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 17, 2018

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T.H. v. Aviva Insurance (17-001125)

The claimant sought entitlement to non-earner benefits. The insurer argued the claimant had not suffered a complete inability to carry on a normal life. Adjudicator Robert Watt applied the factors found in the Ontario Court of Appeal decision of Heath v. Economical and determined that the claimant failed to meet the burden of proof. The...

January 16, 2018

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Applicant v The Guarantee Company of North America (17-002558)

The applicant sought medical benefits for physiotherapy services. The respondent brought a motion to strike the applicant's reply. The applicant filed a response to the motion to strike a day after the deadline. Adjudicator Goela held that despite being late, she would consider the applicant's response as it did not prejudice the respondent. Adjudicator Goela...

January 16, 2018

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Unifund Assurance Company (17-001773)

The insurer sought repayment of income replacement benefits. Adjudicator Robert Watt reviewed the jurisprudence of section 52 and noted that a proper repayment notice should include: (i) identification of the type of benefit that was overpaid, (ii) the payment period for which repayment is sought, (iii) the amount of repayment sought, and (iv) the amount...

January 16, 2018

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C.W. v. Unifund Assurance Company (16-003336)

The insurer sought reconsideration of the Tribunal's decision that the claimant's injuries were non-minor due to a partial shoulder tear and pre-existing back pain. Executive Chair Lamoureux dismissed the reconsideration. She held that the Tribunal's decision was based on the evidence before it and that the Tribunal was entitled to weight the contradicting evidence as...

January 16, 2018

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Applicant v. Aviva Insurance Canada (16-003323)

The claimant sought entitlement to non-earner benefits, as well as a number of medical treatment plans. The insurer denied entitlement to all claims. Adjudicator Rebecca Hines reviewed the medical evidence and determined the claimant failed to prove the treatment plans were reasonable and necessary, and also failed to establish a complete inability to carry on...

January 16, 2018

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A.R. v. Wawanesa Mutual Insurance Company (17-000149)

The claimant sought entitlement to two proposed orthopaedic assessments. Adjudicator Msosa denied both assessments. He first wrote that without the treatment plans before him, he could not determine whether they were reasonable. He also accepted the opinion of the insurer's expert that the claimant had not sustained orthopaedic injury in the accident and there was...

January 16, 2018

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C.W. v. Unifund Assurance Company (16-003336)

The insurer sought reconsideration of the Tribunal's decision that the claimant's injuries were non-minor due to a partial shoulder tear and pre-existing back pain. Executive Chair Lamoureux dismissed the reconsideration. She held that the Tribunal's decision was based on the evidence before it and that the Tribunal was entitled to weight the contradicting evidence as...

January 15, 2018

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Y.L. v. Pafco (17-000480)

The claimant sought entitlement to IRBs. Arbitrator Neilson found that the claimant was not entitled to IRBs as she found the claimant was not employed or receiving employment insurance at the time of the accident and had not worked for at least 26 weeks during the 52 weeks prior to the accident. Arbitrator Neilson preferred...

January 12, 2018

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The Applicant v. State Farm Insurance Company (16-002503)

The minor claimant sought a determination that he was catastrophically impaired. Both parties agreed that the claimant suffered a traumatic brain injury and soft tissue injuries in the accident, but the claimant had significant pre-existing medical problems, including a brain injury, epilepsy, developmental delay and autism spectrum disorder. Insurer examinations determined that the claimant was...

January 12, 2018

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Applicant v. Traditional Mutual Insurance Company (17-002734)

The claimant sought entitlement to a psychological assessment. Adjudicator Norris held that the proposed assessment was reasonable and necessary. He relied upon the claimant's consistency of reporting, prescription for antidepressants, and more than one medical practitioner opining that the claimant may suffer a psychological disorder.

January 12, 2018

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A.R. v. TD General Insurance Company (16-003487)

The claimant sought interest on re-instated IRBs and entitlement to an orthopaedic mattress. The insurer opposed paying interest, arguing that the claimant had not provided evidence earlier in her claim supporting IRB entitlement. Adjudicator Maedel held that once the insurer re-instated IRBs, the claimant was entitled to interest for the period IRBs had not been...

