Derek Grant

The applicant sought statutory accident benefits for psychological impairments allegedly sustained after her mother was injured in a motor vehicle accident.

The applicant claimed entitlement to three treatment plans for social rehabilitation and vocational/academic counselling.

The adjudicator found that the applicant failed to prove the treatment plans were reasonable and necessary, noting that her pre-existing psychological issues and family circumstances were the primary cause of her impairments, and that her accident-related symptoms had resolved.

The application was dismissed.

The applicant sought statutory accident benefits for psychological impairments allegedly resulting from her mother's motor vehicle accident.

The applicant claimed entitlement to social rehabilitation counselling and vocational/academic counselling.

The Licence Appeal Tribunal found that the applicant's psychological symptoms were primarily related to pre-existing factors, including her parents' separation and the loss of her grandfather, rather than the accident.

The Tribunal concluded that the applicant failed to prove the proposed treatment plans were reasonable and necessary to address accident-related impairments.

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 claimed to suffer from chronic pain and psychological impairments requiring treatment beyond the $3,500 MIG limit.

The Tribunal found that the applicant's injuries were predominantly minor soft tissue injuries, relying on the insurer's examination reports which were consistent with the treating physician's records.

As the MIG limits were exhausted, the disputed treatment plans were not payable, and claims for interest and a section 10 award were dismissed.

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

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

The Tribunal found that the applicant failed to provide compelling evidence of chronic pain or psychological impairment to justify removal from the MIG.

As the MIG limits were exhausted, the disputed treatment plans were not reasonable and necessary.

The claims for a non-earner benefit and an award for unreasonable delay were also dismissed.

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

The respondent denied various treatment plans and an income replacement 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 soft tissue in nature and captured by the MIG.

The Tribunal rejected the applicant's claims of psychological impairment and chronic pain, noting inconsistent self-reporting and placing little weight on a chronic pain assessment conducted via videoconference without objective documentation.

As the applicant failed to prove her injuries warranted removal from the MIG and the $3,500 limit was exhausted, the disputed treatment plans were denied.

The claim for an income replacement benefit was also dismissed as the applicant provided no submissions on the issue.

The applicant, who sustained a catastrophic impairment in a 2000 motor vehicle accident, sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The Licence Appeal Tribunal found that treatment plans for massage therapy, physiotherapy, aqua therapy, and a hot tub were reasonable and necessary to address the applicant's chronic pain.

However, claims for a Costco membership, private pool therapy, a rehabilitation support worker, and occupational therapy were dismissed as the applicant failed to prove they were reasonable and necessary.

The Tribunal also denied the applicant's request for a special award under s. 10 of Regulation 664, finding that the insurer did not unreasonably withhold or delay benefits by relying on its s. 44 assessments.

The applicant was injured in a motor vehicle accident and sought medical and rehabilitation benefits for chiropractic treatment, massage therapy, and a chronic pain assessment.

The insurer denied the treatment plans.

The Licence Appeal Tribunal found that the applicant failed to prove the treatment plans were reasonable and necessary, preferring the evidence of the insurer's assessors over the applicant's chronic pain assessor, whose report was given little weight due to methodological flaws and contradictions.

The application was dismissed.

The applicant sought a non-earner benefit (NEB) under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The respondent insurer denied the benefit, arguing the applicant's post-accident condition was not significantly different from his pre-accident state due to extensive pre-existing injuries.

The Tribunal applied the Heath test and found that the accident exacerbated the applicant's chronic pain and mobility issues, resulting in a complete inability to carry on a normal life.

The Tribunal gave limited weight to the insurer's s. 44 assessors because they failed to review the applicant's medical records.

The applicant was awarded the NEB with interest.

The applicant sought payment for a witness fee and a chiropractic treatment plan following a 2015 motor vehicle accident.

The Tribunal found that the witness fee was not a payable expense under section 38(2) of the Statutory Accident Benefits Schedule.

The Tribunal also found that the chiropractic treatment plan was not reasonable and necessary, noting the lack of contemporaneous medical records and drawing an adverse inference from the applicant's failure to produce updated records requested by the respondent.

The claims for an award and interest were also dismissed.

The applicant sought various statutory accident benefits following a 2015 motor vehicle accident, including attendant care benefits, occupational therapy assessments, and a concussion assessment.

The Licence Appeal Tribunal denied the claims for attendant care and occupational therapy, finding the applicant had returned to full-time work and was independent in his activities of daily living.

However, the Tribunal granted the request for a concussion assessment, noting the applicant's ongoing headache and balance issues warranted further investigation, and preferred the evidence of concussion experts over the insurer's physiatrist.

The claim for a special award under O. Reg. 664 was dismissed as the insurer reasonably relied on its assessors' reports.

The applicant sought statutory accident benefits following a motor vehicle accident in August 2015.

