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.

October 13, 2017

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Applicant v. Certas Direct Insurance (16-004092)

The insurer argued that the claimant had failed to attend a requested IE, and therefore could not pursue his claim for two medical benefits. Adjudicator Go held that the insurer's IE request letter did not satisfy the requirements of section 44 in failing to provide medical reasons for the examination. The claimant was therefore permitted...

October 13, 2017

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Applicant v. Aviva Insurance Company of Canada (16-001934)

The claimant sought entitlement to a chronic pain assessment. The insurer denied the assessment. Adjudicator Chris Sewrattan referenced a previous decision in the same matter where it was held that it was reasonably possible the claimant suffered from chronic pain syndrome. Based on the medical evidence, Adjudicator Sewrattan reasoned that a chronic pain assessment was...

October 13, 2017

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Applicant v. Aviva Insurance Company of Canada (16-001934)

The claimant sought entitlement to a chronic pain assessment. The insurer denied the assessment. Adjudicator Chris Sewrattan referenced a previous decision in the same matter where it was held that it was reasonably possible the claimant suffered from chronic pain syndrome. Based on the medical evidence, Adjudicator Sewrattan reasoned that a chronic pain assessment was...

October 12, 2017

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The Applicant v. Aviva General Insurance (17-004239)

The claimant sought entitlement to one treatment plan for chiropractic treatment. Adjudicator Treksler concluded that although the claimant had been diagnosed with whiplash as a direct result of the accident, she had not provided any objective medical opinion to support that the chiropractic treatment would improve or resolve her injuries. The claimant was not entitled...

October 11, 2017

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Applicant v. Allstate Insurance Company (16-003204)

The claimant sought entitlement to a number of medical treatment plans. The insurer denied the plans based on IE reports. Adjudicator Brian Norris reviewed the medical evidence and determined that the treatment plans were not reasonable and necessary. The application was dismissed.

October 10, 2017

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Melo v. Northbridge Personal Insurance Corporation (2017 ONSC 5885)

The claimant appealed Adjudicator Sewrattan's denial of further IRBs to the Divisional Court. The Court upheld the decision, writing that the standard of review was reasonableness, and that Adjudicator Sewrattan had used the proper test to consider entitlement to IRBs, applied the proper standard of proof, and grounded his reasons in the evidence before him.

October 10, 2017

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K.D. v. TD Insurance Meloche Monnex (17-004213)

The claimant brought a motion seeking to add additional issues in dispute. The insurer resisted the motion. Adjudicator Cezary Paluch relied on Rule 20.5 and noted that "the Tribunal has an obligation to ensure a fair, just, expeditious and cost efficient determination of every case on its merits." The issues were added.

October 6, 2017

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N.N. v. Allstate Insurance Company (17-000006)

The claimant sought entitlement to IRBs and three medical benefits. Adjudicator Hans concluded that as a result of the claimant's physical impairments, he was substantially unable to perform the essential tasks of his employment as a marble shop worker. The Adjudicator was not persuaded by the respondent's argument that the claimant was able to work...

October 6, 2017

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N.Y. v. TD Insurance Meloche Monnex (17-001054)

The claimant sought entitlement to accident benefits. The LAT case conference adjudicator ordered a hybrid hearing with evidence to be entered via writing. After the claimant filed submissions, the insurer responded with submissions containing addendum IE reports as evidence. The claimant made a motion objecting to the admissibility of the new addendum reports and was...

October 6, 2017

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N.Y. v. TD Insurance Meloche Monnex (17-001054)

The claimant sought entitlement to accident benefits. The LAT case conference adjudicator ordered a hybrid hearing with evidence to be entered via writing. After the claimant filed submissions, the insurer responded with submissions containing addendum IE reports as evidence. The claimant made a motion objecting to the admissibility of the new addendum reports and was...

