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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November 10, 2017

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Applicant v. Aviva Insurance Company (17-001922)

The claimant sought entitlement to a number of medical benefits. The insurer asserted that the treatment plans were not reasonable and necessary and that one plan was partially approved in accordance with the Professional Service Guidelines. Adjudicator Therese Reilly, on review of the evidence, found none of the claimant's claims payable. The PSGs were accepted...

November 10, 2017

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F.F. v. Aviva Canada (16-000941)

The claimant sought entitlement to income replacement benefits and was successful at the LAT. The insurer sought reconsideration and pled the claimant did not comply with a section 33 information request and it is therefore not required to pay for benefits during the period of non-compliance. Executive Chair Linda Lamoureux determined that the information requested...

November 10, 2017

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C.T. v. Aviva Insurance Canada (16-000958)

The claimant sought entitlement to income replacement benefits and was successful at the LAT. The insurer sought reconsideration as it asserted that the claimant was working during a period in which IRBs were awarded. The claimant countered by asserting improper notice was provided under Rule 18.1. Executive Chair Linda Lamoureux determined that the proviso noting...

November 9, 2017

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I.A. v. Unifund Claims Inc (17-000785)

The claimant sought entitlement to a number of treatment plans. The insurer asserted a MIG position and also raised a limitation defense to one of the treatment plans. Adjudicator Billeh Hamud reviewed the denial letter of the insurer and found it to be clear and unequivocal. However, Adjudicator Hamud also noted that the claimant established...

November 9, 2017

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G.V. v. Northbridge Insurance (16-001689)

The claimant sought entitlement to NEBs and medical benefits. Shortly before the hearing, the insurer removed the claimant from the MIG and agreed to pay for a disputed medical benefits. Adjudicator White held that a special award was payable on the medical benefit due to the late approval by the insurer. She did not award...

November 9, 2017

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E.W. v. Primmum Insurance Company (16-003891)

The claimant sought a declaration of catastrophic impairment due to a GCS score less than 9. He was involved in a single vehicle accident and sustained serious physical injuries. His GCS at the scene of the accident was 13, and his GCS upon arrival at the hospital was 15. The only point at which the...

November 9, 2017

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Applicant v. Certas Home and Auto Insurance (16-002278)

The claimant sought entitlement to a number of treatment plans, both psychological and physical-based. The insurer asserted a MIG position. On review of the medical evidence, Adjudicator Paul Gosio determined the claimant established the injuries sustained were outside the MIG by virtue of a psychological report, which was not rebutted by the insurer. As a...

November 8, 2017

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G.P. v. Aviva Insurance Company of Canada (16-000726)

The insurer appealed the Tribunal decision that a 2006 denial of income replacement benefits was not valid. Executive Chair Lamoureux agreed with the insurer and held that the Tribunal's decision was a substantial error in law. She wrote that the denial had clearly and unequivocally communicated to the claimant that her entitlement to further income...

November 8, 2017

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Applicant v. Unifund Claims Inc. (17-001129)

The claimant alleged that his injuries were non-minor and that he was entitled to various medical benefits. Adjudicator Ferguson rejected the claimant's position. He held that the claimant suffered soft tissue injuries in the accident, and was not suffering psychological impairment as a result of the accident. The adjudicator also rejected the claimant's position that...

November 8, 2017

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G.P. v. Aviva Insurance Company of Canada (16-000726)

The insurer appealed the Tribunal decision that a 2006 denial of income replacement benefits was not valid. Executive Chair Lamoureux agreed with the insurer and held that the Tribunal's decision was a substantial error in law. She wrote that the denial had clearly and unequivocally communicated to the claimant that her entitlement to further income...

November 7, 2017

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Applicant v. The Personal Insurance Company (17-002301)

The claimant sought entitlement to a chronic pain assessment. Adjudicator Ferguson held that the insurer's denials were compliant with section 38 of the SABS, and that the claimant had not proven that the assessment was reasonable and necessary. He noted that the claimant had reported a steady improvement in symptoms, and had returned to normal...

November 7, 2017

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Applicant v. The Co-operators (16-004674)

The claimant sought removal from the MIG, entitlement to various medical benefits, and entitlement to the cost of an accounting report. The insurer raised a preliminary issue regarding the claimant's non-attendance at various insurer examinations. Adjudicator Treksler held that the claimant was suffering from chronic pain syndrome and psychological impairment. However, she awarded only some...

November 7, 2017

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Applicant v. State Farm Insurance Company (16-002858)

The claimant sought entitlement to three additional assessments related to a catastrophic impairment determination. The insurer denied them as being duplicative and unreasonable. Adjudicator Johal held that the in order to be payable, the proposed catastrophic impairment assessment had to be reasonable and necessary. Each proposed assessment was to be examined on that standard. Adjudicator...

November 6, 2017

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J.S. v. Aviva General Insurance Company (16-002529)

The claimant sought entitlement to a treatment plan. The insurer asserted the treatment plan was not reasonable a necessary. The insurer also objected to evidence supplied by the claimant's OT, as it was not disclosed at the case conference. Adjudicator Sandeep Johal ruled that the inclusion of more documentation on the part of the claimant...

November 6, 2017

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Applicant v. Waterloo Insurance (17-001265)

The claimant sought removal from the MIG and entitlement to four treatment plans. A number of procedural issues were first addressed. Adjudicator Ferguson rejected the claimant's objection to the insurer's expert report being considered by the Tribunal because the issue was not raised until the claimant's reply submissions. The adjudicator rejected the insurer's objection about...

November 2, 2017

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R.B. v. Aviva Insurance Canada (17-001238)

The claimant sought entitlement to a number of treatment plans the insurer denied. On review of the medical evidence, Adjudicator Billeh Hamud held that some of the plans were payable. The treatment plans that were denied were denied due to a lack of evidence substantiating the plans as reasonable a necessary. While the claimant sought...

November 2, 2017

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M.A. v. Intact Insurance Company (16-003510)

The claimant sought entitlement to attendant care benefits. The insurer asserted the claim was barred due to the limitations provisions. The claimant challenged the denial letter of the insurer. Adjudicator Therese Reilly held that the insurer's denial was not clear and unequivocal. The letter relied upon by the insurer was a suspension of benefits for...

November 2, 2017

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Applicant v. Aviva Insurance (17-004068)

The claimant sought production of the entire file from the insurer's IE assessors based on notations in the reports referring to drafts. The insurer did not object to production of the file from the IE assessors. Adjudicator Makhamra ordered the IE assessors to produce their entire files including all draft reports.

November 1, 2017

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H. A-R v. Aviva Insurance (16-003039)

The claimant sought accident benefits, however, withdrew the claim the day before a case conference. As a result, the insurer sought costs. Adjudicator Robert Watt held that the insurer did not establish the claimant acted in an unreasonable, vexatious, frivolous, or bad faith manner, during the proceedings. The withdrawal of the claim, though inconvenient, does...

October 31, 2017

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A.P. v. Coseco Insurance Company (16-004363)

The catastrophically-impaired claimant sought payment of attendant care benefits based on service provided by his mother. The mother had training as a PSW but was not employed at the time of the accident. The dispute concerned whether the mother qualified as a professional service provider under the "incurred expense" definition. Adjudicator Truong concluded that the...

October 30, 2017

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D.G. v. Allstate Insurance Company of Canada (17-001641)

The claimant sought entitlement to one treatment plan for physiotherapy services. The respondent relied upon the orthopaedic IE report of Dr. Yousif, in which he concluded that the claimant did not require further treatment. The claimant provided only two documents with his written submissions: the Motor Vehicle Accident Report prepared by the police and the...

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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