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.

January 19, 2018

/

tgp-admin

Applicant v. TTC Insurance Company Limited (17-002561)

The claimant sought a declaration that she suffered a catastrophic impairment as a result of the accident, and entitlement to a psychological paper review. The claimant had submitted two OCF-19s - the first alleged a catastrophic impairment due to a 55 percent Whole Person Impairment; the second alleged a catastrophic impairment due to a Class...

January 18, 2018

/

tgp-admin

Applicant v. Aviva Insurance Company (17-001007)

The claimant sought removal from the MIG and entitlement to two treatment plans for physical therapy. Adjudicator Watt held that the claimant's injuries fell within the MIG and wrote that the claimant had not explained why her pre-existing obesity, hypertension, and sciatic nerve problems would prevent maximal recovery under the MIG. He favoured the opinions...

January 17, 2018

/

tgp-admin

K.S.Y. v. Aviva Insurance Canada (16-003903)

The claimant sought a determination that her impairments were outside of the MIG and entitlement to benefits proposed in two treatment plans for physical rehabilitation and one treatment plan for a psychological assessment. The insurer raised a preliminary issue, submitting that the claimant was precluded from adjudicating the issues in dispute for failure to attend...

January 17, 2018

/

tgp-admin

T.H. v. Aviva Insurance (17-001125)

The claimant sought entitlement to non-earner benefits. The insurer argued the claimant had not suffered a complete inability to carry on a normal life. Adjudicator Robert Watt applied the factors found in the Ontario Court of Appeal decision of Heath v. Economical and determined that the claimant failed to meet the burden of proof. The...

January 16, 2018

/

tgp-admin

Applicant v The Guarantee Company of North America (17-002558)

The applicant sought medical benefits for physiotherapy services. The respondent brought a motion to strike the applicant's reply. The applicant filed a response to the motion to strike a day after the deadline. Adjudicator Goela held that despite being late, she would consider the applicant's response as it did not prejudice the respondent. Adjudicator Goela...

January 16, 2018

/

tgp-admin

Unifund Assurance Company (17-001773)

The insurer sought repayment of income replacement benefits. Adjudicator Robert Watt reviewed the jurisprudence of section 52 and noted that a proper repayment notice should include: (i) identification of the type of benefit that was overpaid, (ii) the payment period for which repayment is sought, (iii) the amount of repayment sought, and (iv) the amount...

January 16, 2018

/

tgp-admin

C.W. v. Unifund Assurance Company (16-003336)

The insurer sought reconsideration of the Tribunal's decision that the claimant's injuries were non-minor due to a partial shoulder tear and pre-existing back pain. Executive Chair Lamoureux dismissed the reconsideration. She held that the Tribunal's decision was based on the evidence before it and that the Tribunal was entitled to weight the contradicting evidence as...

January 16, 2018

/

tgp-admin

Applicant v. Aviva Insurance Canada (16-003323)

The claimant sought entitlement to non-earner benefits, as well as a number of medical treatment plans. The insurer denied entitlement to all claims. Adjudicator Rebecca Hines reviewed the medical evidence and determined the claimant failed to prove the treatment plans were reasonable and necessary, and also failed to establish a complete inability to carry on...

January 16, 2018

/

tgp-admin

A.R. v. Wawanesa Mutual Insurance Company (17-000149)

The claimant sought entitlement to two proposed orthopaedic assessments. Adjudicator Msosa denied both assessments. He first wrote that without the treatment plans before him, he could not determine whether they were reasonable. He also accepted the opinion of the insurer's expert that the claimant had not sustained orthopaedic injury in the accident and there was...

January 16, 2018

/

tgp-admin

C.W. v. Unifund Assurance Company (16-003336)

The insurer sought reconsideration of the Tribunal's decision that the claimant's injuries were non-minor due to a partial shoulder tear and pre-existing back pain. Executive Chair Lamoureux dismissed the reconsideration. She held that the Tribunal's decision was based on the evidence before it and that the Tribunal was entitled to weight the contradicting evidence as...

January 15, 2018

/

tgp-admin

Y.L. v. Pafco (17-000480)

The claimant sought entitlement to IRBs. Arbitrator Neilson found that the claimant was not entitled to IRBs as she found the claimant was not employed or receiving employment insurance at the time of the accident and had not worked for at least 26 weeks during the 52 weeks prior to the accident. Arbitrator Neilson preferred...

