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.

October 11, 2022

/

tgp-admin

Hilaire v. Sonnet Insurance Company (20-006329)

The claimant filed a LAT Application disputing five OCF-18s for physiotherapy services, the MIG and entitlement to NEBs. The insurer requested repayment of NEBs in the amount of $6,105.00 under s. 52 of the SABS on the basis that the benefit was paid in error. The insurer argued that it erroneously paid the claimant NEBs...

October 11, 2022

/

tgp-admin

Nesbesnuik v. Aviva General Insurance Company (20-007540)

The claimant applied to the LAT seeking entitlement to an attendant care benefit ("ACBs") and assistive devices including a lawnmower with snow blower attachment, cell phone, and computer. Adjudicator Pahuta found that the claimant had failed to establish that ACBs had been incurred. The only evidence before the Tribunal was a written statement authored by...

October 4, 2022

/

tgp-admin

Aviva General Insurance Company v. Manalastas (20-010171) & Manalastas v. Aviva General Insurance Company (20-007000)

The claimant sought entitlement to a number of OCF-18s, as well as a special award and interest. The insurer sought repayment of IRBs for the period of July 21, 2018 to December 2, 2018 in the amount of $6,865.97, and from December 2, 2018 to March 10, 2019 in the amount of $5,600.00. At the...

September 29, 2022

/

tgp-admin

Wu v. Aviva Insurance Company (20-011618)

The claimant applied to the LAT disputing the insurer's partial approval of catastrophic assessments. The dispute centered around the proper reading of s. 25(2)(a) of the SABS which provides a $2,000 limit for as assessment. Adjudicator Shapiro concluded that a plain language reading of the section set a clear total limit of $2,000 which would...

September 28, 2022

/

tgp-admin

Sorouri v. Intact Insurance Company (20-003723)

The claimant applied for accident benefits after he was assaulted while working an Uber driver on March 24, 2019. After he had picked up four passengers, multiple assailants surrounded his vehicle and attempted to remove a female passenger from the rear passenger seats. One assailant allegedly punched the claimant's face and pulled and twisted his...

September 27, 2022

/

tgp-admin

Carleton v. Unica Insurance Inc. (20-002008)

The claimant was injured in an accident and applied for an attendant care benefit but was denied on the basis that it was not reasonable or necessary. Vice Chair Johal found that the claimant was entitled to 315 minutes per week of attendant care that had been incurred for feeding and 45 minutes per week...

September 27, 2022

/

tgp-admin

Z .R. v. Gore Mutual Insurance Company (18-000017)

The claimant applied to the LAT seeking entitlement to attendant care benefits in the amount of $8,280.86 per month, various medical benefits, and the cost of examinations (including $11,250.00 for CAT assessments). The claimant had been declared catastrophically impaired in a previous LAT decision. As a preliminary issue, the insurer argued that pursuant to s....

September 26, 2022

/

tgp-admin

Eid v. Allstate Insurance Company of Canada (20-001143)

The self-employed claimant applied to the LAT seeking entitlement to IRBs for various periods since the 2017 accident and a determination of the appropriate quantum of IRBs. The issues in dispute included the following: What is the proper period to calculate the claimant's IRBs in these circumstances? Does the calculation provided for in s. 4(3)...

September 23, 2022

/

tgp-admin

Bustin v. Economical Insurance Company (20-007017)

The claimant sought entitlement to accident benefits after witnessing a fatal collision on October 13, 2019. He claimed that he had been involved in the accident and was an "insured person" as defined in the SABS. The claimant had been sitting on the porch of his aunt's home when two vehicles struck one another in...

September 19, 2022

/

tgp-admin

Williams v. Unifund Assurance Company (20-015158)

The claimant applied to the LAT seeking entitlement to various benefits, including payment for catastrophic assessments. The claimant submitted that the proposed CAT assessments met both the reasonableness and guideline requirements for entitlement to funding. Adjudicator Kaur disagreed with the claimant's position, noting that she had failed to submit appropriate evidence before the Tribunal in...

September 16, 2022

/

tgp-admin

Handy v. Aviva Insurance Company of Canada (20-006124)

The claimant sought catastrophic impairment designation under Criterion 7, arguing that he developed chronic pain from the soft tissue injuries sustained in the accident along with exacerbation of pre-existing asymptomatic degenerative disc disease and knee osteoarthritis. The insurer submitted that the claimant's present health condition was caused by an unrelated subsequent fall. The claimant's assessors...

