Derek Grant

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

The insurer denied the treatment plans based on insurer examinations.

The Tribunal found that the applicant's ongoing reports of pain and functional limitations, supported by medical records, established that the disputed physiotherapy treatments and assessments were reasonable and necessary.

The Tribunal ordered the insurer to pay the disputed benefits along with interest on the overdue amounts.

The applicant sought medical benefits and an income replacement benefit (IRB) following a motor vehicle accident.

The respondent denied the benefits, arguing the applicant's injuries were predominantly minor and subject to the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to demonstrate a pre-existing condition, physical injuries, psychological impairment, or chronic pain that would warrant removal from the MIG.

The Tribunal also found the applicant was not entitled to an IRB, as she had returned to full-time employment and failed to establish a substantial inability to perform the essential tasks of her employment.

The application was dismissed.

The applicant sought a non-earner benefit (NEB) for the period of December 22, 2019 to October 16, 2020, following a motor vehicle accident.

The respondent denied the claim on the basis that the applicant failed to submit a completed Disability Certificate (OCF-3) until October 16, 2020.

The Tribunal found that under section 36(3) of the Statutory Accident Benefits Schedule, entitlement to a NEB commences only upon receipt of a completed OCF-3, with no exceptions for late submission.

As the OCF-3 was not submitted until October 16, 2020, the applicant was not entitled to the benefit for the period claimed prior to that date.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including medical and rehabilitative benefits, a non-earner benefit, and an attendant care benefit.

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's physical injuries were predominantly minor and that he failed to establish psychological impairments or chronic pain warranting removal from the MIG.

The Tribunal also dismissed the claims for non-earner and attendant care benefits, concluding the applicant did not suffer a complete inability to carry on a normal life and was precluded from attendant care benefits due to the minor injury classification.

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

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

The adjudicator found that the applicant failed to demonstrate that his injuries warranted removal from the MIG, preferring the insurer's expert reports which concluded the injuries were soft tissue in nature and that the applicant did not suffer a psychological disorder.

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

The applicant applied for statutory accident benefits following a motor vehicle accident.

The applicant failed to attend two scheduled case conferences and did not provide any written submissions or evidence despite receiving multiple notices from the Tribunal.

The Tribunal found that the applicant had abandoned the claim and dismissed the application pursuant to Tribunal Rule 3.4.

The applicant sought statutory accident benefits, including income replacement benefits (IRBs), following a motor vehicle accident.

The respondent insurer denied the IRBs on the basis that the applicant had returned to work and raised a preliminary issue regarding eligibility.

The Tribunal found that the applicant did not suffer a substantial inability to perform the essential tasks of his employment, as he returned to work without taking time off and later elected to receive a non-earner benefit.

The Tribunal concluded that the applicant was ineligible to apply for an IRB under section 5 of the Schedule.

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

The respondent denied certain benefits, determining the applicant's injuries were predominantly minor and subject to the Minor Injury Guideline (MIG).

The Tribunal found the applicant failed to provide corroborative objective medical evidence, such as clinical notes and records, to establish that her physical injuries warranted removal from the MIG.

Furthermore, the Tribunal placed no weight on a psychological report from an inactive practitioner, concluding the applicant did not establish a psychological impairment.

As the applicant remained within the MIG, the disputed treatment plans exceeding the limit were not reasonable and necessary.

The applicant sought statutory accident benefits following a motor vehicle accident, including housekeeping services, an emotional support dog, and lidocaine injections.

The Tribunal found the applicant failed to prove the housekeeping service providers were ordinarily engaged in that employment, rendering the expenses not 'incurred' under the Schedule.

The claim for an emotional support dog was dismissed because the expense was incurred before a treatment plan was submitted.

The lidocaine injections were deemed not reasonable and necessary based on medical evidence showing a lack of efficacy.

All claims were dismissed.

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

The respondent argued the applicant was statute-barred from proceeding with his claim for psychological services because he failed to commence his application within two years of the denial, and statute-barred from claiming other medical benefits because he failed to attend a scheduled independent examination under s. 44 of the Schedule.

The Tribunal found the applicant failed to provide evidence justifying an extension of the limitation period under s. 7 of the LAT Act and failed to establish that his heart surgery prevented him from attending the independent examination.

The application was dismissed as statute-barred.

The applicant sought repayment of income replacement benefits (IRBs) that the insurer had suspended and deducted due to an alleged overpayment and non-compliance with requests for post-accident income information.

The Tribunal found that while the insurer could not rely on section 287 of the Insurance Act or section 52 of the Schedule to unilaterally reduce benefits based on an alleged error without an agreement or order, it was entitled to suspend benefits under section 33 of the Schedule due to the applicant's failure to provide requested income documentation.

