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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August 18, 2017

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Applicant v. Aviva General Insurance (17-001178)

The claimant sought entitlement to a psychological treatment plan. The insurer denied the treatment plan and cited a psychological insurer's examination report as justification. Adjudicator Christopher Ferguson reviewed the medical reports on both sides and noted contradictions in the claimant's self-reporting. The insurer's evidence was considered more credible and the treatment plan was deemed not...

August 17, 2017

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Y.X.Y. v. The Personal Insurance Company (16-000438)

The primary issue in dispute was whether the claimant sustained a predominantly minor injury as a result of the accident. Adjudicator Neilsen explained that ongoing pain alone was insufficient to remove the claimant from the "minor injury" definition. Rather, she had to prove chronic pain syndrome. The ongoing pain had to be accompanied by some...

August 17, 2017

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T.S. v. Aviva General Insurance (17-000835)

The primary issue in dispute was whether the claimant sustained a predominantly minor injury as a result of the accident. Adjudicator Ferguson rejected the claimant's allegations of psychological injury. He also rejected the submission that the claimant's chronic pain was not covered by the definition of "minor injury." Adjudicator Ferguson accepted that the claimant did...

August 16, 2017

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Chen v. Unifund Assurance Company (17-001476)

A catastrophically injured minor sought entitlement to the insurer's log notes as part of the preliminary issues, arguing that the insurer's denials were insufficient to explain why claimed benefits were denied. The insurer argued that the log notes were not relevant and that the claimant was engaged in a "fishing expedition." Adjudicator White ordered the...

August 16, 2017

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Applicant v. Jevco Insurance Company (16-002000)

The claimant was involved in a serious accident and had sustained ongoing physical, psychological, and cognitive impairments. He had returned to doing some work on a part-time basis, but was unable to engage in full time work or retraining. Adjudicator Truong held that the claimant was entitled to post 104-week IRBs based on a holistic...

August 14, 2017

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D.T. v. Wawanesa Mutual Insurance Company (16-000266)

The claimant sought reconsideration of the Tribunal's decision to deny medical benefits above MIG limits and IRBs. The Tribunal had denied the claimant's entitlement to these benefits based on its review of the available medical evidence. The claimant made multiple arguments: first, that the Tribunal did not consider evidence indicating she suffered from a pre-existing...

August 14, 2017

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C.L. v. Wawanesa Mutual Insurance (16-002085)

The claimant sought entitlement to a number of treatment plans. The insurer asserted the plans were not reasonable and necessary. Adjudicator Derek Grant determined the injuries complained of by the claimant were as a result of the accident; however, on review of the medical evidence, the treatment plans were deemed not reasonable and necessary.

August 14, 2017

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D.T. v. Wawanesa Mutual Insurance Company (16-000266)

The claimant sought reconsideration of the Tribunal's decision to deny medical benefits above MIG limits and IRBs. The Tribunal had denied the claimant's entitlement to these benefits based on its review of the available medical evidence. The claimant made multiple arguments: first, that the Tribunal did not consider evidence indicating she suffered from a pre-existing...

August 11, 2017

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L.K. v. The Guarantee Company of North America (16-003577)

The claimant's entitlement to income replacement benefits had been suspended for about six months due to her failure to provide a copy of her CPP file, which had been requested by the insurer under section 33 of the SABS. Upon receipt of the CPP, the insurer reinstated income replacement benefits, but refused to pay for...

August 11, 2017

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Applicant v. Security National Insurance Company (16-003024)

The claimant sought entitlement to medical benefits and removal from the MIG. He also argued that the insurer's denials did not comply with section 38 of the SABS. Adjudicator Belanger-Hardy dismissed the claims. She held that the insurer's denials provided sufficient information to comply with the SABS. She also held that the evidence submitted supported...

August 10, 2017

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R.R. v. Aviva Insurance (16-001627)

The claimant sought entitlement to treatment plans requesting assistive devices and psychological treatment. The insurer denied the plans as not being reasonable and necessary. Adjudicator Chris Sewrattan reviewed the medical evidence and determined that the claimant did not provide sufficient evidence to show the devices were reasonable. However, the psychological treatment was considered payable. No...