She claimed entitlement to medical benefits for occupational therapy assessments, a concussion assessment, assistive devices, and retroactive attendant care benefits.

The Licence Appeal Tribunal dismissed all claims, finding that the applicant failed to demonstrate the treatment plans were reasonable and necessary.

The Tribunal preferred the respondent's expert evidence, noting the significant passage of time since the accident and the applicant's self-reported independence with activities of daily living.

The claims for retroactive attendant care benefits were denied as the applicant did not provide a reasonable explanation for the delay in submitting the required forms, nor did she prove the expenses were incurred.

Claims for interest and a special award were consequently dismissed.

The applicant requested a reconsideration of a decision finding she did not meet the criteria for catastrophic impairment under s. 3(2)(f) of the Statutory Accident Benefits Schedule.

The applicant argued the adjudicator erred in law by treating a brain injury as a necessary element of the test, and erred in fact by misstating her expert's impairment rating.

The Tribunal dismissed the request, finding that the original decision did not add a brain injury requirement but merely noted the absence of one in evaluating the evidence.

Furthermore, the Tribunal confirmed that the original decision explicitly acknowledged the applicant's expert's Class 4 impairment rating but properly exercised its discretion to prefer the respondent's expert report.

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

The respondent denied benefits on the basis that the applicant was in the course of his employment at the time of the accident and was entitled to WSIB benefits.

The applicant failed to file submissions or evidence for the written hearing.

The Tribunal found that the applicant was deemed an employee by the WSIB, had not opted out of WSIB benefits to pursue a tort claim, and was therefore precluded from receiving accident benefits under s. 61 of the Schedule.

The application was dismissed.

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

The insurer denied the treatment plans.

The Tribunal found that the applicant was removed from the Minor Injury Guideline due to psychological impairments.

The Tribunal held that the treatment plans for massage therapy, chiropractic treatment, physiotherapy, and optometric services were reasonable and necessary to address the applicant's ongoing pain and post-concussion symptoms.

However, the Tribunal denied the plans for occupational therapy and social work services, finding them redundant as the applicant had been recommended to participate in a comprehensive hospital pain management program that would adequately address those needs.

Interest was awarded on the approved benefits.

The applicant, a pedestrian struck by a vehicle, sought statutory accident benefits for physical and psychological injuries.

The respondent denied the treatment plans, arguing the injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant failed to demonstrate her physical injuries or psychological impairments warranted removal from the MIG.

The Tribunal relied on the respondent's section 44 physiatry and psychological assessments, concluding the disputed treatment plans and assessments were not reasonable and necessary.

Claims for an award and interest were also dismissed.

The applicant sought statutory accident benefits after slipping and falling on ice while inflating his vehicle's tires at a gas station.

The respondent 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 applied the purpose and causation test, finding that while the purpose test was met, the causation test was not.

The Tribunal concluded that the ice was an intervening act and the dominant feature of the fall, breaking the chain of causation.

As the incident was not an accident, the application for benefits was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including attendant care benefits, medical and rehabilitation benefits, and the cost of various assessments.

The insurer denied the benefits.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to demonstrate that the claimed attendant care benefits were incurred or reasonable and necessary, given her self-reported independence with activities of daily living.

The Tribunal also found that the proposed psychological, chiropractic, and neurological assessments and treatments were not reasonable and necessary, preferring the evidence of the insurer's examiners.

As no benefits were payable, claims for interest and a special award were also dismissed.

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

The insurer denied benefits and scheduled insurer examinations under section 44 of the Schedule.

The applicant failed to attend the scheduled examinations and provided no medical evidence or reasonable explanation for her non-attendance.

The Tribunal found that the insurer provided proper notice and that the applicant's failure to attend prejudiced the insurer's ability to assess the claims.

Consequently, the applicant is statute-barred from proceeding with her application pursuant to section 55(1)2 of the Schedule.

The applicant sought statutory accident benefits following a motor vehicle accident, including income replacement benefits (IRBs) and medical benefits for chiropractic treatment.

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

The Licence Appeal Tribunal found that the applicant suffered predominantly minor injuries and failed to provide compelling medical evidence to warrant removal from the MIG.

The Tribunal also dismissed the claims for IRBs, finding no evidence of a substantial inability to perform the essential tasks of employment, and concluded the disputed treatment plans were not reasonable and necessary.

The insurer requested a reconsideration of a decision finding the insured entitled to an attendant care assessment after being removed from the Minor Injury Guideline (MIG) due to a pre-existing condition.

The insurer argued that removal from the MIG did not equate to removal from the definition of a 'minor injury', and thus the insured was still barred from receiving an in-home assessment.

The adjudicator dismissed the request, holding that removal from the MIG removes all its constraints, including limits on goods and services, and that no error of law was made in the original decision.