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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December 9, 2016

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N.E. v. Waterloo Regional Municipalities Insurance Pool (16-000066)

The claimant sought IRBs at a rate above the weekly rate paid by the insurer. The claimant also sought removal from the MIG. Adjudicator Gottfried dismissed the claim for increased IRBs as the claimant had not provided any documentation to support increasing the weekly quantum. The adjudicator also noted that entitlement to ongoing IRBs does...

December 7, 2016

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TD General Insurance Company v. A.B. (16-000060)

The insurer sought repayment of IRBs based on the claimant's return to work prior to IRB discontinuance. Adjudicator Go found that the claimant had returned to work as of at least May 1, 2014, and ordered repayment of IRBs from that date onward. The adjudicator was unwilling to find that the claimant had returned to...

December 7, 2016

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N.C. v. RBC General Insurance Company (16-000282)

Following an accident, the self-employed claimant stopped operating his business in January 2016. Adjudicator Sewrattan concluded that the IRB calculation could not take into account business losses, as the claimant did not have business losses (as calculated by the Income Tax Act) after he ceased operations of his business. In terms of medical benefits, the...

December 6, 2016

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M.M. v. Wawanesa Mutual Insurance Company (16-000642)

The claimant sought removal from the MIG, and entitlement to two treatment plans. Arbitrator Truong concluded that the MIG applied despite various pre-existing conditions, previous motor vehicle accidents, and earlier psychological injuries.

December 2, 2016

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Applicant v. Old Republic Insurance Company (16-000179)

The insurer appealed a decision by an adjudicator that the claimant was entitled to IRBs up until a particular date in the future. The Executive Chair held that the adjudicator made an error of law by setting an end date for the reinstated IRBs. An insurer has an ongoing obligation to adjust a file, and...

December 2, 2016

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Applicant v. Old Republic Insurance Company (16-000179)

The insurer appealed a decision by an adjudicator that the claimant was entitled to IRBs up until a particular date in the future. The Executive Chair held that the adjudicator made an error of law by setting an end date for the reinstated IRBs. An insurer has an ongoing obligation to adjust a file, and...

December 1, 2016

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L.W. v. The Co-operators General Insurance Company (16-000536)

The claimant sought entitlement to six treatment plans. Adjudicator Sewrattan adopted FSCO case law on the legitimacy of pain relief being a reasonable and necessary goal of treatment, and awarded all six treatment plans. The adjudicator also rejected the insurer's position that surveillance could accurately capture the sensation of pain.

November 29, 2016

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D.J. v. Aviva Insurance Canada (16-000098)

The claimant sought removal from the MIG and entitlement to various treatment plans. Adjudicator Theoharis concluded that the claimant suffered from depression and anxiety, which entitled her to benefits above the MIG limits. However, Adjudicator Theoharis concluded that all treatment plans for physical treatment were not reasonable and necessary, as the claimant had met maximum...

November 21, 2016

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J.W. v. Echelon General Insurance Company (16-000082)

The claimant sought IRBs for both the first 104 weeks after the accident, and beyond the first 104 weeks after the accident. Adjudicator Flude accepted the that the claimant met the "complete inability" test as neither the claimant nor the insurer submitted evidence of employment for which the claimant might reasonably be suited by education,...

November 15, 2016

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J.W. v. The Co-operators General Insurance Company (16-000248)

The claimant sought IRBs during a period in which he was in non-compliance with the requirement to attend an IE. He argued that there were no "medical and any other reasons" in the IE notice. Adjudicator Richards upheld the non-payment of IRBs, stating there is no requirement to "invent" a medical reason; medical and other...

November 8, 2016

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R.M. v. Optimum Insurance Company (16-000344)

The claimant brought an application for interest and a special award on IRBs that had been miscalculated by the insurer. Adjudicator Bickley awarded interest on IRBs after they were recalculated at a higher amount. A special award was denied because the parties had proceeded on the shared assumption of the weekly IRB quantum for six...

November 2, 2016

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J.T. v. Intact Insurance Company (16-000041)

Rule 19.1 provides that costs may be requested during a proceeding if a party, during a proceeding, acts unreasonably, frivolously, vexatiously and/or in bad faith. Correspondence which took place prior to the LAT application cannot be considered under Rule 19.1. A special award was not given because the insurer did not "withhold or delay" payment...

November 2, 2016

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D.S. v. Economical Mutual Insurance Company (16-000201)

The claimant sustained a catastrophic impairment. The claimant applied for caregiver benefits. The main issue was whether the claimant or his wife was the primary caregiver at the time of the accident. The claimant was denied caregiver benefits by Adjudicator Treksler because his wife was found to be the primary caregiver from both a quantitative...

November 1, 2016

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B.U. v. Aviva Canada Inc. (16-000143)

The claimant sought removal from the MIG and entitlement to ACBs and various medical benefits. The claimant was removed from the MIG based on psychological grounds and awarded various assessments and psychological treatment. ACBs were denied. Adjudicator Lester noted that even if the claimant had been found to require personal assistance, the evidence did not...

October 28, 2016

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S.A.R. v. State Farm Mutual Automobile Insurance Company (16-000212)

The claimant sought entitlement to NEBs and various medical benefits. Adjudicator Pay found that the initial denial of NEBs was not vitiated by subsequent correspondence from the insurer denying NEBs. The opposite result was found in relation to two treatment plans. Although the plans were denied four years prior to the LAT application, the insurer...

October 26, 2016

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C.S. v. Unifund Assurance Company (16-000087)

The claimant sought entitlement to four treatment plans and removal from the MIG. As a preliminary issue, the insurer argued that two treatment plans were barred by the limitation period. Adjudicator An concluded that one treatment plan was statute barred, but that the claimant had applied to the LAT in a timely fashion for the...

October 20, 2016

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S.G. v. The Personal Insurance Company (16-000338)

The claimant sought to admit an audio recording he made during an IE assessment. The insurer objected to the audio recording being entered as evidence. Adjudicator Lester relied upon the section 15 of the SPPA in establishing her authority to determine what evidence to admit at the hearing. She concluded that the audio recording was...

October 20, 2016

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D.S. v. Certas Home and Auto Insurance Company (16-000279)

A completed OCF-3 was submitted; the claimant was said to have not met the test for NEBs. An OCF-10 was submitted whereby the claimant elected NEBs. The insurer sought a preliminary hearing to have the claimant's claim for NEBs dismissed without a hearing. Adjudicator Pay concluded that the claimant was still entitled to pursue a...

October 19, 2016

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Applicant v. Aviva (16-000474)

This is a reconsideration of the LAT's failure to consider a request for costs by the insurer following the claimant's withdrawal of a LAT application. Executive Chair Lamoureux concluded that it was a violation of procedural fairness for the Tribunal to have failed to consider the insurer's request for costs. The matter was sent back...

October 5, 2016

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M.R. v. Aviva Insurance Company of Canada (16-000216)

The claimant was involved in an MVA in December of 2013. An OCF-1 was submitted in February of 2014. Aviva sent OCF-9s in February, March, April, and May 2014, informing the Applicant that the MIG governed her injuries and as such she did not have coverage for attendant care benefits. The Applicant brought an application...

October 3, 2016

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Applicant v. Dominion of Canada General Insurance Company (16-000063)

The claimant applied to the LAT for both NEBs and IRBs. This preliminary hearing was to determine whether the claimant was entitled to litigate claims for both NEBs and IRBs. Adjudicator Marzinotto held that the insurer should have provided an election to the claimant, but had failed to do so. As a result, the claimant...

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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