August 9, 2017

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Applicant v. Yarmouth Mutual Fire (17-001057)

The minor claimant sought entitlement to medical benefits and mileage. Adjudicator Ferguson dismissed all claims. He held that proposed social worker services were duplicative of approved treatment; further the claimant was completing self-care and school tasks as expected for someone of his age. In terms of OT services, the claimant did not explain what in-home...

August 9, 2017

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Applicant v. Yarmouth Mutual Fire (17-001061)

The minor claimant sought entitlement to medical benefits and mileage. Adjudicator Ferguson dismissed all claims. He held that proposed social worker services were duplicative of approved treatment; further the claimant was completing self-care and school tasks as expected for someone of his age. In terms of OT services, the claimant did not explain what in-home...

August 8, 2017

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A.H. v. Belair Direct Insurance Company (16-001063)

The claimant sought entitlement to a number of treatment plans and attendant care benefits. Adjudicator Lori Marzinotto noted that some of the treatment plans sought were not submitted as evidence, nor specifically addressed in the claimant's submissions; those plans were denied. Other treatment plans sought mileage beyond the Professional Service Guidelines. Adjudicator Marzinotto highlighted no...

August 4, 2017

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L.F. v. Unifund Assurance Company (16-001020)

The claimant sought entitlement to IRBs and two treatment plans for a social emotional assessment and a functional abilities evaluation. The respondent initially paid weekly IRBs of $209.61. Payments were stopped when the claimant failed to attend three IEs in March and April 2016. After the claimant attended IEs in August 2016, the respondent denied...

August 4, 2017

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O.D. v. Unifund Assurance Company (16-004399)

The claimant applied for entitlement to non-earner benefits, which was rejected by the insurer. Adjudicator Treksler denied entitlement to non-earner benefits reasoning that the claimant had not submitted sufficient evidence of the activities she could no longer perform, and which activities were important to her prior to the accident. She also noted that the submission...

August 4, 2017

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C.A. v. The Dominion of Canada General Insurance Company (16-004033)

The claimant sought further medical benefits and removal from the MIG. Adjudicator Hines concluded that the claimant's injuries were minor injuries, and rejected the expert opinion of his assessors. Adjudicator Hines was critical of the claimant's assessors for failing to be provided with full medical documentation, for relying largely upon the claimant's self-reporting, and for...

August 4, 2017

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B.H. v. Belair Direct Insurance (16-002779)

Shortly before the hearing, the insurer accepted that the claimant suffered a catastrophic impairment, and was entitled to IRBs. The only remaining issues were the claimant's entitlement to attendant care benefits, and a special award. In terms of the attendant care claim, the insurer accepted that the claimant was medically entitled to assistance; the dispute...

August 3, 2017

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K.S. v. The Dominion of Canada General Insurance Company (16-002099)

The claimant sought entitlement to attendant care benefits and multiple treatment plans. A preliminary issue was whether late submitted medical records should be excluded from the hearing. Regarding the late records, Adjudicator Treksler admitted the records reasoning that third parties had control over the records and that the claimant could not control the date of...

August 1, 2017

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S.U. v. Wawanesa Mutual Insurance Company (16-003333)

The claimant sought entitlement to medical benefits; the insurer argued that the claimant had not complied with section 33 requests and that the claimed benefits were not reasonable and necessary. Regarding the section 33 argument, Adjudicator Ferguson held that the information requested by the insurer was not "reasonably necessary" to determine entitlement as the insurer...

August 1, 2017

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H.A. v. Aviva General Insurance (16-003279)

The claimant sought entitlement to the form fee and HST associated with an assessment plan. The insurer indicated that the treatment plan was subject to the monetary cap under section 25(5). The claimant asserted the form fee was a separate cost, not subject to the cap. Adjudicator Christopher Ferguson referred to Superintendent's Guideline No. 03/14...

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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