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 6, 2018

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J.N. v. Aviva General Insurance Company (17-000518)

The claimant sought entitlement to NEBs and the cost of an in-home assessment. Adjudicator Truong dismissed the claim for NEBs, but awarded the in-home assessment. She found the reports by the claimant's assessors to be contradictory and unhelpful in supporting the NEB claim. There were also injuries that the claimant's assessor tried to link to...

February 6, 2018

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J.D. v Aviva General Insurance (17-002713)

The claimant sought the cost of an orthopaedic assessment. Adjudicator Goela held that the respondent's denial letter did not provide a medical reason why an orthopedic examination was not reasonable or necessary pursuant to section 38(8) of the SABS. The denial letter stated that pursuant to the physiatrist report, further physical intervention would not affect...

February 6, 2018

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S.T. v. Wawanesa Mutual Insurance Company (17-003874)

The insurer sought production of the settlement documents from an earlier accident the claimant was involved in. Adjudicator Neilson ordered the records produced. She held that it was relevant to the current dispute what the claimant was paid in her earlier claim, and how the benefits were allocated. She noted that there was no evidence...

February 6, 2018

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Applicant v. State Farm Insurance (16-004619)

The claimant sought ongoing IRBs. Adjudicator Gosio rejected the claim. He held that the claimant had failed to meet her burden under the post-104 week test. In particular, he was critical of the claimant's assessors basing their report solely on the claimant's self-reporting, the assessors failure to consider the claimant's vocational background, and the failure...

February 5, 2018

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Applicant v. The Sovereign General Insurance Company (16-004501)

The claimant sought entitlement to various denied catastrophic impairment assessments, and the cost of x-rays. The insurer had approved some of the catastrophic impairment assessments, but denied others. At the time of the hearing, the claimant had been declared catastrophically impaired. Adjudicator Sewrattan awarded the cost of the physiatry assessment, even though an orthopaedic assessment...

February 5, 2018

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Applicant v. TD Insurance (17-003496)

The claimant sought entitlement to six assessments to address his potential catastrophic impairment. Each assessment was in excess of $2,000. The insurer denied the assessments on the basis that the claimant had failed to prove causation (i.e. the accident was minor, and the claimant suffered psychological difficulties before the accident). Adjudicator Sewrattan granted the claimant's...

February 5, 2018

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Applicant v. Aviva Insurance Canada (17-002465)

The insurer argued that the claimant was barred from seeking NEBs due to her failure to submit a Disability Certificate. Adjudicator Sewrattan rejected the insurer's position and held that the claimant likely had submitted a Disability Certificate. He relied upon a billed invoice from the clinic showing that a Disability Certificate had been completed. He...

February 1, 2018

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Applicant v. Unifund (17-000982)

The claimant sought entitlement to NEBs, removal from the MIG, and further medical benefits. The insurer argued that the claimant was barred from seeking NEBs due to the limitation period. Adjudicator Harmison accepted that the insurer had denied NEBs more than five years prior, and that the denial was clear and unequivocal. In terms of...

February 1, 2018

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Applicant v. Aviva General Insurance (17-002651)

The claimant sought ongoing IRBs. Adjudicator Sewrattan dismissed the claim on the basis that the claimant had failed to prove what his essential pre-accident employment tasks were, which of those tasks he was unable to perform, and the extent to which the claimant was unable to perform those tasks.

January 31, 2018

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T.N. v. Aviva Insurance Canada (17-002971)

The claimant sought entitlement to a number of medical benefits. The insurer denied the treatment and cited that the plans were not reasonable and necessary. Adjudicator Derek Grant reviewed the medical evidence and concluded that the claimant failed to establish the medical benefits sought were reasonable and necessary. The claims were dismissed.

January 31, 2018

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S.T. v. Economical Insurance Company (16-0003034)

The claimant sought reconsideration of the Tribunal's decision to deny attendant care and housekeeping benefits. The Tribunal had determined that the two year time limit for the claimant to dispute her entitlement had passed. The claimant filed her request for reconsideration outside of the 21 day period stipulated in the LAT Rules. Executive Chair Lamoureux...

