Derek Grant

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 applicant argued for removal from the MIG based on chronic pain and psychological impairments.

The Tribunal found the applicant's physical injuries were predominantly minor and not supported by diagnostic imaging.

The Tribunal preferred the respondent's psychological and medical assessments, concluding the applicant did not suffer from chronic pain or a psychological condition warranting removal from the MIG.

The application was dismissed.

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

The respondent denied the claims, determining the injuries were predominantly minor and subject to the Minor Injury Guideline (MIG).

The applicant argued for removal from the MIG due to an accident-related psychological impairment.

The Tribunal found insufficient evidence to support a psychological impairment, noting the lack of psychological treatment and the respondent's expert evidence indicating symptom magnification.

The Tribunal concluded the injuries were within the MIG and the disputed treatment plan was not reasonable and necessary.

The applicant sought additional interest on income replacement benefits and a special award following a motor vehicle accident.

The insurer had paid the benefits and calculated interest at $25.22.

The applicant claimed $50.80 in interest but provided no basis for the calculation.

The Tribunal found no grounds to interfere with the insurer's interest calculation and dismissed the claim for a special award, noting that a one-day delay in responding to a form was not unreasonable.

The insurer's request for costs was also dismissed, as the applicant's failure to produce documents did not amount to unreasonable, frivolous, or vexatious behaviour.

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

The respondent raised a preliminary issue that the claim was statute-barred because the applicant failed to submit a completed disability certificate (OCF-3) indicating a complete inability to carry on a normal life within 104 weeks of the accident.

The Tribunal agreed, finding that the applicant's initial OCF-3 submitted within the 104-week period indicated she did not suffer a complete inability, and the qualifying OCF-3 was submitted over three years after the accident.

The claim for a non-earner benefit was dismissed as statute-barred under sections 12(3)(c) and 36(3) of the Schedule.

The applicant's request for costs was also dismissed.

The applicant was injured in a motor vehicle accident and sought medical benefits from the respondent insurer.

The insurer denied the benefits on the basis that the applicant's injuries were predominantly minor and subject to the $3,500 limit under the Minor Injury Guideline (MIG).

The applicant applied to the Licence Appeal Tribunal, arguing that pre-existing conditions, psychological impairments, and chronic pain warranted removal from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence that her pre-existing diabetes and hypertension prevented her recovery, or that she suffered from chronic pain or psychological impairments outside the MIG.

The application was 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 applicant applied to the Licence Appeal Tribunal, arguing that pre-existing conditions, psychological impairments, and chronic pain warranted removal from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence to support removal from the MIG.

Consequently, the disputed treatment plans were deemed not reasonable and necessary, and the application was dismissed.

The applicant was injured in a motor vehicle accident while riding his bicycle and sought various statutory accident benefits, including a determination of catastrophic impairment.

The Licence Appeal Tribunal found that the applicant did not meet the criteria for catastrophic impairment under the Schedule, preferring the insurer's expert evidence that the applicant did not suffer a marked psychological impairment.

However, the Tribunal found the applicant was entitled to non-earner benefits, as his physical injuries caused a complete inability to carry on a normal life.

Claims for attendant care, housekeeping, and certain treatment plans were dismissed as not reasonable and necessary, though an occupational therapy assessment was approved.

The claim for a special award was denied.

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's pre-existing knee injury was exacerbated by the accident, precluding recovery within the MIG.

The Tribunal approved treatment plans for chiropractic treatment, massage therapy, an orthopaedic assessment, and a chronic pain assessment as reasonable and necessary.

However, requests for a social work assessment and a functional assessment evaluation were denied.

Interest was awarded on the approved benefits.

The applicant requested a reconsideration of a decision denying payment for chiropractic treatment, arguing bias, errors of fact, and new medical evidence.

The Tribunal dismissed the request, finding no reasonable apprehension of bias and concluding that an acknowledged factual error would not have changed the outcome.

Furthermore, the new medical evidence presented by the applicant included a recommendation from a spinal neurosurgeon explicitly advising against spinal manipulation, which undermined the claim that chiropractic treatment was reasonable and necessary.

Claims for a special award and costs were also dismissed.

The applicant requested a reconsideration of a previous Licence Appeal Tribunal decision which found that his accident-related impairments did not warrant removal from the Minor Injury Guideline (MIG).

