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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September 7, 2017

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J.U. v. Co-operators General Insurance Company (17-000713)

Both the insurer and claimant agreed the claimant was entitled to income replacement benefits; at issue was quantum. The claimant did not provide alternative calculations, instead asserted consumer protection to avoid financial hardship. Adjudicator Therese Reilly applied the formula provided in section 4(2) and determined the insurer's calculations were correct.

September 5, 2017

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F.R. v. Unifund Assurance Company (16-004030)

The claimant brought an application for a catastrophic determination. Prior to the hearing the insurer accepted the claimant as CAT and the hearing was cancelled. The claimant then brought a subsequent application before the LAT seeking costs from the previous LAT matter. Vice Chair Terry Hunter concluded the LAT did not have jurisdiction to entertain...

September 1, 2017

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S.S. v. RBC Insurance Company (17-000782)

The claimant sought entitlement to a medical treatment plan for physiotherapy. The insurer denied the plan as not reasonable and necessary. The insurer also noted that while the claimant was removed from the MIG on psychological grounds, the restrictions of the MIG applied to the physical treatment sought. Adjudicator Therese Reilly reviewed the medical evidence...

August 31, 2017

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V.C. v. RBC General Insurance Company (17-000081)

The claimant sought entitlement to a number of medical benefits. The insurer asserted a MIG position. Adjudicator Rupinder Hans considered the medical evidence and determined that the claimant had met the evidentiary burden that the injuries sustained fell outside of the MIG. The treatment plans in dispute were deemed reasonable and necessary and therefore payable....

August 30, 2017

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P.I. v. Aviva Insurance Company (16-001320)

The claimant sought entitlement to further medical benefits and removal from the MIG. Adjudicator Sewrattan concluded that the claimant had not proven an ongoing psychological injury or physical injury that fell outside of the "minor injury" definition. There was also insufficient evidence submitted by the claimant to prove that injuries arising from an earlier motor...

August 29, 2017

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Applicant v TD General Insurance Company (16-001308)

The claimant sought entitlement to IRBs, interest, and expenses. The Tribunal was also asked to determine whether the applicant was statute-barred from proceeding with his application. Adjudicator Gottfried held that the applicant was not statue-barred, as he brought his application within the 90-day time limit after receipt of a FSCO mediation report. Adjudicator Gottfried further...

August 29, 2017

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Applicant v. TD General Insurance Company (16-001308)

The claimant sought entitlement to IRBs beyond the date of termination. The insurer argued that the claimant failed to apply to the LAT before the limitation period expired. Adjudicator Gottfried rejected the insurer's submissions and held that the claimant applied to the LAT within 90 days after FSCO Mediator's Report. However, she denied the claimant...

August 28, 2017

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Y.G. v. Primmum Insurance (16-004192)

The claimant sought entitlement to various medical benefits and costs of examinations. The claimant failed to attend IEs scheduled for April and December 2016. The respondent argued that the claimant was barred from applying to the LAT in accordance with section 55. The claimant argued that she was not required to attend the IEs because...

August 25, 2017

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M.M. v. Echelon General Insurance Company (17-001456)

The insurer brought a motion to compel the claimant to produce tax returns. Adjudicator Robert Watt ordered the claimant to produce the requested productions as the parties appeared to agree that the order was necessary.

August 25, 2017

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Applicant v. The Co-operators General Insurance Company (16-003564)

The claimant sought entitlement to one psychological treatment plan. The insurer denied the plan and cited the excessive progress report fees as one of the reasons the plan was not reasonable and necessary. Adjudicator Lori Marzinotto evaluated the Ontario Psychological Association Guidelines for Assessment and Treatment in Insurance Claims and agreed that the treatment plan...

August 24, 2017

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P.J. v. Continental Casualty Insurance Company (16-004272)

The claimant sought entitlement to a number of treatment plans. The insurer asserted a MIG defense. On review of the evidence, Adjudicator Nicole Treksler ruled the claimant's injuries, including chronic pain, were outside of the MIG. The treatment sought was deemed payable. The claimant also sought costs for the insurer failing to provide log notes...