The applicant's claims for repayment and a special award were dismissed.

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

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

The Tribunal found the applicant failed to provide sufficient medical evidence to warrant removal from the MIG, and thus the disputed medical and rehabilitation benefits were not reasonable and necessary.

However, the Tribunal found the respondent failed to comply with the notice requirements under s. 36(4) of the Schedule regarding the non-earner benefit.

Consequently, the applicant was awarded the non-earner benefit for the period of non-compliance, along with interest.

The Tribunal also ordered a $500 award against the respondent under s. 10 of O. Reg. 664 for unreasonably delaying the non-earner benefit payment.

The applicant insurer sought repayment of $8,909.00 from the respondent, alleging the motor vehicle incident was staged and the respondent wilfully misrepresented the facts to claim statutory accident benefits.

The respondent did not participate in the hearing.

The Tribunal found that the incident was staged based on the respondent's own admission during an Examination Under Oath and a forensic reconstruction report.

Consequently, the respondent was not involved in an 'accident' and engaged in wilful misrepresentation.

However, the Tribunal held that the insurer's investigative fees did not constitute 'benefits' under s. 52 of the Schedule and were not subject to repayment.

The respondent was ordered to repay only $200.00 for form completion costs.

The insurer's request for costs was denied.

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

The respondent insurer raised a preliminary issue, arguing the applicant was statute-barred under s. 55(1)2 of the Statutory Accident Benefits Schedule for failing to attend insurer's examinations (IEs) under s. 44.

The applicant claimed the IE notices were deficient and cited COVID-19 risks for non-attendance.

The Tribunal found the notices complied with s. 44 and that the applicant, a sophisticated party, failed to provide a reasonable explanation for non-attendance.

The application was dismissed.

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 suffered predominantly minor physical injuries, with no evidence of psychological impairment or chronic pain warranting removal from the MIG.

The applicant's claims for medical benefits beyond the MIG limit and for an award were dismissed.

The applicant sought non-earner benefits following a motor vehicle accident.

The insurer raised a preliminary issue that the claim was statute-barred because the applicant failed to submit a Disability Certificate (OCF-3) within 104 weeks of the accident and failed to dispute the denial within the two-year limitation period.

The Tribunal found that the applicant did not submit a qualifying OCF-3 until over four years after the accident and failed to appeal the denial within two years.

The Tribunal declined to extend the limitation period under s. 7 of the LAT Act, finding the delay unreasonable and prejudicial to the insurer.

The claim for non-earner benefits was dismissed as statute-barred.

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

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

The applicant argued her injuries warranted treatment beyond the MIG due to chronic pain and psychological injuries.

The Tribunal found the applicant's injuries were predominantly soft tissue in nature and fell squarely within the definition of minor injuries.

The applicant failed to provide sufficient evidence of chronic pain syndrome or psychological impairment.

The application for medical benefits and interest was dismissed.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, including assessments, physiotherapy, chiropractic treatment, and case management services.

The respondent removed the applicant from the Minor Injury Guideline (MIG) due to pre-existing conditions but denied the treatment plans as not reasonable and necessary.

The Tribunal found that the attendant care assessment and physiotherapy were reasonable and necessary, supported by the applicant's ongoing physical impairments and recommendations from treating practitioners.

The claims for a psychological assessment, chiropractic treatment, and case management services were dismissed for lack of persuasive evidence.

The Tribunal also denied the applicant's request for a special award under s. 10 of O. Reg. 664, finding no unreasonable withholding or delay by the respondent.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied his claims for various medical and rehabilitation benefits, including vocational retraining, medical marijuana, assistive devices, and a gym membership.

The applicant argued the adjudicator made errors of fact and law in weighing the medical evidence.

The Tribunal dismissed the request, finding that the applicant was merely attempting to re-argue his position and reweigh the evidence, which does not meet the criteria for reconsideration under Rule 18.2(b) of the Common Rules.

The respondent insurer requested a reconsideration of a decision awarding the applicant a psychiatric assessment and a chronic pain assessment.

The insurer argued the Tribunal erred by not requiring the applicant to first seek OHIP funding and by failing to apply the statutory monetary caps to the psychiatric assessment.

The Tribunal dismissed the OHIP argument as it was not raised at the initial hearing.

However, the Tribunal agreed it erred in law by not applying the statutory maximums under the Schedule and Guidelines.

The reconsideration was partially granted, and the amount payable for the psychiatric assessment was reduced to $2,200.