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 22, 2017

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Applicant v. RBC Insurance Company (16-002047)

The claimant sought entitlement to a number of medical treatment plans. The insurer asserted a MIG position. On review of the medical reports and evidence, Adjudicator Sandeep Johal concluded the claimant provided compelling evidence that the injuries sustained warranted removal from the MIG. The treatment plans were also considered reasonable and necessary. However, despite the...

November 22, 2017

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Applicant v. Aviva Insurance Canada (17-003557)

The claimant sought removal from the MIG and entitlement to various medical benefits. Adjudicator Ferguson held that the claimant had not submitted evidence that she sustained any injuries more severe than soft tissue injuries, and that the claimant had not proven any pre-existing conditions that would prevent recovery under the MIG.

November 21, 2017

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I.R. v. Allstate Insurance Company (17-003304)

The claimant sought to enforce a purported settlement with the insurer. The insurer resisted the claim and asserted that a Settlement Disclosure Notice was not signed. On review of FSCO jurisprudence, Adjudicator Christopher Ferguson adopted the reasoning and determined that a SDN is necessary for a binding settlement. The claimant's claim was dismissed.

November 21, 2017

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B.C. v. Aviva Insurance Canada (17-001340)

The claimant sought entitlement to psychological treatment. Adjudicator Go agreed that it was reasonable and necessary. She was critical of the insurer's IE report which did not specifically reference or review a psychological report provided by the claimant.

November 21, 2017

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Applicant v. Wawanesa Mutual Insurance Company (16-001732)

The claimant sought entitlement to a number of medical treatment plans. The insurer asserted a MIG position. Adjudicator Robert Markovits reviewed the evidence and determined that there was compelling evidence of a pre-existing medical condition preventing recover within the MIG. The treatment plans were considered reasonable and necessary, with a psychological assessment capped at $2,000.00...

November 21, 2017

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Applicant v. Certas Home and Auto Insurance Company (16-001905)

The claimant sought entitlement to IRBs and various medical benefits. Regarding IRBs, Adjudicator Bickley held that the claimant had failed to prove a substantial inability beyond three months, and also held that the claimant had failed to provide financial records supporting a higher weekly IRB quantum. The adjudicator made an adverse inference due to the...

November 21, 2017

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Applicant v. Aviva Insurance (17-000612)

The claimant sought entitlement to a treatment plan for physical therapy. The insurer tendered medical evidence for the proposition that the claimant did not need further facility-based treatment. On review of the medical evidence, Adjudicator Derek Grant noted that while the claimant still experienced effects from the accident, the proposed treatment plan was not reasonable...

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...

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416.507.1850

eodonnell@tgplawyers.com

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Toronto, Ontario M5H 3S5

416.507.1850

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