September 15, 2022

/

tgp-admin

Alkhazov v. Aviva Insurance Company of Canada (21-004825)

The insurer brought a preliminary motion to address whether the claimant was barred from proceeding with his claim for NEBs as he failed to submit an OCF-10 form electing benefits. The claimant was injured in an automobile accident on April 18, 2019, and applied for accident benefits (OCF-1) on April 23, 2019. In his OCF-1,...

September 13, 2022

/

tgp-admin

Belanger v. Intact Insurance Company (19-013755)

The insurer requested reconsideration of the Tribunal’s earlier decision which held that the claimant was not statute barred pursuant to s. 56 of the Schedule. In the initial decision, the Tribunal found that the delivery of the initial IRB denial letter dated March 26, 2015, despite being an adequate stoppage letter, was not done in...

September 12, 2022

/

tgp-admin

Day v. BelairDirect Insurance Company (20-005603)

The claimant sought catastrophic impairment designation under Criterion 8 as a result of her involvement in an April 2016 accident. Both parties agreed that the claimant had a class 4 marked impairment due to a mental or behavioural disorder, but the insurer denied that her mental or behavioural disorder was caused by the accident and...

September 12, 2022

/

tgp-admin

Ladouceur v. Intact Insurance Company (2022 ONSC 5206)

The claimant sought judicial review of the Tribunal's decision that the limitation period barred the claim for NEBs, and the Tribunal's decision not to extend the limitation period under section 7 of the LAT Act. The Court dismissed the matter, holding that judicial review was only warranted in rare circumstances. The claimant chose not to...

September 6, 2022

/

tgp-admin

Ferlisi v. Allstate Insurance Company of Canada (21-000013)

The claimant sought catastrophic impairment under Criterion 7. The claimant sustained soft tissue injuries to her left side and developed chronic regional pain syndrome (CRPS) in her left foot as a result of the accident. She had a spinal cord stimulator (SCS) surgically inserted into her spine to address the pain she experienced from the...

September 1, 2022

/

tgp-admin

Aviva Insurance Company of Canada v. Spence (2022 ONSC 4988)

The insurer appealed the Tribunal's decision that EI sickness benefits are not deductible from IRBs as "gross employment income". The Court reversed the Tribunal's decision, holding that there was no ambiguity in the SABS, and that EI sickness benefits were deductible as "gross employment income". The Court wrote that the Tribunal erred in not treating...

August 30, 2022

/

tgp-admin

Jevco Insurance Company v. Hang (2022 ONSC 4961)

The insurer brought an urgent motion for a stay of the scheduled hearing due to counsel's unavailability to attend the hearing. Justice London-Weinstein applied the three-prong test from RJR MacDonald v. Canada (Attorney General) and concluded that a stay was not warranted. The insurer demonstrated that there was a serious issue to be tried, and...

August 30, 2022

/

tgp-admin

Lynch v. Intact Insurance Company (20-014497)

The claimant applied to the LAT seeking CAT determination under Criteria 8 and entitlement to post-104 IRBs . Vice-Chair Shapiro applied the "but for" test to the issue of causation. Vice-Chair Shapiro found that the claimant's current stand-up comedy activities were a "hobby" and not a career that disqualified the claimant from post-104 IRBs. The...

August 29, 2022

/

tgp-admin

Mears (Griffiths) v TD General Insurance Company (20-012014)

The parties agreed that the claimant met the legal test for entitlement to IRBs for the time period claimed, but could not agree on the appropriate quantum owed. The claimant relied on an accounting report from ADS, which calculated his past entitlement to be $166,821.32. The insurer relied on an accounting report from PWC, which...

August 26, 2022

/

tgp-admin

Vaillancourt v. Intact Insurance Company (19-009063)

This is a reconsideration decision. In the initial preliminary hearing decision, the LAT found that that the exclusion in s. 31(1)(a)(i) of the SABS did not apply in this matter. Pursuant to 31(1)(a)(i), an insurer is not required to pay IRBs, NEBs, or a benefit under ss. 21, 22, or 23 in respect of a...

Contact Us

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

416.507.1850

eodonnell@tgplawyers.com

© 2020 Thomas Gold Pettingill LLP Disclaimer | Privacy Policy | Statement of Principles

Powered by Crow & Pitcher

Subscribe to get TGP’s case summaries straight to your inbox

Subscribe to get TGP’s case summaries straight to your inbox

Contact Us

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

416.507.1850

eodonnell@tgplawyers.com

© 2020 Thomas Gold Pettingill LLP