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.

December 19, 2017

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N.N. v. Certas Direct Insurance Company (17-001002)

The claimant sought entitlement to attendant care benefits and two treatment plans. Adjudicator Billeh Hamud reviewed the medical evidence and determined that the claimant was independent with his day to day activities and was functional to the point that attendant care benefits were not reasonable and necessary. In the alternative, Adjudicator Hamud also determined that...

December 19, 2017

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Applicant v. Certas Home and Auto Insurance Company (16-004624)

The claimant sought entitlement to non-earner benefits. On review of the limited medical evidence Adjudicator Gregory Flude determined the claimant had not satisfied the disability test for non-earner benefits. In making the determination, Adjudicator Flude indicated that submissions that were not supported by evidence were not considered. As an example, a chart purportedly identifying pre-...

December 18, 2017

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Aviva Insurance Canada v. “Mr.P” (16-004349)

The claimant applied for and received various accident benefits from Aviva, including $14,514 in IRBs. Aviva subsequently voided the policy because the claimant failed to disclose that his partner, who had a poor driving record, had moved in with him one year prior to the accident. Aviva applied for an order requiring the claimant to...

December 18, 2017

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D.P. v. Aviva General Insurance (17-000636)

The claimant sought entitlement to an orthopedic assessment at a cost of $2,912.00. The insurer asserted the claim was governed by the MIG and that the maximum allowable fee for an assessment was $2,000.00. Adjudicator Blaine Baker determined that since the claimant had broken her arm, the MIG did not apply. On review of the...

December 18, 2017

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Certas Direct Insurance Company v. T.T. (17-000272)

The insurer sought repayment of income replacement benefits, asserting the claimant failed to disclose post-accident income. The claimant did not participate in the hearing. Adjudicator Sandeep Johal determined that the claimant was indeed employed during the payment period, and that the insurer had given adequate and timely notice regarding repayment. Furthermore, the claimant committed a...

December 17, 2017

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Applicant v. State Farm Insurance (17-000018)

The claimant disputed her entitlement to IRBs. Adjudicator Paluch dismissed the claimant's application finding that the claimant was not entitled to IRBs for either the pre- or post-104 week period. Adjudicator Paluch also concluded that the claimant did not comply with s. 33 and did not provide a reasonable explanation for her delay in providing...

December 15, 2017

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M.D. v. Intact Insurance Company (17-000532)

The insurer defended the claim on the basis that the accident was staged and that no accident benefits were payable. Adjudicator Neilson accepted the insurer's position. She first rejected FSCO case law that held that a staged accident still qualified for accident benefits. She noted that section 118 of the Insurance Act states that a...

December 15, 2017

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Applicant v. Wawanesa Mutual Insurance Company (17-001083)

The claimant sought entitlement to eight treatment plans for various physical and psychological treatment and assessments. Adjudicator White denied entitlement to all of the claims. She held that the claimant had sustained relatively minor injuries in the accident. She was critical of the claims for in-home treatment and the proposal for various assistive devices as...

December 15, 2017

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A.K. v. Aviva Canada (17-000746)

The claimant sought entitlement to two chiropractic treatment plans as well as an attendant care assessment. The insurer denied the claims and asserted none were reasonable and necessary. Adjudicator Marisa Victor determined that the claimant failed to provide sufficient medical evidence to establish the treatment plans were reasonable and necessary. Adjudicator Victor also favoured the...

December 14, 2017

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Aviva Insurance Company of Canada v. N.S. (17-001880)

The insurer sought repayment of IRBs after the claimant was retroactively approved for LTD benefits. The claimant argued that the insurer was only entitled to recoup the repayment by way of deduction from her weekly IRB payments. The insurer argued that it was entitled to an order for lump sum repayment. Adjudicator Mather agreed with...

December 14, 2017

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R.P. v. Wawanesa Mutual Insurance Company (16-002947)

The claimant sought entitlement to attendant care benefits and a number of treatment plans. Adjudicator Eleanor White reviewed the claimant's submissions for attendant care and noted that no evidence was provided showing that attendant care had been incurred. Accordingly, Adjudicator White determined that regardless of a determination regarding the reasonableness and necessity of the claimant's...