January 12, 2018

/

tgp-admin

The Applicant v. State Farm Insurance Company (16-002503)

The minor claimant sought a determination that he was catastrophically impaired. Both parties agreed that the claimant suffered a traumatic brain injury and soft tissue injuries in the accident, but the claimant had significant pre-existing medical problems, including a brain injury, epilepsy, developmental delay and autism spectrum disorder. Insurer examinations determined that the claimant was...

January 12, 2018

/

tgp-admin

Applicant v. Traditional Mutual Insurance Company (17-002734)

The claimant sought entitlement to a psychological assessment. Adjudicator Norris held that the proposed assessment was reasonable and necessary. He relied upon the claimant's consistency of reporting, prescription for antidepressants, and more than one medical practitioner opining that the claimant may suffer a psychological disorder.

January 12, 2018

/

tgp-admin

A.R. v. TD General Insurance Company (16-003487)

The claimant sought interest on re-instated IRBs and entitlement to an orthopaedic mattress. The insurer opposed paying interest, arguing that the claimant had not provided evidence earlier in her claim supporting IRB entitlement. Adjudicator Maedel held that once the insurer re-instated IRBs, the claimant was entitled to interest for the period IRBs had not been...

January 11, 2018

/

tgp-admin

Applicant v. RSA Insurance (17-000233)

The claimant disputed his entitlement to income replacement benefits (IRBs), medical benefits and the MIG. Adjudicator Treksler concluded that the claimant's injuries fell outside of the MIG due a post-accident psychological impairment and diagnosis of chronic pain syndrome. In her reasons, Adjudicator Treksler noted that she preferred the evidence of the claimant's family physician to...

January 11, 2018

/

tgp-admin

Economical Mutual Insurance Company (17-002716)

The insurer sought repayment of overpaid income replacement benefits, as well as the cancellation fee for a missed examination under oath. Adjudicator Sandeep Johal reviewed the evidence of the insurer and determined that it failed to establish the claimant made a willful misrepresentation resulting in an error. Because a willful misrepresentation was not established, repayment...

January 11, 2018

/

tgp-admin

Applicant v. Allstate Insurance Company (16-004309)

The claimant sought entitlement to ongoing NEBs and two proposed treatment plans for physiotherapy. Adjudicator Baker denied entitlement to NEBs but awarded the treatment plans. In terms of NEBs, Adjudicator Baker wrote that the claimant had submitted only limited evidence about his pre-accident and post-accident life, which did not support entitlement to NEBs. He also...

January 10, 2018

/

tgp-admin

Applicant v. Unifund Assurance Company (16-003709)

The claimant sought entitlement to IRBs and ACBs. The insurer sought repayment of IRBs paid for a period that the claimant was working. Adjudicator Bickley denied entitlement to both IRBs and ACBs. She held that the claimant's return to work shortly after the accident and frequency gym attendances suggested that the claimant did not suffer...

January 10, 2018

/

tgp-admin

A.S. v. Economical Mutual Insurance Company (16-003197)

The claimant was entitled to IRBs. The insurer argued that it was entitled to deduct the claimant's post-accident income from his personal business. The claimant argued that he did not "earn" the income from his business because he was not actively engaged in the business. Adjudicator Watt concluded that the claimant was actively involved in...

January 9, 2018

/

tgp-admin

S.J.L.V. v. Certas Direct Insurance Company (17-000796)

The claimant was the driver of a vehicle when she and her boyfriend were subject to a gun attack. The claimant's boyfriend was hit by bullets and the claimant fled the scene in the vehicle and tried to find a hospital for her boyfriend. Her boyfriend eventually died of his injuries. The claimant argued that...

January 9, 2018

/

tgp-admin

C.R. v. Scottish & York Insurance Company (16-002077)

The claimant sought removal from the MIG and entitlement to one treatment plan. Adjudicator Anwar held that the claimant's suffered pre-existing conditions that would prevent maximal recovery under the MIG and development of chronic pain. He relied upon the expert reports completed for the claimant, which detailed pre-existing injuries. The insurer argued that the Tribunal...

Contact Us

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

416.507.1850

eodonnell@tgplawyers.com

© 2020 Thomas Gold Pettingill LLP Disclaimer | Privacy Policy | Statement of Principles

Powered by Crow & Pitcher

Subscribe to get TGP’s case summaries straight to your inbox

Subscribe to get TGP’s case summaries straight to your inbox

Contact Us

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

416.507.1850

eodonnell@tgplawyers.com

© 2020 Thomas Gold Pettingill LLP