Derek Grant

The applicant sought an ongoing income replacement benefit (IRB) and a special award for a previously delayed IRB payment following a motor vehicle accident.

The Tribunal dismissed the claim for ongoing IRBs, finding the applicant failed to prove a substantial inability to perform the essential tasks of his employment.

However, the Tribunal granted a special award of 50% of the delayed IRB amount, finding the insurer unreasonably withheld payment by incorrectly deducting the applicant's employment insurance benefits contrary to the Statutory Accident Benefits Schedule.

The applicant sought accident benefits following a motor vehicle accident, including a chronic pain assessment and chronic pain treatment.

The respondent insurer denied the treatment plans, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 statutory limit.

The Licence Appeal Tribunal found that the applicant sustained predominantly minor soft tissue injuries, preferring the evidence of the insurer's orthopaedic surgeon and the applicant's own treating chiropractor over the applicant's chronic pain assessors.

As the injuries were deemed minor, the applicant was not entitled to the disputed treatment plans for chronic pain.

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), limiting medical and rehabilitation benefits to $3,500.

The Tribunal found that the medical evidence, including clinical notes from the applicant's treating family physician and a disability certificate, supported that the injuries were minor in nature.

The applicant failed to provide objective medical evidence of chronic pain or other injuries outside the MIG.

As the $3,500 limit had been exhausted, the application for further medical benefits was dismissed.

The applicant sought statutory accident benefits after falling while rollerblading to avoid a van that failed to yield.

The respondent denied the claim, arguing the incident did not meet the definition of an 'accident' under the Schedule because there was no contact with a vehicle and a police officer's statement contradicted the applicant's version of events.

The Tribunal accepted the applicant's evidence over the officer's delayed statement, finding that the use or operation of a motor vehicle directly caused the impairment.

The Tribunal concluded the incident met the causation test and qualified as an accident.

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

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

The Tribunal found that the insurer failed to provide notice of its denial within the required 10 business days under section 38(8) of the Schedule, and was therefore prohibited from relying on the MIG limit.

However, the Tribunal ultimately dismissed the application, finding that the applicant failed to prove on a balance of probabilities that the proposed psychological treatment was reasonable and necessary, as the objective medical evidence did not support a significant psychological impairment.

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

The respondent insurer initially denied the benefits under the Minor Injury Guideline, but later conceded the applicant's injuries were non-minor based on a psychological assessment.

The applicant argued that pre-existing lower back pain and chronic pain syndrome necessitated further chiropractic care.

The adjudicator found that the applicant failed to provide objective medical evidence to support the treatment plans, noting that her own treating physicians recommended physiotherapy rather than chiropractic treatment.

The application for medical benefits, interest, and costs was dismissed.

The applicant sought a medical benefit of $4,124.88 for chiropractic services following a motor vehicle accident.

The respondent insurer initially denied the benefit under the Minor Injury Guideline, but later conceded the applicant was removed from the guideline based on a psychological assessment.

The adjudicator found that the applicant failed to provide objective medical evidence to prove the chiropractic treatment was reasonable and necessary, noting that her own treating physicians recommended physiotherapy rather than chiropractic care.

The application was dismissed, and the applicant's request for costs based on the insurer's alleged bad faith was denied.

The applicant was injured in a motor vehicle accident in 2007 and sought payment for a physical therapy treatment plan proposed in 2014.

The insurer denied the claim based on an insurer's examination which concluded that the applicant had already received appropriate facility-based treatment and required no further treatment.

The Licence Appeal Tribunal found that the applicant's medical evidence was outdated and insufficient to prove that the proposed treatment was reasonable and necessary seven years post-accident.

The application for the medical benefit was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to physical therapy, chiropractic treatment, and various examination expenses.

The insurer denied the claims on the basis that the applicant had reached maximum medical recovery from facility-based treatment.

The Licence Appeal Tribunal found that while the applicant sustained soft tissue injuries from the accident, the requested physical treatments and examination expenses were not reasonable and necessary.

The Tribunal preferred the evidence of the insurer's medical examiner over the applicant's psychologists regarding physical impairments.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits and a physiotherapy treatment plan.

The respondent denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that he did not suffer a substantial inability to perform his pre-accident employment.

The Tribunal found that the applicant sustained predominantly minor soft tissue injuries and failed to provide compelling evidence to remove him from the MIG.

As the $3,500 limit was exhausted, the physiotherapy claim was denied.

The Tribunal also dismissed the claim for income replacement benefits, preferring the detailed reports of the respondent's assessors over the applicant's initial disability certificate.

The respondent's claim for costs was dismissed.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits under the Statutory Accident Benefits Schedule for chronic pain.

The respondent insurer denied the claims, arguing the applicant's symptoms were due to pre-existing arthritis and that she had reached maximum recovery.

The adjudicator applied the material contribution test and found that the accident materially contributed to the applicant's pre-existing condition, resulting in chronic pain.

The adjudicator granted the claims for chiropractic and physiotherapy services, a pain management program, Lidocaine infusions, an exercise program, and an occupational therapy assessment, finding them reasonable and necessary for pain relief and management.

The claim for an EEG assessment was denied as there was no evidence of a traumatic brain injury.

The applicant was also awarded interest on overdue payments.