August 24, 2017

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D.D.D. v. RBC Insurance Company (16-000097)

The claimant asked for reconsideration of the denial of IRBs. Executive Chair Lamoureux held that the adjudicator's factual findings were not subject to review, and that the evidence that the claimant had returned to work and was let off due to work shortages supported the conclusion that the claimant was not entitled to IRBs.

August 24, 2017

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D.D.D. v. RBC Insurance Company (16-000097)

The claimant asked for reconsideration of the denial of IRBs. Executive Chair Lamoureux held that the adjudicator's factual findings were not subject to review, and that the evidence that the claimant had returned to work and was let off due to work shortages supported the conclusion that the claimant was not entitled to IRBs.

August 23, 2017

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Applicant (By his Litigation Guardian) v. State Farm Insurance (16-001691)

The insurer denied payment of IRBs following the 104 week period. The claimant brought an application before the LAT; however, the insurer asserted a limitation position. Adjudicator D. Gregory Flude reviewed the chronology of events and noted the claimant's steadily declined in condition and eventual need for a court appointed litigation guardian. Nevertheless, no explanation...

August 22, 2017

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S.S. v. Aviva General Insurance (17-001183)

The claimant sought entitlement to two treatment plans. The insurer denied the plans and cited insurer's examination reports as justification. Adjudicator Christopher Ferguson reviewed the medical reports on both sides and noted contradictions in the claimant's self-reporting. Additionally, one of the treatment plans sought was not included as evidence. The insurer's evidence was considered more...

August 22, 2017

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M.Z. v. Royal and Sun Alliance Insurance (16-002126)

The claimant sought entitlement to three medical benefits, including a vocational assessment. She was not employed at the time of the accident. Adjudicator Anwar awarded all three medical benefits on the basis of medical evidence showing potential lumbar spine injuries. He also awarded the vocational assessment reasoning that it was appropriate for the claimant to...

August 18, 2017

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N.K. v. Unica Insurance Inc. (17-001473)

The claimant sought removal from the MIG and entitlement to medical benefits. Adjudicator Ferguson held that the claimant suffered a concussion and post-concussion syndrome, which were not minor injuries. The claimant was therefore removed from the MIG. The sought medical benefits were denied because the claimant and his treatment providers had not explained how the...

August 18, 2017

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Applicant v. Aviva General Insurance (17-001178)

The claimant sought entitlement to a psychological treatment plan. The insurer denied the treatment plan and cited a psychological insurer's examination report as justification. Adjudicator Christopher Ferguson reviewed the medical reports on both sides and noted contradictions in the claimant's self-reporting. The insurer's evidence was considered more credible and the treatment plan was deemed not...

August 17, 2017

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Y.X.Y. v. The Personal Insurance Company (16-000438)

The primary issue in dispute was whether the claimant sustained a predominantly minor injury as a result of the accident. Adjudicator Neilsen explained that ongoing pain alone was insufficient to remove the claimant from the "minor injury" definition. Rather, she had to prove chronic pain syndrome. The ongoing pain had to be accompanied by some...

August 17, 2017

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T.S. v. Aviva General Insurance (17-000835)

The primary issue in dispute was whether the claimant sustained a predominantly minor injury as a result of the accident. Adjudicator Ferguson rejected the claimant's allegations of psychological injury. He also rejected the submission that the claimant's chronic pain was not covered by the definition of "minor injury." Adjudicator Ferguson accepted that the claimant did...

August 16, 2017

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Chen v. Unifund Assurance Company (17-001476)

A catastrophically injured minor sought entitlement to the insurer's log notes as part of the preliminary issues, arguing that the insurer's denials were insufficient to explain why claimed benefits were denied. The insurer argued that the log notes were not relevant and that the claimant was engaged in a "fishing expedition." Adjudicator White ordered the...

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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