Derek Grant

The applicant sought statutory accident benefits after being shot in the hand by her husband while sitting on a stopped ATV during a hunting trip.

The respondent insurer denied the claim on the basis that the incident did not meet the definition of an 'accident' under the Statutory Accident Benefits Schedule.

The Tribunal held a preliminary issue hearing and found that while the purpose test was met, the causation test was not.

The shooting was an intervening act that broke the chain of causation, and the use or operation of the ATV did not directly cause the applicant's impairment.

The application was dismissed.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied a treatment plan for catastrophic impairment assessments.

The applicant argued the Tribunal made errors of fact and law, violated procedural fairness, and improperly relied on hearsay evidence from hospital records.

The applicant also objected to the original adjudicator hearing the reconsideration.

The Tribunal dismissed the request, finding that while minor errors were made (such as misidentifying the form as an OCF-25 instead of an OCF-18 and using the word 'synchronous'), they would not have changed the outcome.

The Tribunal also held that hospital records are admissible as an exception to the hearsay rule and that having the original adjudicator hear the reconsideration does not create a reasonable apprehension of bias.

Both the applicant and the insurer requested reconsideration of a previous Tribunal decision.

The applicant challenged the finding that she was not entitled to income replacement benefits (IRBs) because she did not earn employment income prior to the accident.

The insurer challenged the finding that it was not entitled to repayment of $17,563.50 in IRBs because it failed to obtain explicit consent to serve the notice of repayment electronically.

The Tribunal dismissed both requests, finding no errors of law or fact in the original decision.

The applicant's request for costs was also denied.

The applicant sought medical benefits for physiotherapy and psychological treatment following a motor vehicle accident.

The Tribunal found that the applicant failed to meet her burden of proving that the proposed treatment plans were reasonable and necessary.

The medical evidence provided either did not support the specific treatments requested or pre-dated the treatment plans significantly.

The application was dismissed.

The applicant sought reconsideration of a Licence Appeal Tribunal decision denying her claims for medical benefits, expenses, and an award under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The adjudicator found no error of fact or procedural unfairness regarding the denial of several OCF-18 treatment plans, noting the applicant's ongoing pain complaints indicated the treatment goals were not being met.

However, the adjudicator found an error was made regarding an October 2018 OCF-23, ruling that the outstanding amount was payable because the applicant had changed clinics while under the Minor Injury Guideline.

The request for reconsideration was partially granted.

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

The insurer denied the claims for chiropractic treatment and out-of-pocket expenses on preliminary grounds of non-compliance with the Statutory Accident Benefits Schedule.

The Tribunal found that the applicant incurred the chiropractic treatment before submitting the treatment plans, contrary to s. 38(2).

Furthermore, the applicant and his unlicensed service provider failed to follow the mandatory procedural steps for submitting invoices under s. 49.1 and s. 64(7).

The application for benefits was dismissed.

The applicant sought statutory accident benefits for dental treatment following a motor vehicle accident.

The respondent denied the treatment plan on the basis of an independent medical examination which found no evidence of accident-related trauma to the applicant's teeth.

The Tribunal found that the applicant failed to prove the dental treatment was reasonable and necessary, as there was no evidence connecting the dental complaints to the accident.

The claims for an award and interest were dismissed, and the respondent's request for costs was also denied.

The applicant sought statutory accident benefits for physiotherapy and chiropractic treatments following a motor vehicle accident.

The respondent insurer denied the treatments and brought a preliminary motion to strike portions of the applicant's reply submissions for improperly introducing new evidence.

The Tribunal partially granted the motion to strike, removing new arguments and evidence that should have been in the initial submissions.

On the substantive issues, the Tribunal found the physiotherapy treatment plan reasonable and necessary based on the applicant's credible self-reporting of pain relief, despite the medical assessors not explicitly recommending it.

The claim for the balance of the chiropractic treatment plan was dismissed as the applicant failed to prove that the proposed exercises required the supervision of a chiropractor.

The applicant was injured in a motor vehicle accident and sought income replacement benefits (IRBs) from the respondent insurer.

The insurer denied the claim, arguing the applicant did not suffer a substantial inability to perform the essential tasks of her pre-accident employment as a waitress and usher.

The Tribunal found the applicant's medical evidence, including reports from an orthopaedic surgeon and a chiropractor, persuasive in establishing her functional limitations due to a fractured wrist, shoulder strain, and back pain.

The Tribunal placed little weight on the insurer's assessments, noting they were incomplete and failed to account for pain during testing.

The applicant was awarded IRBs of $315.27 per week for the disputed period, plus interest.

The applicant sought entitlement to seven treatment plans for chiropractic services following a motor vehicle accident.

The respondent requested the claim be dismissed due to the applicant's late filing of evidence and submissions.

The Tribunal allowed the late filing to avoid prejudice but awarded $300 in costs to the respondent for the applicant's unreasonable behaviour.

On the merits, the Tribunal dismissed the claim for chiropractic benefits, finding the applicant failed to prove they were reasonable and necessary, noting his increased post-accident activities and lack of supportive medical evidence.

