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 22, 2018

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Applicant v. Aviva Insurance Canada (16-004616)

The claimant sought entitlement to medical benefits for physiotherapy, chiropractic, and psychological treatment; the cost of an orthopedic assessment; a special award; and interest on overdue payments. Adjudicator Anwar held that the claimant was entitled to all of the medical benefits for treatment in dispute and interest thereon, but denied entitlement to the assessment and...

February 22, 2018

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Applicant v. Aviva Insurance Canada (17-001414)

The claimant sought entitlement to NEBs, treatment outside the MIG and entitlement to seven treatment plans. Adjudicator Watt dismissed the claimant's claim for NEBs and concluded that the claimant's injuries fell within the MIG. As the claimant's injuries were found within the MIG, Adjudicator Watt found that the disputed treatment plans were not payable. With...

February 21, 2018

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Applicant v. State Farm Mutual Automobile Insurance Company (16-001226)

The claimant sought a catastrophic impairment on both mental or behavioural grounds as well as WPI. Adjudicator Paul Gosio reviewed the medical evidence and conducted a pre- and post-accident review of the claimant's functionality, and determined that the claimant sustained a Class 4 marked impairment in the fields of activities of daily living, concentration, persistence...

February 20, 2018

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Applicant v. Certas Direct Insurance Company (17-001627)

The claimant sought entitlement to 15 treatment plans, non-earner and attendant care benefits. The insurer paid the non-earner and attendant care benefits for two years, before stopping both with IE reports. The insurer, in its written submissions, reversed its position on medical benefits, and ultimately approved the disputed treatment plans. However, Adjudicator Susan Sapin determined...

February 16, 2018

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Applicant v. Economical Mutual Insurance Company (17-002867)

The claimant brought a motion to change the format of a preliminary issue hearing from written hearing to proceed via teleconference. Adjudicator Trojek denied the claimant's motion. Adjudicator Trojek concluded that the claimant did not provide her with adequate reasons to change the format of the preliminary motion hearing.

February 16, 2018

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G.A.E. v. Aviva Insurance Canada (17-000317)

The claimant sought entitlement to a number of medical benefits. In addition to a MIG position, the insurer asserted that the claimant was barred from bringing a claim as notice to claim accident benefits was not provided within seven days (or reasonably thereafter) of the MVA, pursuant to sections 32 and 55. Adjudicator S.F. Mather...

February 16, 2018

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Applicant v. Aviva General Insurance (17-003539)

The claimant sought removal from the MIG and three medical benefits. Adjudicator Norris held that the claimant's partial rotator cuff tear was an injury that fell within the MIG, and that the claimant's pre-accident reports of back pain did not constitute pre-existing injuries that would prevent recovery under the MIG. He also concluded that the...

February 14, 2018

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Applicant v. Wawanesa Mutual Insurance Company (16-002633)

The claimant sought removal from the MIG and two medical benefits. The insurer argued that the claim was time barred. Adjudicator Maedel held that the claimant had applied to the LAT within 90 days of receipt of the FSCO Report of Mediator, and was therefore within the limitation period. He concluded that the claimant's injuries...

February 14, 2018

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Applicant v. TD Insurance Meloche Monnex (17-000640)

The claimant sought entitlement to NEBs, removal from the MIG, and two treatment plans. Adjudicator Neilsen first exclude one report submitted by the claimant because it was given to the insurer 10 days prior to the hearing. In terms of the benefits in dispute, the adjudicator concluded that the claimant failed to adduce sufficient evidence...

February 14, 2018

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Applicant v. Co-operators General Insurance Company (16-003821)

The claimant sought removal from the MIG and entitlement to four medical benefits. Adjudicator Makhamra accepted that the claimant suffered from a compression fracture caused by the accident, and from psychological impairments; the claimant was removed from the MIG. The adjudicator awarded all of the claimed medical benefits, as being reasonable and necessary.

February 14, 2018

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Applicant v. Certas Direct Insurance Company (17-003571)

The claimant sought entitlement to treatment outside of the MIG and to three treatment plans. Adjudicator Johal dismissed the claimant's claim finding that her injuries fell within the MIG. As Adjudicator Johal concluded that the MIG applied, he held that he did not need to address whether the proposed treatment plans were reasonable and necessary.

February 13, 2018

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S.R. v. Aviva Insurance Canada (17-004556)

The insurer argued that the claimant was barred from seeking IRBs due to the limitation period. It had denied IRBs when the claimant returned to work. The denial letter stated that if the claimant was off work again due to injuries, the insurer would require an updated Disability Certificate. Adjudicator Ferguson held that the denial...

February 13, 2018

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M.K. v. Aviva Insurance Company (17-003608)

The claimant sought entitlement to NEBs, removal from the MIG, and one treatment plan. The insurer argued that the claimant failed to attend an IE. Adjudicator Watt agreed that the claimant failed to attend a scheduled IE, and he therefore could not dispute his entitlement to the denied treatment plan. In terms of NEBs, the...

February 12, 2018

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R.S. v. Wawanesa Mutual Insurance Company (17-000513)

In this preliminary decision relating to IRBs, the insurer argued that the claimant had failed to provide documents requested under section 33 of the SABS, and that the claimant failed to seek medical treatment as required under section 57 of the SABS. Adjudicator Norris held that the claimant had failed to provide relevant documents over...

February 9, 2018

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Z.M. v. Aviva Insurance Company (17-002894)

The claimant sought removal from the MIG and three treatment plans. The insurer argued that the claimant failed to attend scheduled IEs. Adjudicator Norris concluded that the insurer's IE notices complied with the SABS, and that the claimant failed to attend the IEs. He rejected the submission that the insurer had to provide the claimant...

February 9, 2018

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M.H.E. v. Aviva Insurance Company (17-002624)

The claimant sought removal from the MIG and entitlement to six treatment plans. Adjudicator Mather concluded that the claimant suffered from chronic pain, which was a non-"minor injury." The adjudicator accepted that pain relief was a valid treatment goal, and awarded four of the claimed treatment plans. Two of the treatment plans were denied due...

February 9, 2018

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D.N. v. Aviva Insurance Company (17-004104)

The claimant sought entitlement to two assessments, and argued that the treatment plans were denied more than 10 days after submission. The insurer argued that the claimant failed to attend IEs. Adjudicator Norris agreed with the claimant that the treatment plans had been denied more than 10 days after submission due to the deeming provision...

February 8, 2018

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K.K. v. Unifund Assurance Company (17-003303)

The insurer brought a motion to dismiss the application after the claimant's failure to submit any written materials. Adjudicator Watt granted the motion and dismissed the application. He reasoned that the claimant's failure to bring a motion to extend the deadline for submissions after retaining new counsel amounted to an abuse of process, and that...

February 8, 2018

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Applicant v. Aviva Insurance Company (17-002907)

The claimant sought removal from the MIG and entitlement to four medical benefits. Adjudicator Lester held that the claimant's disc bulges, degenerative changes, and chronic pain disorder were not minor injuries, and removed the claimant from the MIG. She also awarded the cost of a chronic pain assessment, chronic pain treatment plan, and a psychological...

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...

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Contact Us

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

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Contact Us

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

416.507.1850

eodonnell@tgplawyers.com