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.

February 28, 2018

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M.F. v. Allstate Insurance Company (17-001328)

The claimant sought entitlement to the cost of an attendant care assessment and interest. Adjudicator Kowal dismissed the claimant's application as the claimant had not incurred the cost of the attendant care assessment. However, Adjudicator Kowal held that in order for an initial s. 25 attendant care assessment to be found payable, five criteria must...

February 28, 2018

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A.L. v. The Personal Insurance Company (17-002582)

The Tribunal initially decided that the claimant was precluded from applying to the LAT in light of his non-attendance at multiple insurer examinations. Associate Chair Batty initiated a reconsideration on his own initiative to remedy a breach of procedural fairness in the preliminary issue hearing. In its reasons, the LAT had described how the respondent's...

February 28, 2018

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A.L. v. The Personal Insurance Company (17-002582)

The Tribunal initially decided that the claimant was precluded from applying to the LAT in light of his non-attendance at multiple insurer examinations. Associate Chair Batty initiated a reconsideration on his own initiative to remedy a breach of procedural fairness in the preliminary issue hearing. In its reasons, the LAT had described how the respondent's...

February 27, 2018

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Aviva Insurance Canada v. D.P. (17-004352)

The insurer sought repayment of benefits, the costs it incurred in conducting IEs, and the cost of adjusting the claim based on the claimant's wilful misrepresentation and fraud. The claimant was unrepresented and did not participate in the proceedings. Adjudicator Ferguson agreed with the insurer's submissions that, based on the evidence, the claimant was not...

February 27, 2018

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A.K. v. Aviva Insurance Canada (16-004622)

The claimant sought entitlement to three disputed treatment plans and the payment of an OCF-3. Adjudicator Anwar found that the claimant was entitled to all three disputed treatment plans but not the cost of the OCF-3. Adjudicator Anwar concluded that the accident aggravated the claimant's pre-existing chronic back and neck pain and the proposed treatment...

February 26, 2018

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Z.Z. v. Wawanesa Mutual Insurance Company (17-007223)

The insurer brought a motion seeking an order against the claimant's employer for the full employment file. Adjudicator Makhamra concluded that the LAT had jurisdiction to order a third party to produce records, and ordered the employer to produce the entire employment file. The adjudicator noted that the claimant consented to the order, but that...

February 26, 2018

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N.H. v. Aviva Insurance Company (17-001088)

The claimant sought entitlement to medical benefits. The insurer, after receipt of the application to the LAT, arranged for an IE. The claimant objected and the Tribunal at a preliminary issue hearing determined that the IE was reasonable and could go forward. The Tribunal would adjourn the hearing on the merits to allow for the...

February 26, 2018

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N.C. v. Aviva Insurance Canada (17-004085)

The claimant sought entitlement to one medical treatment plan. Adjudicator Anita Goela, on review of the medical evidence, determined that the treatment plan was not reasonable and necessary. The matter was dismissed.

February 26, 2018

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J.R. v. Certas Home and Auto Insurance Company (16-003921)

The claimant sought entitlement to a number of medical benefits. The insurer denied the treatment plans based on IE reports and the LAT agreed with the denials. On reconsideration, however, Executive Chair Linda Lamoureux determined that the Tribunal arrived at the determination in a manner that was procedurally unfair to the claimant. At the Tribunal...

February 26, 2018

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I.K. v. Primmum Insurance Company (16-001652)

The claimant sought entitlement to a number of medical benefits as well as attendant care benefits. The insurer argued the claimant was barred from proceeding with a LAT application for failing to attend a number of IEs, pursuant to section 55. The LAT agreed and dismissed the matter. On reconsideration, Executive Chair Linda Lamoureux upheld...

February 26, 2018

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Applicant v. Aviva Insurance Canada (17-002213)

The claimant sought entitlement to two medical treatment plans and attendant care benefits. Adjudicator Brian Norris reviewed the chronology of Form 1s and denial letters and determined that the insurer had paid all payable attendant care and no further benefits were owed. On review of the medical evidence, Adjudicator Norris determined that one of the...