The applicant requested a reconsideration of a decision finding her statute-barred from proceeding with an application for a non-earner benefit.

The applicant filed the request two days late and sought an extension of time, citing the COVID-19 pandemic emergency order.

The Tribunal denied the extension, finding no evidence that the pandemic caused the delay.

On the merits, the Tribunal found no significant error of law or fact in the original decision, confirming that the insurer's denial was clear and unequivocal and that the applicant qualified for income replacement benefits, precluding her from receiving a non-earner benefit.

The request for reconsideration and the insurer's request for costs were both denied.

The applicant sought entitlement to statutory accident benefits for psychological services, massage therapy, and chiropractic treatment following a motor vehicle accident.

The adjudicator found that the applicant failed to prove the treatment plans were reasonable and necessary.

The psychological assessment relied upon by the applicant was given little weight because it was unclear whether the supervising psychologist or the psychometrist conducted the clinical interview and made the diagnosis.

The respondent's psychological assessment, which found no impairment warranting a diagnosis, was preferred.

The claims for massage and chiropractic treatment were also dismissed as there was insufficient evidence they would provide relief comparable to physiotherapy.

The application was dismissed.

The applicant, injured in utero during a motor vehicle accident and born prematurely with cerebral palsy, sought attendant care benefits.

The insurer initially approved the benefits based on a medical report but later sought to raise a causation defence relying on a new report from an obstetrician.

The applicant argued the insurer was precluded from raising causation due to the two-year limitation period and waiver, and sought to exclude the new report.

The Adjudicator held that the insurer was not precluded from arguing causation, finding no waiver and that the limitation period in s. 56 of the Schedule applies to claims, not defences.

The Adjudicator also permitted the insurer to rely on the new medical report, finding it was validly obtained under s. 44.

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

The insurer denied the claim, and the applicant applied to the Licence Appeal Tribunal over two years later.

The insurer raised a preliminary issue that the application was statute-barred.

The Tribunal found that the insurer's denial was clear and unequivocal, triggering the two-year limitation period.

The Tribunal declined to extend the limitation period under section 7 of the Licence Appeal Tribunal Act, finding no bona fide intention to appeal within the time limit and an unreasonable delay.

The application was dismissed as statute-barred.

The applicant requested a reconsideration of a Tribunal decision which found her accident-related injuries were predominantly minor and fell within the Minor Injury Guideline (MIG).

The applicant argued the adjudicator erred in fact and law by failing to properly consider psychological evidence and the context of the MIG.

The adjudicator denied the request, finding no significant error of law or fact that would have led to a different result, noting that the original decision appropriately weighed the conflicting medical evidence and the applicant's self-reporting.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and various medical and rehabilitation expenses.

The insurer denied the benefits, arguing the applicant suffered predominantly minor injuries subject to the $3,500 limit under the Minor Injury Guideline, which had been exhausted.

The Tribunal found the applicant did not suffer a substantial inability to perform the essential tasks of his employment and was therefore not entitled to IRBs.

Furthermore, the Tribunal concluded the applicant's injuries were predominantly minor, and since the $3,500 limit was exhausted, no further medical benefits were payable.

The application was dismissed.

The applicant sought payment for a $25,659.25 treatment and assessment plan (OCF-25) for catastrophic impairment assessments following a 2006 motor vehicle accident.

The Licence Appeal Tribunal found the assessments were not reasonable and necessary, as the medical evidence did not support a causal relationship between the accident and the current complaints, which were similar to those from a prior 2002 accident.

The Tribunal also noted the physical injuries were minor and there was no evidence of psychological impairment.

The claims for the OCF-25, interest, and a special award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries fell outside the Minor Injury Guideline (MIG) due to chronic pain.

The applicant also argued the insurer was barred from relying on the MIG due to alleged non-compliance with the 10-day notice requirement under s. 38(8) of the Schedule.

The Tribunal found the insurer had complied with the notice requirements.

Furthermore, relying on medical assessments from both parties' experts which showed largely normal findings, the Tribunal concluded the applicant did not meet the AMA Guides criteria for chronic pain.

The application was dismissed as the injuries were predominantly minor and the $3,500 limit had been exhausted.

The applicant sought a medical and rehabilitation benefit for physiotherapy following a motor vehicle accident.

The insurer initially denied the treatment plan but approved it after receiving updated medical records.

The applicant proceeded to a hearing seeking an award for unreasonable delay and costs.

The Tribunal dismissed the application, finding that the insurer did not act unreasonably or in bad faith, as it approved the treatment plan within a reasonable time after receiving the necessary medical evidence.

The applicant requested a reconsideration of a Tribunal decision which found her accident-related injuries were predominantly minor and subject to the Minor Injury Guideline (MIG) funding limit.

The applicant argued the Tribunal erred in law by applying the MIG criteria instead of the reasonable and necessary test, and erred in fact by failing to consider evidence supporting her claim of psychological impairment.

The adjudicator dismissed the request, finding no significant error of law or fact, as the exhaustion of the MIG limit rendered the reasonable and necessary analysis moot, and the original decision appropriately weighed the conflicting evidence, including the applicant's own self-reports.