The applicant argued that the adjudicator erred in law and fact regarding his alleged knee fracture, pre-existing knee condition, and psychological impairments.

The Tribunal dismissed the request, finding that the applicant was merely asking to reweigh the evidence.

The medical evidence did not support a knee fracture, and the adjudicator's preference for the respondent's psychological assessment over the applicant's was a reasonable weighing of evidence, not an error of law or fact.

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

The respondent denied the disputed treatment plans on the basis that the applicant's injuries were predominantly minor and subject to the Minor Injury Guideline (MIG).

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

The Tribunal also found no evidence of a clinically significant psychological impairment that would warrant removal from the MIG.

As the MIG limits had been exhausted, the disputed treatment plans were not reasonable and necessary, and no award or interest was payable.

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

A written hearing was scheduled, but the applicant failed to file written submissions by the deadline.

Despite being given an extension to re-file an adjournment request, the applicant did not do so and provided no explanation.

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

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming the cost of an OCF-3 disability certificate and a chronic pain treatment program.

The respondent denied the benefits, arguing the OCF-3 was not requested and the chronic pain program was not reasonable and necessary.

The Tribunal found the OCF-3 was payable as it provided material medical evidence that led to the reinstatement of the applicant's non-earner benefit.

The Tribunal also approved the chronic pain treatment plan, preferring the evidence of the applicant's chronic pain specialist over the respondent's general practitioner, and finding the applicant met the criteria for chronic pain syndrome.

Interest was awarded on the overdue benefits.

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

The insurer denied several treatment plans and a disability certificate.

The Tribunal found that the applicant was statute-barred from pursuing claims for three treatment plans because she failed to commence proceedings within two years of the insurer's clear and sufficient denials.

The Tribunal further held that the remaining treatment plans and the disability certificate were not reasonable and necessary, as the applicant failed to provide sufficient medical evidence to support them and the proposed fees did not comply with the Professional Services Guideline.

The claim for an award under Regulation 664 was also dismissed.

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

The insurer denied certain medical benefits and income replacement benefits (IRBs) on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found that the applicant's ongoing chronic pain warranted removal from the MIG, entitling her to funding for physiotherapy, a physiatry assessment, an occupational therapy assessment, and a chronic pain assessment.

The Tribunal also awarded IRBs for the first 104 weeks post-accident, finding the applicant suffered a substantial inability to perform the essential tasks of her pre-accident employment as a cleaner.

However, the Tribunal denied IRBs beyond 104 weeks, as the applicant failed to prove a complete inability to engage in any suitable employment.

Claims for a psychological assessment and a special award for unreasonable delay were also dismissed.

The applicant sought entitlement to a Non-Earner Benefit and two treatment plans following a motor vehicle accident.

The adjudicator found that the applicant failed to demonstrate a complete inability to carry on a normal life, as his pain did not practically prevent him from engaging in his pre-accident activities.

The adjudicator also denied the treatment plans, noting the applicant failed to produce the plans in evidence or demonstrate they were reasonable and necessary.

The application was dismissed.

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

The insurer denied the claims and raised a preliminary issue, arguing the applicant was statutorily barred from proceeding with her application under s. 55(1)2 of the Statutory Accident Benefits Schedule because she failed to attend multiple scheduled insurer's examinations (IEs) under s. 44.

The Tribunal found that the insurer's requests for the IEs were reasonably necessary and complied with the notice requirements of s. 44(5).

Because the applicant failed to attend the properly scheduled IEs, she was statute-barred from proceeding with her application.

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

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

The Tribunal found that the applicant's physical and psychological injuries were predominantly minor and that she did not suffer from chronic pain or a pre-existing condition that would warrant removal from the MIG.

As the MIG limits were exhausted, the application for treatment plans and interest was dismissed.

The applicants sought statutory accident benefits after the applicant wife slipped and fell on ice in a parking garage while walking toward her vehicle to retrieve groceries.

The respondent insurer denied the claims on the basis that the incident was not an 'accident' under the Schedule.

The Tribunal found that the incident did not meet the causation test, as the vehicle was not the dominant feature and the injuries were caused by the icy conditions of the parking garage, which constituted an intervening act.

The applications were dismissed.

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 Tribunal found that the applicant failed to meet the burden of proving his injuries warranted removal from the MIG.

As the MIG limits were exhausted, the disputed treatment plans and assessments were not payable, and no interest was owed.