care assessment and assistive devices, interest, and a special award. Adjudicator Truong found that the claimant...

May 4, 2018

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E.A. v. Aviva Insurance Company of Canada (17-005601)

The claimant sought entitlement to various medical benefits. The insurer argued that the claimant had applied more than two years after the relevant denials. The claimant conceded that two years had passed, but relied upon section 7 of the LAT Act arguing that the insurer had delayed providing copies of the denials to the new...

May 4, 2018

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Aviva Insurance Canada v. W.D.W. (17-005894)

The claimant and the insurer disputed the proper calculation of IRBs. The claimant was self-employed at the time of the accident. He argued that his IRB entitlement was to be calculated based solely on his farming income, without regard to losses attributed to his separate numbered corporation. Aviva argued that the losses of the numbered...

May 3, 2018

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S.W. v. Aviva Insurance Company of Canada (17-005302)

At the beginning of the hearing, the insurer conceded that the impairments suffered by the claimant were sufficient for her to meet the test for IRBs, so the issue before Adjudicator Flude was what amounts the insurer could deduct from the $400 per week IRB quantum regarding the claimant's EI maternity benefits and employer top...

May 2, 2018

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D.C. v. Aviva Insurance Company (17-002921)

The claimant sought entitlement to NEBs, medical benefits, and the cost of various examinations. The insurer raised s. 55 and s. 33 defences. Pursuant to s. 55, Adjudicator Ferguson held that the claimant was barred from commencing part of the application as a result of his failure to attend IE assessments. He was only barred...

May 1, 2018

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Applicant v. Aviva Insurance Company (17-002973)

The claimant sought entitlement to IRBs, ACBs, and medical benefits. The insurer argued that the claimant failed to attend an IE assessment contrary to the SABS. Adjudicator Maedel agreed with the insurer in regard to most of the claimed benefits, and held that the IEs were not requested inappropriately. In terms of the MIG and...

April 28, 2018

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Applicant v. Certas Direct (17-002792)

The claimant sought entitlement to IRBs, one treatment plan, and interest. Adjudicator Msosa held that the medical evidence did not indicate the claimant had suffered a substantial inability to perform his employment as a security guard and was therefore not entitled to IRBs. The claimant argued that the treatment plan was payable as the insurer...

April 26, 2018

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V.S. v. Travelers Insurance Company of Canada (17-001670)

The claimant sought reconsideration that he was not entitled to treatment outside of the MIG. With the insurer having approved both treatment plans in dispute and removing the claimant from the MIG in advance of the reconsideration hearing, the single issue to be decided was whether the claimant was entitled to interest on the insurer's...

April 25, 2018

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Applicant v. Aviva Insurance Company (17-002638)

The claimant sought entitlement to ongoing IRBs, various medical benefits outside of the MIG, and a special award. The claimant submitted that psychological impairments and chronic pain took him outside of the MIG. Adjudicator Boyce found that the claimant's impairments were predominantly minor injuries, holding that in the absence of evidence of a full or...

April 25, 2018

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Applicant v. Certas Direct Insurance Company (16-003108)

The claimant sought entitlement to NEBs, ACBs, and a chronic pain assessment. The insurer argued that the claimant was barred from seeking the chronic pain assessment for failure to attend an IE assessment. Adjudicator Anwar found that the claimant was barred from pursuing the cost of the chronic pain assessment due to her nonattendance at...

April 24, 2018

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J.G. v. Travelers Canada (17-001630)

Prior to the written hearing, the respondent agreed to remove the claimant from the MIG and pay any invoices for incurred treatment. The claimant decided to proceed with the hearing and sought entitlement to a special award, costs, and interest on overdue payments. Adjudicator Sharma held that the claimant was entitled to the claimed interest...

April 24, 2018

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Applicant v. Aviva Insurance Company (17-003600)

The claimant sought entitlement to medical benefits outside of the MIG and a special award. Adjudicator Victor found that the claimant was outside of the MIG because of the extent of her psychological symptoms, and she was entitled to the cost of a psychological assessment, plus interest. The claimant was not found entitled to a...

April 24, 2018

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P.R. v. Aviva Canada Insurance (16-002782)

The insurer requested reconsideration of the LAT's decision to deny its request for costs, arguing that the claimant's failure to address serious evidentiary issues throughout he proceeding amounted to frivolous and vexatious conduct warranting a costs award. Associate Chair Batty denied the request. While the LAT did not explicitly apply the definitions of frivolous and...

April 23, 2018

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J.B. v Allstate Canada (17-005951)

The claimant sought medical benefits for driver reintegration sessions and psychotherapy sessions, as well as travel expenses. Adjudicator Maedel held that the claimant failed to establish that the benefits sought were reasonable and necessary. Allstate had partially approved the OCF-18 in dispute for eight one-hour weekly driver reintegration sessions and six one-hour psychotherapy sessions, as...

April 23, 2018

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B.A. v Certas Direct Insurance Company (17-004796 and 17-004801)

The claimant was involved in two motor vehicle accidents and appealed Certas' MIG determination for each accident. The claimant also sought medical benefits for physiotherapy for the first accident and chiropractic services for the second accident. Adjudicator Cavdar held that the claimant's injuries for each accident fell within the MIG. The claimant suffered soft-tissue injuries...

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

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150 York Street, Suite 1800
Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com