October 4, 2017

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O.A. v. TD General Insurance Company (16-003897)

The claimant sought entitlement to income replacement benefits. The insurer denied the benefit based on the claimant being outside of the limitation period. The insurer also asserted that a completed disability certificate was not submitted within two years of the MVA, pursuant to section 36 and sought to have the application dismissed. On review of...

October 4, 2017

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L.M. v. Gore Mutual Insurance Company (16-003772)

The claimant sought entitlement to non-earner benefits. The insurer resisted the claim and relied on medical reports as well as a statement from the claimant. Adjudicator Deborah Neilson reviewed the medical evidence and distilled the claimant's pre- and post-accident activities of daily living. On review, it was held the claimant was completely disabled from performing...

October 2, 2017

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The Applicant v. Wawanesa Mutual Insurance Company (16-002823)

The claimant submitted four treatment and assessment plans to the insurer. The insurer held that the claimant had suffered minor injuries and that his treatment fell within the Minor Injury Guideline. Adjudicator Anwar explained in order to allege that an injured person has pre-existing medical injuries that required treatment in excess of the MIG limits,...

September 29, 2017

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Applicant v. The Co-operators General Insurance Company (16-003478)

The claimant and the insurer disagreed on the amount payable to a case manager. The claimant sought $150 per hour; the insurer argued that the Professional Services Guideline capped the hourly rate at $89.07. Adjudicator Maedel concluded that the PSGs applied to the services provided to the claimant, and that $89.07 was the maximum payable....

September 28, 2017

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J.M. & N.M. v. RBC General Insurance Company (17-001227 & 17-001283)

The claimants, two adult children whose mother was seriously injured in a motor vehicle accident, sought entitlement to one treatment plan each for social work assessments. The claimants failed to attend IEs. The claimants took the position that they were not required to attend the IEs because the treatment plans were automatically payable on the...

September 28, 2017

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R.D. v. Wawanesa Mutual Insurance Company (16-001535)

The deceased claimant had been involved in a motor vehicle accident in which his car rolled over and the airbags deployed. He did not seek medical attention at the scene, and met his brother-in-law at an auto repair shop. Shortly after arriving at the auto repair shop, the claimant was found unresponsive. He was taken...

September 27, 2017

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K.B. v. Intact Insurance Company (16-004096)

The claimant sought accident benefits; however, the insurer denied access and asserted that no accident within the definition had occurred. Adjudicator Rebecca Hines noted that the claimant dropped her kids off at a birthday party event at a mall. While returning to her vehicle she tripped on a pothole in the parking lot, "a few...

September 25, 2017

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J.F. v. Aviva Insurance Company of Canada (16-004503)

The claimant was a tow truck driver who sustained injuries while opening the garage bay door at a mechanic's shop. He was opening the door to push a broken taxicab inside the garage. He sought benefits from his auto insurer, which were denied. The issue at the LAT was whether the claimant had been involved...

September 25, 2017

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S.Y. v .Aviva General Insurance Company (16-004549)

The claimant sought entitlement to medical benefits. Some of the treatment plans were not included as original issues in dispute, others were already paid by the insurer. Adjudicator Anna Truong reviewed the medical evidence and determined that two treatment plans were reasonable, while a psychological treatment plan was not. Other treatment plans were denied due...

September 22, 2017

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T.B. v. Security National Insurance Co. (16-002570)

The claimant sought entitlement to income replacement and housekeeping benefits. At the outside of the hearing the parties advised Adjudicator Gregory Flude that the matter had settled. Accordingly, Adjudicator Flude closed the file.

September 22, 2017

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M.F.Z. v. Aviva Insurance Canada (16-000517)

The Tribunal had determined in both cases that the MIG did not apply because the insurer failed to comply with section 38(8) of the SABS. The insurer sought reconsideration. Executive Chair Lamoureux held that the Tribunal had not made a significant error in concluded that section 38(8), and that the insurer's notice was deficient. She...

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Toronto, Ontario M5H 3S5

416.507.1850

eodonnell@tgplawyers.com

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

416.507.1850

eodonnell@tgplawyers.com