February 26, 2018

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A.D. v. Aviva Insurance Canada (17-004156)

The claimant sought entitlement to income replacement benefits. The insurer denied the claim based on a number of IE reports. Adjudicator Chris Sewrattan, on review of the chronology of the claimant's application, held that the claimant failed to satisfy the disability test for ongoing income replacement benefits. However, the period before the insurer's denial and...

February 26, 2018

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J.R. v. Certas Home and Auto Insurance Company (16-003921)

The claimant sought entitlement to a number of medical benefits. The insurer denied the treatment plans based on IE reports and the LAT agreed with the denials. On reconsideration, however, Executive Chair Linda Lamoureux determined that the Tribunal arrived at the determination in a manner that was procedurally unfair to the claimant. At the Tribunal...

February 26, 2018

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I.K. v. Primmum Insurance Company (16-001652)

The claimant sought entitlement to a number of medical benefits as well as attendant care benefits. The insurer argued the claimant was barred from proceeding with a LAT application for failing to attend a number of IEs, pursuant to section 55. The LAT agreed and dismissed the matter. On reconsideration, Executive Chair Linda Lamoureux upheld...

February 23, 2018

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Applicant v. RSA Insurance Company (17-000502)

The claimant sought pre- and post-104 IRBs and entitlement to various medical benefits, as well as the cost of a completed OCF-3. Adjudicator Truong found the claimant to be an unreliable witness at the oral hearing, and he gave less weight to the s. 25 psychology opinion as the claimant's unreliable self-reporting was the entire...

February 23, 2018

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Applicant v. Echelon General Insurance Company (16-003153)

The claimant suffered a catastrophic impairment and sought attendant care and housekeeping benefits. The insurer took the position that the claimant was required to show proof of an incurred expense for each benefits pursuant to the 2010 SABS. The claimant argued that since the MVA took place before the 2010 SABS came into force, the...

February 22, 2018

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P.S. v. Aviva Insurance Canada (17-003200)

The claimant sought entitlement to IRBs and the cost of an orthopaedic assessment. Adjudicator Watt rejected both claims. He preferred the evidence of the IE assessors, who concluded that the claimant suffered soft tissue injuries and was able to return to his pre-accident employment. The family physician made no recommendations regarding avoiding work or referrals...

February 22, 2018

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Applicant v. Aviva Insurance Canada (16-004616)

The claimant sought entitlement to medical benefits for physiotherapy, chiropractic, and psychological treatment; the cost of an orthopedic assessment; a special award; and interest on overdue payments. Adjudicator Anwar held that the claimant was entitled to all of the medical benefits for treatment in dispute and interest thereon, but denied entitlement to the assessment and...

February 22, 2018

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Applicant v. Aviva Insurance Canada (17-001414)

The claimant sought entitlement to NEBs, treatment outside the MIG and entitlement to seven treatment plans. Adjudicator Watt dismissed the claimant's claim for NEBs and concluded that the claimant's injuries fell within the MIG. As the claimant's injuries were found within the MIG, Adjudicator Watt found that the disputed treatment plans were not payable. With...

February 21, 2018

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Applicant v. State Farm Mutual Automobile Insurance Company (16-001226)

The claimant sought a catastrophic impairment on both mental or behavioural grounds as well as WPI. Adjudicator Paul Gosio reviewed the medical evidence and conducted a pre- and post-accident review of the claimant's functionality, and determined that the claimant sustained a Class 4 marked impairment in the fields of activities of daily living, concentration, persistence...

February 20, 2018

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Applicant v. Certas Direct Insurance Company (17-001627)

The claimant sought entitlement to 15 treatment plans, non-earner and attendant care benefits. The insurer paid the non-earner and attendant care benefits for two years, before stopping both with IE reports. The insurer, in its written submissions, reversed its position on medical benefits, and ultimately approved the disputed treatment plans. However, Adjudicator Susan Sapin determined...

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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