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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April 3, 2017

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G.P. v. Cumis General Insurance Company (16-003144)

The claimant sought entitlement to various medical benefits and a catastrophic impairment determination. The insurer argued that the claimant had not attended two of five IEs it had requested. Adjudicator Pay held that section 55 did not apply, and that the multiple IEs requested by the insurer were not reasonable. The claim was allowed to...

March 31, 2017

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Optimum Insurance Company (16-000760)

The claimant sought entitlement to an in-home assessment and assistive devices. After weighing the evidence, Adjudicator Pay found the treatment plans reasonable and necessary. Although the insurer raised objections to the Reply submissions of the claimant, Adjudicator Pay stated: "Because these submissions of the applicant were not relevant to the determination of the dispute, I...

March 31, 2017

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A.A. v. Aviva Insurance (16-002670)

The claim for various medical benefits and MIG removal was dismissed because the claimant did not participate in the written hearing. Adjudicator Marzinotto held that the insurer did not need to bring a formal notice for a dismissal because the parties had agreed to a written hearing to be held March 14, 2017. Rather, the...

March 28, 2017

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S.C.L. v. State Farm Mutual Automobile Insurance Company (16-001683)

The claimant was struck by a golf cart while on the driveway of a private golf course. The insurer denied that an "accident" had occurred because the golf cart did not qualify as an "automobile". Adjudicator Sewrattan agreed with the insurer and concluded that the golf cart was not an "automobile" because it was not...

March 28, 2017

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P.K. v. Cumis General Insurance (16-001809)

The claimant sought entitlement to eight treatment plans, including prescription medication. Adjudicator Sewrattan found five of the treatment plans were not payable as the treatment was incurred before the submission of treatment plans. When interpreting section 38(2), it was noted that there was no "reasonable excuse" exception; therefore, if the claimant did not meet any...

March 28, 2017

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M.P. v. Northbridge Personal Insurance Corporation (16-001394)

The claimant had already previously adjourned two case conferences due to a death in the family and medical reasons. A preliminary issue hearing was scheduled; however, it was subsequently withdrawn by the insurer and the matter was set to proceed to a hearing. The claimant sought to adjourn a written hearing, so she could undergo...

March 28, 2017

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E.F. v. RBC Insurance Company (16-001038)

The claimant sought entitlement to physiotherapy and an FAE. The insurer denied the treatment based on a MIG determination. Adjudicator Anwar considered the medical evidence submitted, including family doctor clinical notes and records, and determined the claimant did not prove entitlement to treatment beyond the MIG.

March 28, 2017

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B.W. v. Royal SunAlliance Insurance (16-001517)

The claimant sought entitlement to five treatment and assessment plans. The insurer denied the treatment based on a MIG determination. Adjudicator Johal dismissed all claims and upheld the MIG determination. Of note, while Adjudicator Johal found the claimant did suffer from issues of anxiety, depression, sleeping problems, and panic attacks prior to the accident, it...

March 27, 2017

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M.F. v. Belair Direct (16-002057

The insurer brought a preliminary issue motion asserting the claimant was not entitled to income replacement since the claimant knowingly drove without a license, pursuant to section 31 of the SABS. Adjudicator Sewrattan reviewed Section 2.2.1 of OAP 1. It was noted that while a broad interpretation favouring the insured was asserted, not even a...

March 27, 2017

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G.A. v. Co-Operators General Insurance Company (16-001976)

The claimant sought entitlement to income replacement benefits. The insurer asserted a limitations defence. Adjudicator Sewrattan noted that the LAT assumed jurisdiction of accident benefits disputes on April 1, 2016. The parties agreed the 90-day grace period beyond a report of mediator is not applicable to LAT disputes. Adjudicator Sewrattan noted the claimant had ample...

