Derek Grant

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

The insurer denied the benefits on the basis that the applicant's injuries were predominantly minor and subject to the $3,500 limit under the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's physical injuries were soft tissue in nature and fell within the MIG, and that there was insufficient evidence of functionally disabling chronic pain or psychological impairment to warrant removal from the MIG.

As the MIG limits had been exhausted, the disputed treatment plans were deemed not reasonable and necessary, and the claims for interest and a special award were dismissed.

The applicant was injured in a motor vehicle accident and subsequently went on maternity leave, receiving Employment Insurance (EI) maternity benefits.

The insurer conceded entitlement to Income Replacement Benefits (IRB) but sought to deduct the EI maternity benefits and available employer top-up amounts from the IRB quantum.

The Tribunal held that EI maternity benefits and employer top-ups fall within the definition of 'gross employment income' under the Statutory Accident Benefits Schedule and are therefore deductible from IRBs.

The Tribunal also found the applicant was entitled to interest on overdue IRBs but dismissed the claim for a special award, noting the delay was due to the applicant's failure to provide requested employment documentation.

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

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

The Tribunal found that the applicant's physical injuries were predominantly minor soft tissue injuries and that he failed to establish a psychological impairment that would remove him from the MIG.

As the $3,500 MIG limit had already been exhausted, the Tribunal concluded the applicant was not entitled to the claimed treatment plans.

The applicant sought reconsideration of a decision denying income replacement benefits and various treatment plans on the basis that his injuries fell within the Minor Injury Guideline (MIG).

The applicant argued the adjudicator made significant errors of law and fact in weighing the medical evidence regarding his physical limitations, psychological impairment, and chronic pain.

The adjudicator dismissed the reconsideration request, finding no errors of law or fact in the original decision.

The adjudicator reaffirmed that the applicant failed to meet the burden of proving his injuries fell outside the MIG or that he suffered a substantial inability to perform the essential tasks of his employment.

The applicant sought medical benefits following a motor vehicle accident.

The respondent insurer denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The Tribunal found that the medical evidence, including reports from physiatrists and a psychologist, confirmed the applicant sustained soft tissue injuries consistent with the MIG.

The applicant failed to provide sufficient evidence of chronic pain or psychological impairment to warrant removal from the MIG.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that his injuries fell within the Minor Injury Guideline (MIG).

The applicant sought funding for a pain management assessment and a psychological assessment, arguing that chronic pain and psychological impairments warranted removal from the MIG.

The Licence Appeal Tribunal found that the medical evidence did not support a diagnosis of functionally disabling chronic pain or a clinically significant psychological impairment, noting the applicant's own self-reporting contradicted the severity of his alleged psychological issues.

The Tribunal concluded the applicant sustained predominantly minor injuries, and because the MIG limits were exhausted, the disputed treatment plans were not reasonable and necessary.

The applicant was injured in a motor vehicle accident and sought various medical benefits and assessments under the Statutory Accident Benefits Schedule.

The insurer denied the treatment plans.

The Tribunal found that the functional ability evaluation and chronic pain assessment were reasonable and necessary, given the applicant's consistent pain complaints and the persuasive report of a chronic pain specialist.

However, the claims for chiropractic treatment, a neuropsychological assessment, and an orthopaedic assessment were dismissed for lack of supporting objective medical evidence.

The applicant was injured in a motor vehicle accident and sought a non-earner benefit, medical and rehabilitation benefits, and the cost of an examination from the respondent insurer.

The adjudicator found that the applicant failed to prove a complete inability to carry on a normal life, as she continued to engage in her pre-accident activities of daily living.

The adjudicator also preferred the insurer's medical assessments, concluding that the proposed treatment plans and assessments were not reasonable and necessary.

The application was dismissed.

The applicant requested a reconsideration of a preliminary issue decision which found her application for an income replacement benefit (IRB) was statute-barred.

The applicant argued the adjudicator erred in law or fact by finding that the submission of an Election Form (OCF-10) constituted a claim for IRBs and that the insurer's notice letter was a valid denial triggering the limitation period.

The adjudicator dismissed the reconsideration request, finding no error of law or fact.

The adjudicator held that the insurer properly responded to the OCF-10 by denying the claim based on the information available, and the applicant failed to dispute the denial within the two-year limitation period.

The applicant was involved in a motor vehicle accident and sought a psychological assessment.

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

The Tribunal found that the applicant's physical injuries were predominantly minor and that there was insufficient evidence of a psychological impairment or chronic pain to warrant removal from the MIG.

The Tribunal also found that the proposed psychological assessment was not reasonable and necessary, as there was no objective evidence to suspect a psychological condition.

The application was dismissed.

The applicant sought statutory accident benefits for aquatic therapy, physiotherapy, and a chronic pain assessment following a motor vehicle accident.

