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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June 16, 2017

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Applicant v. Gore Mutual Insurance Company (16-001305)

The claimant applied for a CAT determination based on GCS. The insurer denied the determination based on a paper review of a neurologist. Adjudicator Bickley reviewed the medical evidence, which included two ambulance call reports both showing GCS scores of 15. However, during the course of hospitalization, the claimant scored GCS scores of 7, 8,...

June 15, 2017

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L.S. v. Royal & Sun Alliance Insurance Company of Canada (16-002381)

The claimant sought entitlement to a medical treatment plan. In addition to the issues outlined in the Case Conference Order, the claimant also sought a lump sum payment of $35,000.00 for 5 years of future medical treatment. Adjudicator Truong noted that issues not codified by the Case Conference Order were not properly before the Tribunal...

June 13, 2017

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C.M. v. The Co-operators General Insurance Company (16-000793)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to one treatment plan for a psychological assessment. Adjudicator Sewrattan found that the claimant's injuries were predominantly minor and that his entitlement was subject to the MIG. In terms of psychological impairments, the adjudicator found that the diagnosis of mixed...

June 13, 2017

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P.W. v. Aviva Canada Inc. (16-001097)

The claimant sought entitlement to a medical treatment plan. The insurer relied on IE reports and denied the benefit. On review, Adjudicator Norris preferred the evidence of the claimant and determined the treatment plan was reasonable and necessary.

June 12, 2017

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G.P. v. Unifund Assurance Company (16-003165)

The claimant sought payment for various clinic balances for medical treatment. Adjudicator Sewrattan ruled that the claimant failed to submit the treatment plans as evidence and therefore the issue as to whether the treatment was reasonable and necessary was not at issue. The claims were dismissed.

June 12, 2017

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Applicant v. Unifund Assurance Company (16-002818)

The claimant sought entitlement to a number of medical benefits. The insurer asserted a MIG defence. On review of the evidence, Adjudicator Sewrattan determined the claimant's psychological injury was as a result of the accident and not predominantly minor. The psychologically-based treatment plans were found payable, and the physically-based treatment plans were denied as not...

June 12, 2017

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Applicant v. Aviva Insurance Company of Canada (16-001985)

The claimant sought and was successful in obtaining a Tribunal Order for a number of treatment plans. In making the determination, the Tribunal also ordered interest payable at 2 percent per month. On reconsideration, however, Executive Chair Lamoureux noted the Tribunal erred by using the interest provisions of the previous SABS; the correct provision is...

June 12, 2017

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Applicant v. Aviva (16-000775)

The claimant had been involved in two accidents. He had been removed from the MIG due to pre-existing back injuries and sought entitlement to a treatment plan proposing psychological therapy in relation to the first accident. The treatment plan was submitted after the second accident occurred. Adjudicator White took issue with the treatment provider's failure...

June 12, 2017

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A.G. v. Aviva Canada Inc. (17-000270)

The claimant sought entitlement to medical benefits. At the case conference the parties were able to resolve the issues with the exception of costs, which the claimant continued to seek. Adjudicator Truong reviewed Rule 19.1 and affirmed that costs may only arise out of the Tribunal process. While the claimant argued the insurer failed to...

June 12, 2017

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Applicant v. Aviva Insurance Company of Canada (16-001985)

The claimant sought and was successful in obtaining a Tribunal Order for a number of treatment plans. In making the determination, the Tribunal also ordered interest payable at 2 percent per month. On reconsideration, however, Executive Chair Lamoureux noted the Tribunal erred by using the interest provisions of the previous SABS; the correct provision is...

June 9, 2017

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Applicant v. Aviva General Insurance Company (17-000370)

The claimant sought entitlement to a number of benefits. At the case conference, a number of timelines were set. The claimant missed a number of document exchange deadlines and subsequently sought an adjournment and the insurer did not consent. The Tribunal did not grant the adjournment. On reconsideration Executive Chair Lamoureux noted the reason for...

June 8, 2017

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Y.C.T-T. and Certas Home and Auto Insurance Company (16-000872)

The claimant was originally placed within the MIG. During that period, the insurer denied medical benefits as well as an assessment of attendant care needs. The insurer later removed the claimant from the MIG, but did not approve the previously denied treatment plans. The claimant sought entitlement to the previous plans. Adjudicator Leslie found the...

June 7, 2017

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Applicant v. Co-operators General Insurance Company (16-001976)

The claimant applied for FSCO mediation on January 21, 2016 and disputed a denial of IRBs dated February 26, 2014. The FSCO Mediation was scheduled for May 6, 2016 and was not successful. The claimant subsequently applied to the LAT on August 11, 2016 (97 days after the report of mediator). The insurer raised a...

June 6, 2017

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Applicant v. Northbridge Personal Insurance Company (16-001066)

The claimant was injured in an accident. The insurer had previously sought and received a declaration from WSIAT that under section 31 of the WSIA the claimant was barred from seeking accident benefits. WSIAT indicated that the claimant only had a claim against its employer, but could not make a declaration against accident benefits due...

June 5, 2017

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S-A. A. v. TD General Insurance Company (16-004361)

The claimant had sought production of all of clinical notes and records of the insurer's IE assessors prior to the LAT hearing. Those records had not been produced in accordance with the Case Conference order. The claimant sought an order extending the deadline for his opening statements. Adjudicator Lester granted the claimant's motion and issued...

June 5, 2017

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M.T. v. Optimum Insurance Company (16-002744)

In advance of the scheduled LAT hearing, the insurer sought the production of the complete clinical notes and records from a variety of medical practitioners. Adjudicator Markovits rejected the insurer's motion, reasoning that the Case Conference adjudicator clearly set out the documents that the parties had agreed to exchange prior to the hearing. The newly...

June 5, 2017

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M.S. v. Unifund Assurance Company (16-001849)

The claimant sought entitlement to NEBs and removal from the MIG. Adjudicator Belanger-Hardy denied all claims. First, she held that the claimant failed to adduce sufficient evidence of the details of his pre-accident lifestyle and activities to establish his eligibility to NEBs. Second, the claimant did not adduce sufficient evidence that he sustained a non-minor...

June 5, 2017

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D.C. v. Aviva Insurance Company (16-002272)

The claimant withdrew her LAT application two weeks prior to the scheduled hearing. The insurer sought costs. Adjudicator Bickley rejected the claim for costs, and wrote that simply inconveniencing an opposing party did not amount to vexatious, frivolous, unreasonable, or bad faith behaviour. She also rejected FSCO case law concerning costs.

June 5, 2017

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A.V.de V. v. Intact Insurance Company (16-002061)

The claimant sought an adjournment of the LAT hearing after receipt of insurer addendums occurred two weeks before the hearing. Those addendums were completed late in the process because the claimant had himself served the insurer with s.25 reports just five weeks prior. Vice Chair Flude concluded that an adjournment was warranted to allow a...

June 2, 2017

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M.R. v. Aviva Insurance (16-001739)

The insurer filed a motion in advance of the LAT hearing seeking an order for unredacted clinical notes and records and OHIP summary. Adjudicator Lester declined to make an order in advance of the hearing and directed the parties to argue the motion before the hearing adjudicator.

June 2, 2017

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M.R. v. Aviva Insurance (16-001739)

The insurer filed a motion in advance of the LAT hearing seeking an order for unredacted clinical notes and records and OHIP summary. Adjudicator Lester declined to make an order in advance of the hearing and directed the parties to argue the motion before the hearing adjudicator.

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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