December 14, 2017

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Applicant v. Aviva Insurance Company of Canada (17-002688)

The claimant sought entitlement to a number of medical benefits for physical and psychological treatment. The insurer asserted a MIG position. Adjudicator S.F. Mather, on review of the medical evidence, determined the claimant's injuries fell outside of the MIG. The treatment plans that addressed the injuries removing the claimant from the MIG were found payable,...

December 13, 2017

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Y.D. v. Aviva Insurance Canada (16-001810)

The Tribunal ruled against the claimant's application for further attendant care benefits on the basis that no expenses had been incurred, and that the Tribunal did not have equitable jurisdiction to order the ongoing payment of attendant care benefits based solely upon earlier payments of the benefit. Executive Chair Lamoureux upheld the earlier decision and...

December 13, 2017

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N.L. v. North Blenheim Mutual Insurance Company (16-002606)

The Tribunal initially held that the claimant had failed to apply to the LAT within two years. The claimant's application occurred during the transition between FSCO and the LAT. Executive Chair Lamoureux held that it was an error for the Tribunal not to consider whether the limitation period should be extended. She noted that section...

December 13, 2017

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E.D. v. Aviva Insurance Canada (17-002048)

The claimant was an elderly pedestrian knockdown and claimed entitlement to non-earner benefits, attendant care, and a number of medical treatment plans. Adjudicator Christopher Ferguson was critical of the evidence led by the claimant and remarked "The applicant made no submissions in this matter: she advanced no discussion or argument respecting the evidence that she...

December 13, 2017

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Applicant v. Economical Mutual Insurance Company (17-000846)

The claimant sought entitlement to medical, attendance care, and income replacement benefits. The insurer asserted a MIG position. Adjudicator Nicole Treksler, on review of the evidence, determined that the claimant's injuries were governed by the MIG and that the claimant failed to establish a substantial inability to perform the essential tasks of employment in the...

December 13, 2017

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Applicant v. Aviva Insurance Company (17-001173)

The claimant sought entitlement to IRBs and medical benefits. The insurer asserted the claimant's impairments were as a result of an intervening factor, namely a slip and fall, rather than the MVA. Adjudicator Catherine Bickley found the claimant to be a credible witness and attributed her impairments to the MVA. It was also noted that...

December 13, 2017

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N.L. v. North Blenheim Mutual Insurance Company (16-002606)

The Tribunal initially held that the claimant had failed to apply to the LAT within two years. The claimant's application occurred during the transition between FSCO and the LAT. Executive Chair Lamoureux held that it was an error for the Tribunal not to consider whether the limitation period should be extended. She noted that section...

December 12, 2017

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S.H. v. Gore Mutual Insurance Company (17-002632)

The claimant sought entitlement to a medical treatment plan for optometrist services. The insurer denied the treatment plan and relied on an IE assessment which noted the claimant's eye issues were not as a result of the MVA. Adjudicator Avvy Go reviewed the medical evidence and determined that the claimant's eye impairment was a direct...

December 12, 2017

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N.R. v. Pembridge Insurance Company (16-003776)

The claimant sought entitlement to NEBs, ACBs, and medical benefits. Adjudicator Hans rejected all of the claims. In terms of NEBs, the adjudicator wrote that the claimant failed to provide evidence of his pre-accident activities and that without such information, entitlement to NEBs could not be proven. In terms of ACBs, the adjudicator wrote that...

December 12, 2017

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M.B. v. Aviva Insurance Canada (16-002325)

The Tribunal initially held that the claimant failed to attend IEs related to post-104 week IRBs. The claimant applied for reconsideration and was successful. Executive Chair Lamoureux held that the IE notice sent to the claimant did not provide sufficient reasons, in particular because the insurer had simply restated its reasons from IEs related to...

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Contact Us

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

416.507.1850

eodonnell@tgplawyers.com

© 2020 Thomas Gold Pettingill LLP