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.

January 30, 2023

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Rupani v. Travelers Insurance Company of Canada (21-004893/AABS0

The catastrophically-impaired claimant brought an application to dispute medical and housekeeping benefits. Her claim for housekeeping was denied because she was unable to establish that the workers that she hired had provided services in the scope of employment they ordinarily engaged in. Adjudicator Grant found that it was not enough for the claimant's hired workers...

January 27, 2023

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Adams v. Aviva Insurance Company (22-002323/AABS)

This is a preliminary decision regarding late notice to the insurer. The claimant applied for accident benefits one year after the accident. The claimant's explanation for the delay was that she had retained counsel after the accident and did not know the process for claiming benefits. The Adjudicator found that reliance on the solicitor was...

January 27, 2023

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Younes v. Liberty Mutual Insurance Company (20-006050)

This is a preliminary decision regarding late notice to the insurer. The claimant applied for Accident Benefits 20 years after the accident. In addition, the claimant’s insurance expired before the accident. Before October 1, 2003, S. 32(1) of the SABS provided that the insured must advise the insurer of an intention to claim benefits within...

January 26, 2023

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Balasubramaniam v. Aviva General Insurance Company (21-001010/AABS)

The LAT found that the claimant was not entitled to a repayment of IRBs due to non-compliance with s. 33 of the Schedule. The claim was initially heard before Arbitrator Kowalski at the Financial Services Commission of Ontario where it was ordered that the insurer pay a weekly IRB. After the arbitration, the insurer was...

January 24, 2023

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Sonnet Insurance Company v. Crooks (20-011866)

The insurer applied to the LAT, arguing that the claimant was not involved in an accident, and sought repayment of benefits. Adjudicator Grant found that the incident was staged, relying upon the claimant's own evidence at his EUO. He also found an engineering reconstruction report supported the same conclusion. The claimant's reporting of the accident...

January 24, 2023

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Schuknecht v. Economical Insurance Company (19-013098)

The insurer's request for reconsideration was granted. The issue at the hearing was the correct calculation of the quantum of IRBs. The hearing adjudicator had found the claimant was entitled to IRBs in the amount of $172.00 per week after the claimant reached age 65. The insurer argued that the LAT made errors with respect...

January 23, 2023

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Lacroix v. Intact Insurance Company (20-12380/AABS)

The claimant applied to the LAT seeking entitlement to IRBs. The insurer denied IRBs, noting that prior to the accident the claimant was working on a part-time basis and that she had managed to secure a position as a waitress after the accident. The claimant attempted to establish that her medical records showed that she...

January 22, 2023

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Sahadeo v. Pafco Insurance Company (19-006331)

This is an amended Reconsideration Decision. The claimant sought reconsideration after being found not to have a catastrophic impairment . Vice-Chair Lester found that a failure to decide on the claimant’s diagnosis was not an error of fact and law. It was not necessary to rule on the claimant's diagnosis since the level of psychiatric...

January 19, 2023

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Shaikh v. Economical Insurance Company (20-009837/AABS)

The claimant brought a LAT application to dispute NEBs and his MIG designation. Adjudicator Flude found that the claimant was not entitled to NEBs because he had failed to submit a signed application for NEBs until June 8, 2020, approximately a year after the accident of July 16, 2019. Adjudicator Flude confirmed that an application...

January 19, 2023

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Han v. Wawanesa Mutual Insurance Company (21-014475)

The claimant disputed entitlement to a physiatry assessment proposed three years after the accident but which was never incurred. Because the LAT dispute would not be determined until after the expiry of the five year policy period, the insurer brought a motion arguing that the disputed assessment could not be awarded because it was not...

January 18, 2023

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Mbarak v. Wawanesa Mutual Insurance Company (20-014858/AABS)

The claimant was involved in an accident in 2016 and applied to the LAT seeking a CAT designation. The Tribunal found that the claimant had a CAT impairment as a result of one marked impairment in Adaptation. The adjudicator noted that the claimant could not return to work, had poor memory and recall, and was...

January 18, 2023

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Prillo v. Coseco Insurance Company (20-014401/AABS-R)

The claimant filed a request for reconsideration arising from an October 14, 2022 decision, in which Adjudicator Pahuta ruled that the claimant sustained "minor injuries" and was not entitled to further treatment outside of the MIG. The claimant filed for reconsideration under Rule 18.2 (b), alleging that Adjudicator Pahuta made an error of law or...

January 17, 2023

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Chavez v. Unifund Assurance Company (20-011594/AABS)

The insurer raised a preliminary issue and argued that the claimant's claim for NEBs was statute barred. The claimant had failed to submit an OCF-3 with her application pursuant to s. 36 and had failed to apply to the LAT within two years of its refusal to pay NEBs pursuant to s. 56 of the...

January 16, 2023

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Jeffery v. Travelers Insurance Company of Canada (20-013979/AABS)

The claimant was denied IRBs and medical benefits and sought entitlements to the benefits along with a Special Award from the Tribunal. The Tribunal held that the claimant was not entitled to IRBs or medical benefits for physiotherapy treatment. The adjudicator held that since no benefits were owed to the claimant, a s. 10 award...

January 16, 2023

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Adjetey v. Economical Insurance (22-000712)

This is a preliminary decision regarding late notice to the insurer. The claimant applied for accident benefits two years after the accident. Section 32(1) of the SABS provides that the insured must give notice of the intention to claim benefits within 7 days of the loss date. The claimant conceded that they were two years...

January 13, 2023

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Hordo v CAA Insurance Company (20-012761/AABS0

The claimants were involved in an accident. They filed an application, and the LAT found that they were not entitled to non-earner benefits, housekeeping/home maintenance benefits, interest, a special award, or costs. The claimants filed for reconsideration. Their request for reconsideration was denied. Vice-Chair Moore did not find a violation of procedural fairness, as the...

January 13, 2023

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Stoppard v. Economical Insurance, (21-006374/AABS-PI)

The claimant was involved in an accident. She incurred transportation expenses in relation to her hip replacement surgery, and submitted these expenses to her insurer. The insurer denied payment of the transportation expenses as the records did not support that the surgery was required as a result of the accident. The claimant submitted an additional...

January 13, 2023

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Delena v. Aviva Insurance Company (19-007957/AABS)

The claimant filed an Application disputing entitlement to NEBs, interest and sought costs under Rule 19. The claimant relied on limited medical evidence, including some diagnostic reports, an OT functional assessment, and doctors' records. The claimant argued that his accident-related injuries resulted in a complete inability to carry on a normal life. The insurer argued...

January 13, 2023

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Steele v. Aviva General Insurance (21-007268/AABS)

The claimant filed a LAT Application disputing entitlement to NEBs, interest, and a special award. The claimant testified that although she was able to do things, she was not able to totally engage in all of her pre-accident activities due to pain. For example, the claimant noted that she had "some" limitations with respect to...

January 13, 2023

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Intact Insurance Company v. Hashemi (20-011873)

The insurer applied to the LAT seeking repayment of benefits after concluding that the claimant was involved in a staged accident. The insurer sought repayment of accident benefits, examination costs, and other expenses (including EUO expenses and engineering expert expenses). Adjudicator Kepman accepted that the claimant made wilful material misrepresentations regarding the accident. However, only...

January 12, 2023

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Russell v. Dumfries Mutual Insurance Company (20-004264/AABS)

The claimant applied to the LAT for a CAT designation, ACBs, and medication. The adjudicator found that the claimant did have a CAT impairment under Category 8 and was entitled to receive ACBs and medication. The Tribunal rejected the insurer's argument that the pre-accident family death was the cause of the claimant's psychological impairment. The...

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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