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.

November 17, 2017

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H.L. v. Co-operators General Insurance Company (17-006816)

The claimant sought entitlement to a medical treatment plans. The insurer was previously successful in a prior hearing and obtained a decision in which the claimant's injuries were said to be governed by the MIG. The claimant further appealed that decision and a Divisional Court upheld the previous ruling. Accordingly, the insurer sought a preliminary...

November 16, 2017

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Applicant v. Royal Sun Alliance Insurance Company (17-000117)

The claimant sought entitlement to a number of medical benefits. The insurer asserted the treatment plans were not reasonable and necessary. Adjudicator Christopher Ferguson reviewed the medical evidence, and concluded that on a balance of probabilities the proposed treatment plans were reasonable and necessary. Interest on all incurred amounts was also found payable.

November 15, 2017

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Applicant v. Wawanesa Mutual Insurance Company (16-001539)

The claimant sought entitlement to eight treatment plans for further assessments and treatment. Adjudicator Gosio rejected all of the claimed benefits, writing that the claimant had simply repeated the contents of the treatment plans as the justification as to why they were reasonable and necessary. On the other hand, the insurer had provided the opinions...

November 15, 2017

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Applicant v. ACE INA Insurance (17-001422)

The claimant sought entitlement to various medical benefits; the insurer sought repayment of IRBs due to overpayment of the weekly quantum. Adjudicator Treksler held that the claimant failed to provide evidence that the claimed physical therapy and assessments were reasonable and necessary. She ordered the claimant to repay the overpayment in IRBs, stating that the...

November 14, 2017

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R.D. v. Aviva Insurance Canada (17-000851 and 17-000911)

The claimant sought entitlement to a number of medical benefits. The insurer resisted the claims and noted the failure to attend an IE as reason to preclude the proceedings. Adjudicator Rebecca Hines determined that the proposed IE was reasonable and not excessive. Accordingly, the claimant was precluded from proceeding with the claims until the insurer's...

November 14, 2017

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N.F. v. Aviva Insurance Company of Canada (17-000456)

The claimant sought entitlement to a number of medical benefits. In addition to a MIG position, the insurer asserted that the claimant was barred from bringing a claim as notice to claim accident benefits was not provided within seven days (or reasonably thereafter) of the MVA, pursuant to sections 32 and 55. Adjudicator S.F. Mather...

November 10, 2017

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S.K. v. Allstate Insurance Company of Canada (16-004212)

The claimant sought entitlement to accident benefits. The insurer raised a limitations objection and relied on the letter holding the claimant in section 33 non-compliance as the triggering document. Adjudicator Chloe Lester determined that a refusal to pay a benefit from a section 33 notice letter can trigger a limitation objection. A distinction was made...

November 10, 2017

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R.A. v. Intact Insurance Company (16-003508)

The claimant sought entitlement to attendant care benefits. The insurer asserted a limitations defense. Adjudicator Therese Reilly reviewed the denial letter relied upon by the insurer and determined that the letter was not clear and unequivocal to trigger the limitations clock. The letter of the insurer was a notice of examination which did not properly...

November 10, 2017

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F.F. v. Aviva Canada (16-000941)

The claimant sought entitlement to income replacement benefits and was successful at the LAT. The insurer sought reconsideration and pled the claimant did not comply with a section 33 information request and it is therefore not required to pay for benefits during the period of non-compliance. Executive Chair Linda Lamoureux determined that the information requested...

November 10, 2017

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C.T. v. Aviva Insurance Canada (16-000958)

The claimant sought entitlement to income replacement benefits and was successful at the LAT. The insurer sought reconsideration as it asserted that the claimant was working during a period in which IRBs were awarded. The claimant countered by asserting improper notice was provided under Rule 18.1. Executive Chair Linda Lamoureux determined that the proviso noting...