January 31, 2018

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Applicant v. Aviva General Insurance (17-004357)

The claimant sought entitlement to a psychological assessment, as well as a number of psychological treatment plans. Adjudicator Christopher Ferguson reviewed the denial letter for the psychological assessment, and determined that the Notice failed to provide medical reasons for the denial. Accordingly, by operation of section 38, the assessment was deemed payable. However, based on...

January 30, 2018

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D.M. v. Certas Direct Insurance Company (17-000180)

The insurer requested a preliminary issue hearing as to whether the incident in question was an automobile accident. The claimant had sustained injuries after she slipped and fell next to the passenger door of her parked vehicle. The claimant had sought benefits under the SABS, which the insurer denied as the incident did not qualify...

January 30, 2018

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N.H. v. Aviva Insurance Canada (17-001309)

The claimant sought entitlement to a medical treatment plan for optometrist services. The insurer denied the plan, citing the proposal to not be reasonable and necessary. Adjudicator Gemma Harmison noted that the applicant failed to submit the disputed OCF-18 as evidence and subsequently failed to meet the burden of proof. Additionally, Adjudicator Harmison went further...

January 30, 2018

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D.W. v. Heartland Farm Mutual (17-001508)

The claimant sought entitlement to a number of medical treatment plans. The insurer asserted the claimant was barred from proceeding to the LAT due to a failure to attend IEs scheduled. On review of the Notices provided, Adjudicator Rupinder Hans found the requested IEs to be reasonable. Accordingly, because the claimant failed to attend, the...

January 29, 2018

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C.P. v. Wawanesa Mutual Insurance Company (17-001931)

The claimant sought entitlement to income replacement benefits. The insurer denied the benefits citing a return to work. The claimant sought IRBs for the period not working as well as ongoing. Adjudicator Ruth Gottfried concluded the claimant was entitled to IRBs for the time when the claimant was not working, and should have been paid,...

January 29, 2018

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Applicant v. Wawanesa (17-000565)

The claimant sought entitlement to a number of medical treatment plans. The insurer asserted a MIG position. Adjudicator Billeh Hamud reviewed the medical evidence and found the claimant's injuries to be predominantly minor. Adjudicator Hamud also reviewed surveillance footage and social media evidence and found the credibility of the claimant to be negatively impacted. None...

January 29, 2018

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Applicant v. Aviva Insurance Canada (17-001040)

The claimant sought entitlement to a number of medical treatment plans. The insurer denied each as not being reasonable and necessary. Adjudicator Eleanor White reviewed the medical evidence and found half of the treatment plans reasonable and necessary. Interest, in accordance with section 51, was awarded on the payable benefits.

January 28, 2018

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T. T. v. Aviva Insurance Canada (17-002535)

The claimant sought entitlement to a number of medical treatment plans. The insurer denied the treatment and asserted a MIG position. The insurer also tendered surveillance in support of its position, to which the claimant sought to exclude on the basis of bad faith. Adjudicator Avvy Go determined that the surveillance was in contravention of...

January 26, 2018

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Applicant v. TD Insurance (17-003356)

The claimant sought entitlement to medical benefits, including a number of prescription expenses. The insurer raised a causation argument as the claimant's medical history was littered with previous MVAs and workplace injuries. The claimant countered by noting the insurer previously approved treatment, which would suggest the insurer accepted the subject motor vehicle accident as the...

January 26, 2018

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Applicant v. Certas Home and Auto Insurance (17-001228)

The claimant sought entitlement to a number of medical benefits. The insurer denied the treatment asserting the claims were not reasonable and necessary. On review of the medical evidence, Adjudicator Eleanor White determined that the medical benefits sought were payable, with the exception of a neuropsychological examination. A gym membership and assistive devices were also...

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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