January 11, 2018

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Applicant v. RSA Insurance (17-000233)

The claimant disputed his entitlement to income replacement benefits (IRBs), medical benefits and the MIG. Adjudicator Treksler concluded that the claimant's injuries fell outside of the MIG due a post-accident psychological impairment and diagnosis of chronic pain syndrome. In her reasons, Adjudicator Treksler noted that she preferred the evidence of the claimant's family physician to...

January 11, 2018

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Economical Mutual Insurance Company (17-002716)

The insurer sought repayment of overpaid income replacement benefits, as well as the cancellation fee for a missed examination under oath. Adjudicator Sandeep Johal reviewed the evidence of the insurer and determined that it failed to establish the claimant made a willful misrepresentation resulting in an error. Because a willful misrepresentation was not established, repayment...

January 11, 2018

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Applicant v. Allstate Insurance Company (16-004309)

The claimant sought entitlement to ongoing NEBs and two proposed treatment plans for physiotherapy. Adjudicator Baker denied entitlement to NEBs but awarded the treatment plans. In terms of NEBs, Adjudicator Baker wrote that the claimant had submitted only limited evidence about his pre-accident and post-accident life, which did not support entitlement to NEBs. He also...

January 10, 2018

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Applicant v. Unifund Assurance Company (16-003709)

The claimant sought entitlement to IRBs and ACBs. The insurer sought repayment of IRBs paid for a period that the claimant was working. Adjudicator Bickley denied entitlement to both IRBs and ACBs. She held that the claimant's return to work shortly after the accident and frequency gym attendances suggested that the claimant did not suffer...

January 10, 2018

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A.S. v. Economical Mutual Insurance Company (16-003197)

The claimant was entitled to IRBs. The insurer argued that it was entitled to deduct the claimant's post-accident income from his personal business. The claimant argued that he did not "earn" the income from his business because he was not actively engaged in the business. Adjudicator Watt concluded that the claimant was actively involved in...

January 9, 2018

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S.J.L.V. v. Certas Direct Insurance Company (17-000796)

The claimant was the driver of a vehicle when she and her boyfriend were subject to a gun attack. The claimant's boyfriend was hit by bullets and the claimant fled the scene in the vehicle and tried to find a hospital for her boyfriend. Her boyfriend eventually died of his injuries. The claimant argued that...

January 9, 2018

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C.R. v. Scottish & York Insurance Company (16-002077)

The claimant sought removal from the MIG and entitlement to one treatment plan. Adjudicator Anwar held that the claimant's suffered pre-existing conditions that would prevent maximal recovery under the MIG and development of chronic pain. He relied upon the expert reports completed for the claimant, which detailed pre-existing injuries. The insurer argued that the Tribunal...

January 9, 2018

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A.M. v. State Farm Mutual Automobile Insurance Company (16-003519)

The claimant sought entitlement to two treatment plans for dental work. Adjudicator Gosio rejected both claims. He held that the claimant had not submitted medical evidence in support of the claim (such as clinical notes and records, medical reports, or the treatment plans themselves) and that his counsel's submissions were not evidence. Adjudicator Gosio also...

January 8, 2018

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Applicant v. Certas Direct Insurance Company (16-004675)

The claimant sought removal from the MIG and entitlement to two treatment plans. Adjudicator Sewrattan concluded that the claimant suffered minor injuries in the accident. He wrote that neither of the claimant's experts had diagnosed the claimant with a psychological disorder or chronic pain. He also held that the insurer's denials satisfied the requirements of...

January 8, 2018

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Applicant v. Aviva Insurance Canada (17-002689)

The claimant sought entitlement to a medical treatment plan. Adjudicator Derek Grant reviewed the medical evidence and noted that the mere submission of a treatment plan is not enough to establish entitlement. Rather, supporting medical documentation, recommending the treatment sought is critical. In this matter, the claimant failed to provide the necessary supporting evidence and...

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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