November 10, 2017

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Applicant v. Aviva Insurance Company (17-001922)

The claimant sought entitlement to a number of medical benefits. The insurer asserted that the treatment plans were not reasonable and necessary and that one plan was partially approved in accordance with the Professional Service Guidelines. Adjudicator Therese Reilly, on review of the evidence, found none of the claimant's claims payable. The PSGs were accepted...

November 10, 2017

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F.F. v. Aviva Canada (16-000941)

The claimant sought entitlement to income replacement benefits and was successful at the LAT. The insurer sought reconsideration and pled the claimant did not comply with a section 33 information request and it is therefore not required to pay for benefits during the period of non-compliance. Executive Chair Linda Lamoureux determined that the information requested...

November 10, 2017

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C.T. v. Aviva Insurance Canada (16-000958)

The claimant sought entitlement to income replacement benefits and was successful at the LAT. The insurer sought reconsideration as it asserted that the claimant was working during a period in which IRBs were awarded. The claimant countered by asserting improper notice was provided under Rule 18.1. Executive Chair Linda Lamoureux determined that the proviso noting...

November 9, 2017

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I.A. v. Unifund Claims Inc (17-000785)

The claimant sought entitlement to a number of treatment plans. The insurer asserted a MIG position and also raised a limitation defense to one of the treatment plans. Adjudicator Billeh Hamud reviewed the denial letter of the insurer and found it to be clear and unequivocal. However, Adjudicator Hamud also noted that the claimant established...

November 9, 2017

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G.V. v. Northbridge Insurance (16-001689)

The claimant sought entitlement to NEBs and medical benefits. Shortly before the hearing, the insurer removed the claimant from the MIG and agreed to pay for a disputed medical benefits. Adjudicator White held that a special award was payable on the medical benefit due to the late approval by the insurer. She did not award...

November 9, 2017

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E.W. v. Primmum Insurance Company (16-003891)

The claimant sought a declaration of catastrophic impairment due to a GCS score less than 9. He was involved in a single vehicle accident and sustained serious physical injuries. His GCS at the scene of the accident was 13, and his GCS upon arrival at the hospital was 15. The only point at which the...

November 9, 2017

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Applicant v. Certas Home and Auto Insurance (16-002278)

The claimant sought entitlement to a number of treatment plans, both psychological and physical-based. The insurer asserted a MIG position. On review of the medical evidence, Adjudicator Paul Gosio determined the claimant established the injuries sustained were outside the MIG by virtue of a psychological report, which was not rebutted by the insurer. As a...

November 8, 2017

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G.P. v. Aviva Insurance Company of Canada (16-000726)

The insurer appealed the Tribunal decision that a 2006 denial of income replacement benefits was not valid. Executive Chair Lamoureux agreed with the insurer and held that the Tribunal's decision was a substantial error in law. She wrote that the denial had clearly and unequivocally communicated to the claimant that her entitlement to further income...

November 8, 2017

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Applicant v. Unifund Claims Inc. (17-001129)

The claimant alleged that his injuries were non-minor and that he was entitled to various medical benefits. Adjudicator Ferguson rejected the claimant's position. He held that the claimant suffered soft tissue injuries in the accident, and was not suffering psychological impairment as a result of the accident. The adjudicator also rejected the claimant's position that...

November 8, 2017

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G.P. v. Aviva Insurance Company of Canada (16-000726)

The insurer appealed the Tribunal decision that a 2006 denial of income replacement benefits was not valid. Executive Chair Lamoureux agreed with the insurer and held that the Tribunal's decision was a substantial error in law. She wrote that the denial had clearly and unequivocally communicated to the claimant that her entitlement to further income...

November 7, 2017

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Applicant v. The Personal Insurance Company (17-002301)

The claimant sought entitlement to a chronic pain assessment. Adjudicator Ferguson held that the insurer's denials were compliant with section 38 of the SABS, and that the claimant had not proven that the assessment was reasonable and necessary. He noted that the claimant had reported a steady improvement in symptoms, and had returned to normal...

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Contact Us

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

416.507.1850

eodonnell@tgplawyers.com

© 2020 Thomas Gold Pettingill LLP