March 24, 2017

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T.E. v. Unifund Assurance Company (16-001326)

A preliminary hearing was held to decide whether the claim for IRBs was barred by the limitation period. Adjudicator Sewrattan concluded that the denials by the insurer were clear and unequivocal, and that the claim for IRBs was therefore barred. No costs were awarded.

March 24, 2017

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P.C. v. Wawanesa Mutual Insurance Inc. (16-000989)

The claimant sought entitlement to three treatment plans. The insurer denied the plans and maintained a MIG position. Adjudicator Truong reviewed the medical reports and found each to have competing views; as a result, a review of the clinical notes was undertaken. On review, the claimant was said to suffer from soft tissue injuries and...

March 23, 2017

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Y.Y. v. Unica Insurance Inc. (16-000552)

The claimant sought entitlement to attendant care benefits. Adjudicator Theoharis did not find the account of the service provider credible as the testimony was vague and did not sound convincing when cross-examined. Additionally, the claimant provided contrary evidence to a statutory declaration. The evidentiary record also contained conflicting accounts as to who provided services, if...

March 23, 2017

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W.P. v. Aviva Insurance (16-000693)

In this preliminary issue decision, the insurer argued that the claimant had failed to attend an IE and EUO and therefore could not proceed to arbitration at the LAT. Adjudicator Neilsen held that the insurer's request for an IE was reasonable, and the insurer had provided a notice that satisfied section 38 of the SABS....

March 23, 2017

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N.M. v. Certas Direct Insurance Company (16-001438)

The claimant sought entitlement to medical benefits. The insurer denied the benefits and held the claimant within the MIG. The claimant argued that a pre-existing condition of spina bifida warranted removal from the MIG. The claimant also advanced a chronic pain and psychological impairment argument. Adjudicator Rebecca Hines noted that the asserted pre-existing condition was...

March 23, 2017

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Applicant v. Wawanesa Mutual Insurance Company (16-001181)

This is a reconsideration decision under LAT Rule 18.2(b) wherein the original decision found the claimant not entitled to claim expenses related to a trip to Disney World. Executive Chair Lamoureux noted that there were no further submissions on the part of the claimant, and it appeared the Tribunal was merely "urged to discover the...

March 21, 2017

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Applicant v. Aviva Insurance Company (16-001144)

The original adjudicator had awarded IRBs up to the 104 week mark, which was a future date; the weekly quantum of IRBs awarded was not analysed in the decision. The insurer appealed the adjudicator's order related to the period and quantum of IRBs. Executive Chair Lamoureux accepted the insurer's arguments and held that the order...

March 21, 2017

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Applicant (Minor) v. Wawanesa Mutual Insurance Company (16-000323)

The minor claimant sought removal from the MIG based on incomplete medical records and selective school records showing absenteeism. Adjudicator Mather rejected the claimant's position and held that there was insufficient evidence to show that the relatively minor accident was related to the claimant's school performance or causing any psychological difficulties.

March 17, 2017

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Applicant v. Wawanesa Mutual Insurance Company (16-000433)

The insurer requested reconsideration of a costs award against it arising out of the failure to provide records. Executive Chair Lamoureux overturned the costs award, writing that the adjudicator's decision was premised on incorrect facts (the dispute had been resolved at the time).

March 17, 2017

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Applicant v. TD General Insurance Company (16-000134 and 16-000646)

Executive Chair Lamoureux was asked to reconsider two decisions in which the claimant was found MIG and found not entitled to NEBs. The applicant argued that "the entirety" of his evidence was "not considered at all." Similarly, in his request for reconsideration of NEBs the applicant argued that his "evidence was not considered at all...

March 16, 2017

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K.J. v. Wawanesa Mutual Insurance Company (16-001732)

Adjudicator Pay was asked to exclude a report by Dr. Ogilvie-Harris that was served two days before the hearing date. Adjudicator Pay allowed the submission of this late report as it was relevant and likely necessary to the determination of the issues in dispute. However, she extended the timelines for the submission of the insurer's...

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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