The respondent denied the treatment plans, arguing they were not reasonable and necessary, and that the claims for physiotherapy and chronic pain treatment were barred by res judicata due to a previous Tribunal decision.

The Tribunal agreed that res judicata applied to the physiotherapy and chronic pain claims, as they had been previously adjudicated on the merits with no new objective evidence of deterioration.

The Tribunal also found the aquatic therapy plan unreasonable given the availability of a much cheaper aquafit program.

The application was dismissed.

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

The insurer partially approved a treatment plan for a home accessibility assessment, capping it at $2,000 pursuant to s. 25(5)(a) of the Schedule.

The applicant argued the cap only applied to medical assessments.

The Tribunal held that the $2,000 limit applies to any assessment, including home accessibility assessments, as the report involved an appraisal of the applicant's health status.

The Tribunal also awarded the applicant $200 under s. 10 of Regulation 664 due to the insurer's unreasonable delay in paying for occupational therapy cognitive training sessions.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for chiropractic treatment and a chronic pain assessment.

The insurer denied the treatment plans.

The Licence Appeal Tribunal found that the applicant failed to prove the treatments were reasonable and necessary, noting a lack of objective medical evidence and the presence of pre-existing back issues that were not exacerbated by the accident.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought medical benefits and cost of examinations under the Statutory Accident Benefits Schedule.

The insurer denied the claims, initially relying on the Minor Injury Guideline (MIG) limits, though it later conceded the applicant was removed from the MIG due to a psychological impairment.

The Tribunal found that the requested psychological services and driver reintegration assessment were reasonable and necessary, preferring the evidence of the applicant's psychologist over the contradictory reports of the insurer's expert.

However, the Tribunal dismissed the claims for physiotherapy, an orthopaedic assessment, and a functional abilities evaluation, finding insufficient objective evidence to support them and noting the applicant's own report that physical therapy was no longer helpful.

The claim for a special award under s. 10 of Regulation 664 was dismissed as the insurer's reliance on its experts' reports was not unreasonable.

The applicant sought various statutory accident benefits following a motor vehicle accident, including treatment plans for assistive devices, psychological services, hydrotherapy, chiropractic services, and catastrophic impairment assessments.

The insurer denied the benefits, arguing the applicant's ongoing issues were related to a significant pre-existing back condition and opioid dependence, not the accident.

The adjudicator dismissed the application, finding the applicant failed to provide sufficient medical evidence to prove the treatments were reasonable and necessary, and preferred the insurer's medical assessors who concluded the accident did not exacerbate the pre-existing condition.

The applicant sought a medical benefit for physiotherapy in the amount of $1,899.96 following a motor vehicle accident.

The respondent denied the treatment plan, arguing the applicant's physical injuries were predominantly minor and the treatment was not reasonable and necessary.

The Tribunal found that the applicant failed to establish on a balance of probabilities that the treatment plan was reasonable and necessary, noting that the applicant reported only short-term relief from previous treatment.

The application was dismissed, and the respondent's claim for costs was also denied.

The applicant sought reconsideration of a Tribunal decision that denied entitlement to interest, an award, and costs related to an approved treatment plan.

The applicant argued the Tribunal erred in law by failing to consider the remedial nature of the legislation, the applicant's chronic pain, and the provisions for interest under the Schedule.

The adjudicator found no error of law or fact, noting that the insurer approved the treatment plan once sufficient medical evidence was provided, and there was no basis for costs or an award.

The request for reconsideration was denied.

The applicant sought payment for a psychological assessment and a special award following a motor vehicle accident.

The adjudicator found that the psychological assessment was not reasonable and necessary, as the applicant's family physician records showed a scarcity of psychological complaints and the respondent's psychological assessor concluded she did not suffer from a formal psychological condition.

The adjudicator also dismissed the claim for a special award, finding that although the respondent was late in denying the treatment plan, its conduct did not warrant an award.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought payment for a chronic pain assessment and a neurological assessment under the Statutory Accident Benefits Schedule.

The insurer denied the treatment plans.

The Licence Appeal Tribunal found that the applicant failed to establish that either assessment was reasonable and necessary.

The applicant did not meet the AMA Guides criteria for chronic pain and lacked objective medical evidence supporting the need for a neurological assessment.

The application was dismissed.

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

The insurer raised a preliminary issue, arguing the applicant was barred from proceeding with her application because she failed to attend a requested psychiatric insurer's examination to assess her entitlement to post-104-week income replacement benefits.

The Tribunal found that the insurer's request for the examination was reasonable and necessary due to a change in circumstances, including the death of the applicant's son and the different statutory test for post-104 benefits.

Because the applicant failed to attend the examination, she was barred from proceeding with her application under section 55(1)(2) of the Schedule.