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.

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July 12, 2017

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M.S. v. Primmum Insurance Company (16-000546)

Following an earlier decision, in which the claimant's case was dismissed, the insurer sought costs. Adjudicator Sewrattan reviewed the reasoning for the dismissal of the claimant's case, which largely turned upon the claimant's counsel failing to submit materials and evidence to the LAT. He concluded that the applicant had not acted unreasonably, but rather, that...

July 6, 2017

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H.W. v. Intact Insurance Company (16-000347)

The claimant sought entitlement to non-earner benefits. Adjudicator Theoharis dismissed the claim, reasoning that the claimant failed to demonstrate that the accident had resulted in the claimant being continuously prevented from engaging in substantially all of the activities in which she ordinarily engaged in before the accident. Of particular note was the claimant's extensive pre-accident...

July 6, 2017

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G.K. v. Wawanesa Mutual Insurance Company (16-004479)

The claimant sought entitlement to medical benefits. The insurer asserted a MIG designation. On review, Adjudicator Sewrattan determined that the pre-existing back pain of the claimant would not prevent recovery under the MIG. The claimant's injuries were deemed minor and the treatment plans were denied.

July 5, 2017

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P.E. v. The Dominion of Canada General Insurance Company (16-003460)

The claimant sought entitlement to medical benefits. At the outset, the insurer sought a dismissal of the claimant's application for arbitration based on non-compliance with disclosure requirements. Adjudicator Ferguson noted there was no authority under Rule 9 of the LAT Rules to dismiss an application for failing to comply with Tribunal disclosure rules. Moreover, the...

July 5, 2017

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L.D. v. Aviva Insurance Canada (16-003010)

The claimant sought entitlement to non-earner benefits and 11 treatment plans. On review of the medical evidence, Adjudicator Hines awarded five treatment plans. Additionally, Adjudicator Hines ruled that the mere filing of a disability certificate was insufficient to demonstrate entitlement to non-earner benefits; NEBs were denied.

July 4, 2017

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Aviva Insurance Company of Canada v. A.M. (16-001014)

The insurer sought reconsideration of the Tribunal's denial of repayment of IRBs. The request was based on the claimant receiving disability benefits. The claimant had not informed the insurer of his receipt of disability benefits, and the insurer subsequently made a request for repayment of IRBs totalling $4,414.29. The Tribunal had originally denied repayment reasoning...

July 4, 2017

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Aviva Insurance Company of Canada v. A.M. (16-001014)

The insurer sought reconsideration of the Tribunal's denial of repayment of IRBs. The request was based on the claimant receiving disability benefits. The claimant had not informed the insurer of his receipt of disability benefits, and the insurer subsequently made a request for repayment of IRBs totalling $4,414.29. The Tribunal had originally denied repayment reasoning...

June 30, 2017

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D.S. v. Allstate Insurance Company of Canada (17-000224)

The claimant sought entitlement to income replacement benefits and three treatment plans. The insurer advanced a limitations defence. Vice Chair Flude noted there was no evidence presented to refute the validity of the insurer's denials. The notices were deemed compliant with the requirements of Smith v Co-Operators and the claimant was considered outside of the...

June 30, 2017

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Applicant v. Royal Sun Alliance Insurance Company of Canada (16-000068)

The claimant sought ongoing IRBs following a motor vehicle accident. The claimant had been a tow truck driver prior to the accident, but had not returned to work. The insurer terminated the claimant's entitlement to IRBs after eight months. Adjudicator Sapin concluded that the claimant continued to suffer a substantial inability to complete the essential...

June 28, 2017

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R.L. v. State Farm Insurance Company (17-000020)

The insurer brought a preliminary issues motion seeking to preclude the claimant from bringing an application for arbitration disputing the denial of medical benefits. The claimant asserted the requested assessments were unreasonable. Adjudicator Maedel identified the following factors to determine if an IE was requested: (i) The timing of the insurer's request; (ii) The possible...

