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 24, 2017

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M.C. v. Aviva General Insurance (17-002614)

The insurer sought reconsideration of an order made by the Tribunal allowing the claimant to summons the adjuster who had handled his matter. The insurer argued that it should have been given a copy of the claimant's summons request, and should have had the opportunity to respond to that request. Executive Chair Lamoureux rejected the...

November 24, 2017

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Applicant v. Aviva Insurance (16-002568)

The claimant sought entitlement to a chronic pain program and an orthopaedic assessment. Adjudicator Hans awarded both benefits and wrote that he preferred the evidence from the claimant's experts over the opinions of the insurer's experts. In particular, he found the claimant's experts' reports to be more thorough in analysis and recommendation. He also did...

November 24, 2017

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Applicant v. Aviva Insurance (16-001990)

The claimant sought entitlement to income replacement benefits and a number of medical treatment plans. The insurer asserted a MIG position. On review of the medical evidence, Adjudicator Paul Gosio determined the claimant's injuries were minor and governed by the MIG. The treatment plans claimed were dismissed. As it pertained to the IRB claim, Adjudicator...

November 23, 2017

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Z.A. v. Aviva Insurance Canada (16-001928)

The claimant sought entitlement to physiotherapy. The insurer denied the treatment plan and asserted the treatment was not reasonable and necessary. Adjudicator Sandeep Johal reviewed the medical evidence and held that the claimant failed to meet the onus of proof. The treatment plan was deemed not reasonable and necessary.

November 23, 2017

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M.T.R. v. Aviva Insurance Canada (17-001721)

The claimant sought entitlement to non-earner and a number of medical benefits. On review of the claimant's evidence, Adjudicator Christopher Ferguson determined that claimant did not meet the onus to prove a complete inability to carry on a normal life. Moreover, the treatment plans claimed were considered not reasonable and necessary.

November 23, 2017

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F.K.T. v. Aviva Insurance Company (16-004565)

The insurer sought costs after the claimant withdrew his LAT application. Adjudicator Johal rejected the claim for costs and noted that the inconvenience and expense of preparing for a hearing was not grounds to award costs.

November 22, 2017

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D.G. v. TD Home and Auto Insurance Company (17-000608)

The claimant was an Ontario resident involved in an accident while traveling in Michigan. He elected to receive accident benefits pursuant to Michigan's accident benefits regime, rather than under the SABS. The claimant initially received accident benefits through Allstate Insurance pursuant to Michigan's accident benefits scheme. TD Insurance then accepted priority, and informed the claimant...

November 22, 2017

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N.F. v. Aviva Insurance Canada (17-003632)

The insurer sought costs after a claimant withdrew the claims at a case conference. Adjudicator Samia Makhamra reviewed the chronology of events that led to the withdrawal, which included the claimant using profane language during the case conference, and concluded that the behavior did not rise to the level to warrant a costs award.

November 22, 2017

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J.D. v. Aviva Insurance Canada (16-004175)

The claimant sought entitlement to a number of medical treatment plans. The insurer asserted a MIG position. Adjudicator Robert Watt, on review of the medical evidence, concluded that the claimant's injuries were minor and governed by the MIG. Accordingly, the claimant's claims were dismissed.

November 22, 2017

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Applicant v. Unifund Assurance Company (16-002346)

The claimant sought entitlement to three treatment plans. The insurer asserted the plans were not reasonable and necessary. Adjudicator Paul Gosio reviewed the medical evidence and concluded the treatment plans were reasonable and necessary. Although the claimant sought a special award, Adjudicator Gosio denied the claim and noted that "an insurer will not face a...

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...

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com