Derek Grant

The applicant sought statutory accident benefits following a 2014 motor vehicle accident.

The Tribunal found the applicant was entitled to non-earner benefits from August 2014 onward, as chronic pain practically prevented her from engaging in substantially all of her pre-accident activities.

The Tribunal also awarded attendant care benefits at a reduced rate of $1,081.40 per month, relying on an early occupational therapy assessment rather than later assessments that recommended the maximum catastrophic limit.

Claims for various treatment plans and medications were largely dismissed due to non-compliance with s. 33 requests and incomplete forms.

The Tribunal granted a 5% special award under s. 10 of O. Reg. 664, finding the insurer unreasonably delayed payment of the non-earner benefit by failing to properly adjust the file and notify the applicant of the purpose of insurer examinations.

The applicant was injured when she fell off her bicycle after her tire got caught in streetcar tracks while attempting to navigate around a vehicle parked in the bicycle lane.

She applied for statutory accident benefits, which the respondent denied on the basis that the incident did not meet the definition of an 'accident' under section 3(1) of the Schedule.

The Licence Appeal Tribunal found that the incident did not satisfy the purpose or causation tests.

The parked vehicle was not the direct cause of the injuries; rather, the streetcar tracks were the dominant feature and an intervening act.

The application was dismissed.

The respondent insurer requested a reconsideration of a decision that found the applicant was entitled to an income replacement benefit (IRB) and that CERB payments should be included as 'gross employment income' in calculating the IRB quantum.

The Tribunal granted the reconsideration, finding it made an error of law in the original decision.

The Tribunal concluded that CERB payments are a separate form of income that is repayable to the government and not remuneration for employment, and therefore cannot be added to the calculation of IRB quantum.

The decision was varied to reflect an IRB quantum of $195.00 per week.

The applicant sought reconsideration of a decision finding that her physical injuries, sustained while caring for her husband who was injured in a motor vehicle accident, did not occur as a result of an accident.

The applicant argued the Tribunal erred in law by misapplying the purpose and causation tests and failing to find her an 'insured person' under s. 3(1) of the Schedule.

The Tribunal dismissed the request, holding that s. 3(1) only extends coverage to a spouse not directly involved in an accident if they suffer psychological or mental injury.

Because the applicant claimed benefits for physical injuries resulting from caregiving, she did not meet the definition of an 'insured person' under the Schedule.

The applicant sought income replacement benefits following a motor vehicle accident.

The respondent denied the benefits and raised a preliminary issue that the applicant was statute-barred from claiming pre-104 benefits due to her failure to attend section 44 insurer examinations.

The Tribunal agreed, finding the applicant failed to attend properly scheduled examinations without a reasonable explanation.

Regarding post-104 benefits, the Tribunal found the applicant did not suffer a complete inability to engage in employment, noting she had returned to work and closed her business due to pandemic lockdowns rather than accident-related impairments.

The claims for benefits, interest, and an award were dismissed.

The applicant requested a reconsideration of a decision finding he was not involved in an 'accident' when he slipped on ice while putting air in his vehicle's tires.

He argued the adjudicator erred in law by failing to properly consider his case law regarding the ordinary use or operation of a vehicle.

The Tribunal dismissed the request, finding no error of law.

The adjudicator had properly applied the causation test, concluding that the ice was the dominant feature of the fall, which created an intervening event that broke the chain of causation.

The applicant sought reconsideration of a Tribunal decision denying her entitlement to psychological and chronic pain assessments.

She argued the Tribunal erred in finding her assessor was not qualified to diagnose chronic pain and erred in finding no medical evidence linked her psychological complaints to the accident.

The Tribunal found no error regarding the chronic pain assessor's qualifications.

While acknowledging an error of fact regarding the psychological evidence, the Tribunal concluded it would not have changed the outcome, as the applicant had already been diagnosed with an accident-related psychological impairment by an insurer's examination, making an additional assessment unnecessary.

The request for reconsideration was dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

The insurer denied several treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's pre-existing injuries, which were exacerbated by the accident, warranted removal from the MIG.

The Tribunal approved five treatment plans for physiotherapy, finding them reasonable and necessary to address the applicant's ongoing pain and functional limitations.

However, a treatment plan for a social work assessment was denied, as the applicant had largely returned to pre-accident activities and the proposed hourly rate exceeded the professional services guideline.

Interest was awarded on the overdue physiotherapy benefits.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to psychological and physiotherapy services outside the Minor Injury Guideline (MIG).

The applicant argued that pre-existing back pain, psychological impairments, and chronic pain warranted removal from the MIG.

The adjudicator found that the applicant failed to prove a pre-existing condition precluded recovery within the MIG.

Relying on the respondent's medical experts, the adjudicator concluded the applicant's psychological symptoms were related to non-accident stressors (unemployment, diabetes) and that his physical injuries were soft tissue in nature, not chronic pain syndrome.

As the MIG limits were exhausted, the disputed treatment plans were not payable, and claims for an award and interest were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to several treatment plans for physiotherapy, psychological, chronic pain, and vocational assessments.

The respondent denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to meet the burden of proving his injuries warranted removal from the MIG, noting a lack of persuasive medical evidence for chronic pain or psychological impairment.

As the MIG limits were exhausted, the disputed treatment plans were deemed not reasonable and necessary, and the application was dismissed.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, an attendant care assessment, and a chronic pain assessment under the Statutory Accident Benefits Schedule.

