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 12, 2017

/

tgp-admin

Applicant v. Unica Insurance Inc. (16-002234)

The claimant sought entitlement to income replacement benefits as well as a catastrophic impairment designation. The claimant testified that following the accident she had a blackout while a passenger in another car. She indicated that the blackouts prevented her from working or resuming school studies. The insurer asserted that the blackouts were not as a...

December 12, 2017

/

tgp-admin

Applicant v. Travelers Canada (17-002177)

The claimant sought entitlement to a number of medical treatment plans. The insurer asserted a MIG designation. Adjudicator Avvy Go reviewed the medical evidence submitted and concluded that the claimant had failed to meet the burden of proof necessary to remove a MIG designation from her claims. All of the claimed treatment plans were dismissed.

December 12, 2017

/

tgp-admin

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...

December 11, 2017

/

tgp-admin

Rai v. Aviva Insurance (17-002491)

The claimant sought removal from the MIG and entitlement to two treatment plans. Adjudicator Johal concluded that the claimant suffered minor injuries in the accident, and that the claimant's pre-existing conditions did not prevent recovery under the MIG. The adjudicator was critical of the claimant's failure to put any medical evidence before the Tribunal that...

December 11, 2017

/

tgp-admin

Applicant v. Royal Sun Alliance (17-001315)

The claimant sought entitlement to a treatment plan, which the insurer denied due to a MIG determination. The claimant asserted the insurer failed to comply with the Notice provisions of section 38 and that the claimant's pre-existing psychological impairments warranted removal from the MIG. Adjudicator Gemma Harmison determined that the insurer failed to comply with...

December 11, 2017

/

tgp-admin

Applicant v. Aviva Insurance Canada (17-001939)

The claimant sought entitlement to NEBs, removal from the MIG, and an in-home assessment. Adjudicator Ferguson rejected all of the claims. In terms of NEBs, the adjudicator wrote that the claimant failed to adduce evidence as to his pre-accident activities and that without a baseline, entitlement to NEBs could not be proven. With regard to...

December 11, 2017

/

tgp-admin

Applicant v. Aviva Insurance Canada (17-001822)

The claimant sought entitlement to IRBs and a chronic pain assessment. Adjudicator Hines accepted that the claimant suffered a substantial inability to perform the essential tasks of her pre-accident employment as a sales representative. She preferred the medical opinions of the claimant's assessors over the insurer's assessors due to inconsistencies and lack of analysis in...

December 8, 2017

/

tgp-admin

R.W.J. v. Aviva Insurance (17-001866)

The claimant sought entitlement to a special award. During the course of the medical management of the matter, the claimant required medical marijuana. The insurer requested that the claim be submitted via an OCF-18. However, Adjudicator Brian Norris noted that under section 38 a treatment plan is not needed if the drug is prescribed by...

December 8, 2017

/

tgp-admin

P.M. v. RBC General Insurance Company (16-001611)

The claimant suffered a finger fracture in the accident. He was new to Canada and did not understand the accident benefits system. He first applied for EI, which was denied; he appealed and lost again. He first applied for accident benefits eight months after the date of loss. The insurer argued that the claimant did...

December 8, 2017

/

tgp-admin

Applicant v. Travelers Insurance (16-003313)

The claimant sought entitlement to a number of medical benefits. Adjudicator Paul Gosio, on review of the medical evidence, determined that the treatment sought was reasonable and necessary.

December 8, 2017

/

tgp-admin

Applicant v. State Farm Mutual Automobile Insurance Company (16-004375)

This was an amended decision from a previous ruling in which the claimant sought entitlement to a number of medical treatment pans. On review of the medical evidence, Adjudicator Avvy Go determined the treatment plans were reasonable and necessary. Additionally, interest was awarded on the overdue payment of benefits.

December 7, 2017

/

tgp-admin

G.K. v. Unifund Assurance Company (17-001274)

The claimant sought entitlement to income replacement benefits. The insurer agreed benefits were payable but asserted that a deduction of gross short and long term disability benefits was needed to calculate the appropriate quantum. The claimant stated that the deduction involved the net of short and long term disability payments. Adjudicator Ian Maedel determined that...

December 6, 2017

/

tgp-admin

M.J. v. Aviva General Insurance (17-002229)

After the commencement of the hearing, the claimant withdrew the application. The Tribunal closed its file and no costs were awarded.

December 6, 2017

/

tgp-admin

J.C.C. v. Echelon General Insurance Company (17-000848)

The claimant was found entitled to attendant care benefits from a medical standpoint, but was denied payment on the basis that his service provider was not a professional. The service provider had her certification as a PSW, but was not working in the field at the time of the claimant's accident. Adjudicator Go held that...

December 6, 2017

/

tgp-admin

Applicant v. RBC General Insurance Company (16-004500)

The claimant sought entitlement to non-earner and medical benefits. On review of the evidence, Adjudicator Brian Norris concluded the claimant failed to meet the burden of proof for NEBs. After reviewing each treatment plan, it was held that all but one were not reasonable and necessary. The claims, with the exception of the one treatment...

December 1, 2017

/

tgp-admin

T.F. v. Intact Insurance Company (17-002703)

The claimant's husband sought reimbursement for mileage incurred while visiting the claimant and transporting the claimant. Adjudicator Reilly held that the husband was, in fact, an aide because he transported the claimant, and that the proper mileage rate for him as an aide was $0.40 per kilometer per the Transportation Expense Guideline.

December 1, 2017

/

tgp-admin

H.T. v. TD General Insurance Company (16-000608)

The claimant sought reconsideration of a Tribunal decision that dismissed all claims. Executive Chair Linda Lamoureux reviewed the submissions and concluded that no significant error of fact or law took place and noted that it was open to the Tribunal to hold that benefits were suspended due to non-attendance at an EUO. Additionally, no procedural...

December 1, 2017

/

tgp-admin

G.T. v. Unifund Assurance Company (16-001283)

The insurer appealed a ruling in which the claimant was awarded an orthopaedic assessment. The insurer argued that the assessment was available through OHIP, and therefore not payable under the SABS. Executive Chair Lamoureux rejected the reconsideration. She held that the obligation was on the insurer to advance evidence establishing that a benefit at issue...

December 1, 2017

/

tgp-admin

G.K. v. Security National Insurance Company (16-001904)

The insurer sought reconsideration of the Tribunal's decision that the claimant was a resident of Ontario at the time of the accident, and therefore an "insured person." Executive Chair Lamoureux rejected the reconsideration. She held that the Tribunal was asked to make a determination that largely turned on the facts of the case, and that...

December 1, 2017

/

tgp-admin

F.S. v. Aviva Insurance Company (17-002313)

The claimant sought entitlement to various medical benefits. Adjudicator Sewrattan dismissed all of the claims, holding that the claimant had not demonstrated that the proposed treatment was reasonable and necessary. He also noted that the claimant had refused to provide her collateral benefits entitlement information and that he was unable to determine if any of...

December 1, 2017

/

tgp-admin

Aviva Canada Inc. v. R.R. (16-004445)

The insurer appealed the dismissal of its repayment claim, which had been denied because there was no proof that the claimant was given the notice of repayment. Executive Chair Lamoureux held that there had been a breach of procedural fairness because the issue of whether a notice was provided to the claimant was not addressed...

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