Derek Grant

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

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

The adjudicator found that the applicant failed to meet the burden of proving his physical, psychological, or chronic pain impairments removed him from the MIG.

The adjudicator preferred the respondent's psychological assessment over the applicant's due to the use of an interpreter, and relied on surveillance evidence that contradicted the applicant's claims of chronic pain.

The application was dismissed.

The applicant sought reconsideration of a Licence Appeal Tribunal decision that denied her claim for a TMJ assessment and interest.

She argued the Tribunal erred in law by misapplying the doctrine of res judicata and violated procedural fairness by failing to consider a new dental assessment report.

The adjudicator dismissed the request, finding that res judicata was correctly applied because a previous decision had already determined the TMJ impairment was pre-existing and not caused by the accident.

Furthermore, the new dental report was considered but did not alter the conclusion regarding causation.

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

The respondent insurer denied a treatment plan for a chronic pain assessment and requested the applicant attend three independent medical examinations (IEs) under s. 44 of the Schedule.

The applicant failed to attend the IEs, citing she was out of the country, but did not provide this explanation to the insurer.

The respondent raised a preliminary issue that the applicant was barred from proceeding with her application under s. 55 of the Schedule.

The Tribunal found the insurer's request for IEs was reasonable and compliant with the Schedule, and the applicant failed to provide a reasonable explanation for her non-attendance.

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

The applicant sought statutory accident benefits for chiropractic and massage therapy following a motor vehicle accident.

The Tribunal found that the insurer failed to provide adequate medical reasons for denying two treatment plans, violating section 38(8) of the Schedule, and ordered them payable.

The Tribunal also found that the applicant suffered from chronic pain and that the remaining chiropractic treatment plans were reasonable and necessary, except for treatment incurred prior to the submission of the plans.

The claim for massage therapy was denied as no treatment plan had been submitted.

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

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

The Licence Appeal Tribunal found that the applicant suffered from chronic pain as a result of the accident, removing him from the MIG.

The Tribunal ordered the insurer to pay for a chronic pain assessment and a physiotherapy treatment plan, finding them reasonable and necessary, along with interest on overdue payments.

The applicant sought a rehabilitation benefit of $7,545.00 for personal training and a gym membership following a motor vehicle accident.

The adjudicator found that the applicant failed to prove the treatment plan was reasonable and necessary.

Medical evidence indicated the applicant had reached maximum medical improvement and did not specifically endorse the requested exercise program.

The claim was dismissed.

The applicant sought medical benefits following a motor vehicle accident.

The insurer 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 and psychological injuries met the definition of 'minor' under the Schedule.

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

The application was dismissed.

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

The respondent insurer denied the treatment plans.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary.

The applicant had returned to work, was independent in self-care, and denied a desire for psychotherapy.

Insurer examinations concluded the applicant did not evidence clinically significant symptoms of mental illness and had reached maximum medical improvement.

The application was dismissed.

The applicant sought reconsideration of a Licence Appeal Tribunal decision that denied her entitlement to a cost of examination expense for a second chronic pain assessment.

The applicant argued the adjudicator acted outside his jurisdiction by recommending a treatment modality and violated procedural fairness by not allowing reply submissions on surgical options.

The adjudicator dismissed the reconsideration request, finding no error of law, fact, or procedural fairness, as the original decision correctly determined a second assessment was not reasonable and necessary.

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

The insurer subsequently determined the applicant had been working while receiving IRBs and sought repayment of an overpayment totaling $6,578.67.

As a preliminary issue, the applicant argued the insurer was barred from claiming repayment because it failed to provide notice within 12 months of the first payment, pursuant to section 52(3) of the Schedule.

The Tribunal found that the insurer provided notice within 12 months after the overpayment was made, which satisfied the statutory requirement.

The Tribunal held the insurer was not barred from claiming repayment and ordered a case conference to address the substantive issues.

The applicant sought statutory accident benefits after sustaining injuries in a parking lot while waiting for an Uber.

The applicant had no memory of the incident, but emergency reports indicated a slip and fall.

The adjudicator held a preliminary issue hearing to determine if the incident met the definition of an 'accident' under section 3(1) of the Schedule.

Applying the purpose and causation tests, the adjudicator found no evidence that a vehicle was present or involved in the incident.

The application was dismissed as the incident was a slip and fall, not an accident arising from the use or operation of an automobile.

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

The respondent insurer 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, relying on medical reports attributing his back pain to a subsequent work-related injury.

However, the Tribunal held that the respondent failed to comply with the notice requirements under s. 38(9) of the Schedule when denying the psychological assessment and treatment plans, as it did not explicitly state that the MIG applied.

Consequently, under s. 38(11), the respondent was prohibited from taking the position that the MIG applied to the psychological claims and was ordered to pay those benefits.

The applicant sought statutory accident benefits following a motor vehicle accident, including funding for physiotherapy, chiropractic treatment, and various assessments (chronic pain, orthopaedic, and psychological).

The Tribunal found that the insurer complied with the notice requirements under section 38(8) of the Schedule and that the applicant's claim for the balance of a 2015 chiropractic treatment plan was statute-barred.

The Tribunal further held that the applicant failed to prove the proposed treatment plans and assessments were reasonable and necessary, noting that her soft tissue injuries had largely resolved and her ongoing knee pain was not accident-related.

The application was dismissed in its entirety, with no entitlement to an award or interest.

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

The respondent denied certain benefits, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The adjudicator found that the applicant's physical and psychological injuries were predominantly minor and that she failed to provide medical evidence demonstrating impairments that would remove her from the MIG.

Consequently, the disputed treatment plans were not payable, and the application 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 suffered from chronic pain caused by the accident, which removed her from the MIG.

The Tribunal further determined that the disputed treatment plans for chiropractic services, psychological treatment, a chronic pain assessment, and neuropsychological assessments were reasonable and necessary.

The applicant was awarded the claimed benefits, subject to the Guideline's hourly rate cap for psychological treatment, along with interest on overdue payments.

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

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

The Licence Appeal Tribunal found that the applicant failed to provide sufficient medical evidence to prove his physical or psychological injuries fell outside the MIG.

As the injuries were predominantly minor, the applicant was subject to the $3,500 treatment limit, and the application for additional treatment plans and an award was dismissed.

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

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

The Licence Appeal Tribunal found that the applicant failed to provide sufficient medical evidence to prove his physical or psychological injuries fell outside the MIG.

The application for medical and rehabilitation benefits and an award for unreasonable delay was dismissed.

The applicant sought statutory accident benefits after slipping and falling while clearing snow off his parked vehicle.

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

The Tribunal held that the applicant was engaged in the ordinary use and operation of the vehicle at the time of the fall, satisfying both the purpose and causation tests.

The Tribunal found no intervening act and concluded the vehicle was the dominant feature of the incident.

The preliminary issue was resolved in favour of the applicant, entitling him to claim accident benefits.

The applicant was involved in a motor vehicle accident and sought a medical benefit of $1,977.05 for chiropractic services under the Statutory Accident Benefits Schedule.

The insurer denied the treatment plan.

The Adjudicator found that the applicant failed to prove the treatment was reasonable and necessary, noting that her treating physician did not recommend physical treatment for accident-related symptoms and relying on the insurer's assessment that further passive modalities would not be beneficial.

The claims for the medical benefit, interest, and a special award were dismissed.

The applicant sought medical benefits for physiotherapy services following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant failed to prove the proposed treatment plan was reasonable and necessary, as medical evidence indicated pain complaints had increased despite years of similar treatment, and objective testing showed normal range of motion.

The application for benefits and interest was dismissed.