The insurer denied the benefits.

The Tribunal found the applicant was entitled to treatment plans for physiotherapy, a chronic pain assessment, and ergonomic equipment (an L-shaped desk and ergonomic chair) as they were reasonable and necessary to address ongoing accident-related pain.

The Tribunal denied the treatment plans for an attendant care assessment and social work services.

The Tribunal also found the insurer failed to properly deny one treatment plan within the required 10 business days under s. 38 of the Schedule.

The applicant's request for an award under s. 10 of O. Reg. 664 was denied, as the insurer's conduct was not unreasonable.

Interest was awarded on the overdue benefits.

The applicant sought medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The Tribunal found the treatment plan for a Cefaly device to treat post-traumatic headaches was reasonable and necessary, noting it provided pain relief without the side effects of medication.

However, the Tribunal denied multiple treatment plans for psychological services, finding the applicant failed to justify the need for 1.25-hour sessions over standard 1-hour sessions, and upheld the insurer's reduced hourly rate for the psychotherapist.

Claims for a special award under s. 10 of O. Reg. 664 were dismissed as the insurer's reliance on its s. 44 assessor was not unreasonable.

Aviva Insurance Company requested a reconsideration of a Licence Appeal Tribunal decision that awarded the applicant a 5% special award for unreasonable delay in approving treatment plans.

The adjudicator found that he had erred in law in the initial decision by granting an award on approved treatment plans that were not properly before the Tribunal, and by incorrectly finding that Aviva had delayed its responses to the disputed treatment plans.

The reconsideration was granted, and the previous decision was varied to dismiss the special award.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits from the respondent insurer.

The parties disputed the quantum of income replacement benefits (IRBs) and attendant care benefits (ACBs), as well as entitlement to various medical benefits, an award, and costs.

The Tribunal held that the applicant was not barred from proceeding despite initial failures to attend insurer examinations.

On the IRB issue, the Tribunal found that Canada Emergency Response Benefit (CERB) payments received by the self-employed applicant prior to the accident should be included in calculating her pre-accident income, resulting in an IRB of $268.51 per week.

The Tribunal partially approved the ACB claim at $1,791.14 per month based on a review of competing Form 1 assessments.

Most of the disputed treatment plans were denied as not reasonable and necessary, save for one form completion fee where the insurer's denial notice was deficient.

Claims for a special award and costs were dismissed.

The applicant sought various medical and rehabilitation benefits following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant was entitled to funding for physiotherapy, Botox injections, a mental health driving assessment, a virtual social work assessment, a sleep study, an oculo-visual assessment, and prescription medication, as these were reasonable and necessary to treat his accident-related impairments, including a mild traumatic brain injury.

However, claims for a functional cognitive assessment, an attendant care assessment, and occupational therapy were denied because the applicant demonstrated an ability to engage in pre-accident activities and perform necessary tasks independently.

The Tribunal also denied the applicant's request for a special award, finding that the insurer reasonably relied on its assessors' opinions.

The applicant sought entitlement to eight treatment plans for physiotherapy and interest under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The adjudicator found that the applicant failed to prove the treatment plans were reasonable and necessary, noting a lack of evidence showing the goals of treatment or how they would be met.

The adjudicator accepted the respondent's medical examination report, which concluded the applicant had reached maximum medical recovery.

The application was dismissed.

The applicant sought various medical and rehabilitation benefits, attendant care benefits, an award, and interest following a 2018 motor vehicle accident.

The respondent denied the benefits, arguing the applicant's injuries fell within the Minor Injury Guideline and that pre-existing injuries from a 2016 accident were the primary cause of his ongoing complaints.

The Tribunal found that the applicant failed to establish that the proposed treatment plans were reasonable and necessary, noting a lack of objective medical evidence and failure to submit a required Form 1 for attendant care benefits.

The application was dismissed in its entirety.

The applicant was involved in a motor vehicle accident and sought statutory accident benefits for a chronic pain program, psychological services, and driving rehabilitation.

The insurer denied the treatment plans.

The Tribunal found that the applicant failed to meet the burden of proving the treatments were reasonable and necessary.

The applicant did not satisfy the AMA Guides criteria for chronic pain, and the objective medical evidence, including an insurer's examination, did not support a psychological impairment.

The application was dismissed, and claims for interest and a special award were denied.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits and medical/rehabilitation benefits beyond the Minor Injury Guideline (MIG) limit.

The Licence Appeal Tribunal found that the applicant failed to prove a complete inability to carry on a normal life, noting inconsistencies between his reported impairments and his actual function, such as continuing to work in excavation and playing hockey.

The Tribunal also held that the applicant did not provide compelling evidence to justify removal from the MIG.

As the MIG limits were exhausted, the disputed treatment plans were not payable, and claims for an award and interest were dismissed.

The applicant sought statutory accident benefits for psychological impairments allegedly sustained as a result of her mother's involvement in a motor vehicle accident.

The applicant claimed entitlement to four treatment plans (OCF-18s) for vocational, academic, social rehabilitation, and psychological services.

The Tribunal found that the applicant failed to prove on a balance of probabilities that the proposed treatment plans were reasonable and necessary to address any accident-related impairments.

The Tribunal noted that the applicant's post-accident complaints were not significantly different from her pre-accident mental health and well-being.

The application was dismissed.