June 28, 2017

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K.K. v. Aviva Insurance (16-000863)

The claimant sought entitlement to four medical treatment plans. At the hearing the claimant also sought to add a claim for a special award and interest. On review, Adjudicator Bickley refused to allow the additional issues. After examining the medical evidence, one treatment plan was found reasonable and necessary. Because the treatment plan was originally...

June 27, 2017

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M.R. v. Aviva Insurance Company of Canada (16-00216)

The claimant sought a determination that his impairments were outside of the MIG and entitlement to attendant care benefits. As a preliminary issue, the respondents sought to exclude the supplementary report of Dr. El-Hage, psychologist, and the sworn affidavit of the occupational therapist. Adjudicator Nemet granted the motion, as the material was written less than...

June 27, 2017

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H.S. v. TD General Insurance Company (16-002705)

The insurer sought entitlement to costs after the claimant withdrew an application before the LAT. The claimant also sought costs for having to resist the insurer's costs motion. Adjudicator Belanger-Hardy noted that a withdrawal of an application alone will rarely, if ever, be a sufficient basis on which the Tribunal will make a costs order....

June 27, 2017

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Applicant v. TD General Insurance Company (16-002706)

The insurer sought entitlement to costs after the claimant withdrew an application before the LAT. The claimant also sought costs for having to resist the insurer's costs motion. Adjudicator Belanger-Hardy noted that a withdrawal of an application alone will rarely, if ever, be a sufficient basis on which the Tribunal will make a costs order....

June 27, 2017

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Applicant v. Cumis General Insurance Company (16-003144)

The claimant sought a catastrophic designation. The insurer requested five IEs. The claimant agreed to attend three, and did not attend two because she felt the remaining assessments were excessive and unreasonable. On the basis of refusing to attend the remaining IEs, the insurer designated the applicant non-CAT. The claimant filed an application for arbitration....

June 22, 2017

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

The claimant sought entitlement to attendant care benefits provided by her husband (a fertility physician) and the cost of an in-home assessment. The insurer denied that the claimant had "incurred" any attendant care services and further denied that any attendant care services were reasonable and necessary beyond June 2016. The claimant responded that the insurer...

June 21, 2017

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Y.C. v. State Farm Mutual Automobile Insurance Company (16-004494)

The insurer sought to exclude a medical report tendered on behalf of the claimant. The insurer asserted the submission was in contravention of a deadline imposed by a case conference adjudicator. The claimant sought to have the report included and argued procedural fairness. Vice Chair Terry Hunter concluded to allow the report as is would...

June 20, 2017

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V.H.T. v. Certas Home and Auto Insurance Company (16-000874)

The claimant sought entitlement to IRBs and further medical benefits. A preliminary motion was first heard to address the admissibility of late documents. Adjudicator Sapin held that the late documents were admissible, that the insurer had sufficient time to review the new documents, and that the insurer should have requested an adjournment if it believed...

June 20, 2017

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K.L. v. Aviva Insurance Company of Canada (16-002397)

The claimant sought removal from the MIG and entitlement to five treatment plans based on a spinal compression fracture identified two years after the accident. The insurer argued that the claimant had not proven that the compression fracture was related to the accident. Adjudicator Shapiro agreed with the insurer and concluded that the claimant had...

June 20, 2017

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Applicant v. The Guarantee Company of Canada (16-001348)

The claimant originally sought attendant care benefits on an ongoing basis. The initial adjudicator's decision only addressed attendant care benefits up to the date of the hearing and held that the claimant was nominally entitled to $666.23 per month, but that no attendant care services had been incurred. The claimant sought reconsideration of that decision...

June 20, 2017

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Applicant v. Echelon (16-003223)

The claimant was involved in a serious accident in which his daughter was fatally injured. The claimant was deemed to have sustained a catastrophic impairment. The claimant sought entitlement to occupational therapy assistance. The insurer denied the treatment plan and stated there was no rehabilitative goal of consuming the treatment. On review of the medical...

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Contact Us

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

416.507.1850

smilne@tgplawyers.com

© 2020 Thomas Gold Pettingill LLP