Derek Grant

The applicant requested a reconsideration of a preliminary issue decision which found that his fall from the roof of his trailer did not constitute an 'accident' under the Statutory Accident Benefits Schedule.

The applicant argued that the adjudicator erred in law by misapplying the causation test.

The Tribunal dismissed the request, finding no error of law, as the evidence established the applicant lost his footing and the trailer did not directly cause the injuries.

The applicant was involved in a motor vehicle accident and sought various medical benefits, transportation expenses, and an attendant care assessment from the respondent insurer.

The insurer denied the benefits on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal found that the applicant failed to establish on a balance of probabilities that the disputed treatment plans were reasonable and necessary, preferring the evidence of the insurer's physiatrist over the applicant's family physician.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including a non-earner benefit and medical benefits for physiotherapy.

The insurer denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guidelines.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to provide any supporting documentary evidence or analysis to demonstrate entitlement to the disputed benefits.

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

The insurer denied the disputed medical benefits on the basis that the applicant's injuries were predominantly minor and subject to the Minor Injury Guideline (MIG) limit.

The applicant argued that his injuries warranted removal from the MIG due to a pre-existing spine condition and chronic pain.

The Tribunal found that the applicant failed to establish that his pre-existing condition prevented his recovery under the MIG or that he suffered from accident-related chronic pain resulting in functional impairment.

As the MIG limit had not been exhausted, the applicant was entitled to seek treatment up to the limit, with interest payable on any outstanding payments for approved treatment.

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

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

The Tribunal found that the applicant suffered predominantly minor soft-tissue injuries and failed to provide compelling medical evidence of chronic pain or psychological impairments warranting removal from the MIG.

Furthermore, the applicant did not establish a complete inability to carry on a normal life, as she continued to engage in most pre-accident activities, and was therefore not entitled to a non-earner benefit.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought reimbursement for visitor expenses under the Statutory Accident Benefits Schedule after his family travelled from England to visit him.

The insurer denied the claim on the basis that the expenses were not reasonable and necessary.

The Licence Appeal Tribunal dismissed the application, finding that the applicant's injuries were predominantly minor and did not require the assistance of five family members from overseas.

As no benefits were payable, the claim for interest was also dismissed, rendering the insurer's limitation period defence moot.

The applicant requested a reconsideration of a previous decision which found her accident-related injuries were confined to the Minor Injury Guideline (MIG) and denied her disputed medical benefits.

The applicant argued under Rule 18.2(b) of the Common Rules that the adjudicator made errors of fact or law.

The adjudicator dismissed the request, finding that the applicant failed to identify any error of fact or law that would have changed the outcome, and that her submissions merely amounted to a request to reweigh the medical evidence.

The applicant sought statutory accident benefits for chiropractic and psychological treatment plans following a 2016 motor vehicle accident.

The respondent denied the benefits on the basis that they were not reasonable and necessary.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to provide compelling medical evidence supporting the treatment plans and noting that the plans were largely recommended after a subsequent 2018 accident.

As no benefits were payable, the claim for interest was also dismissed.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits, which the respondent insurer denied.

The applicant applied to the Licence Appeal Tribunal.

The adjudicator found that the applicant was entitled to a psychological assessment and psychological services, as the evidence supported that she suffered from accident-related psychological impairments warranting removal from the Minor Injury Guideline (MIG).

However, the adjudicator denied the claims for physical treatments, functional abilities evaluation, and chronic pain programs, finding insufficient objective medical evidence to establish they were reasonable and necessary.

The adjudicator also awarded a 5% special award under s. 10 of O. Reg. 664 and $200 in costs against the respondent due to its unreasonable 16-month delay in removing the applicant from the MIG after its own assessor recommended it.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including post-104-week income replacement benefits (IRBs), attendant care benefits, and funding for medical assessments.

The Tribunal found the applicant was entitled to ongoing IRBs, as her post-concussion syndrome and chronic pain resulted in a complete inability to engage in any employment for which she was reasonably suited.

The Tribunal also approved a neuropsychological assessment but denied a speech language pathology assessment, noting the applicant's post-accident public speaking engagements.

Claims for attendant care benefits, a special award, and costs were dismissed.

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

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

The Tribunal found that the applicant failed to establish that his injuries warranted removal from the MIG, noting a lack of evidence of chronic pain syndrome or functional impairment.

As the MIG limits were exhausted, the disputed treatment plans were not payable and the application was dismissed.

The applicant sought a non-earner benefit (NEB) and a medical benefit for chiropractic services following a motor vehicle accident.

The insurer denied the NEB on the basis that the applicant did not suffer a complete inability to carry on a normal life, and denied the medical benefit as not reasonable and necessary.

The adjudicator found that the applicant was not entitled to the NEB, as she had successfully returned to school and secured full-time employment post-accident, demonstrating an ability to engage in substantially all of her pre-accident activities.

However, the adjudicator found the proposed chiropractic treatment plan to be reasonable and necessary for pain relief, noting that the applicant's symptoms had improved with similar past treatment.

The medical benefit was granted with interest.

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

The respondent initially denied benefits under the Minor Injury Guideline but later approved them upon receiving updated medical records.

The applicant sought a special award for unreasonable delay, interest on overdue benefits, and the respondent sought costs.

The Tribunal found the respondent did not act unreasonably in its delay, as it required the updated records to make a fulsome determination, and dismissed the claim for an award.

The Tribunal granted the applicant interest on the overdue benefits and denied the respondent's request for costs.

The applicant was injured in a motor vehicle accident and sought payment for the balance of a physiotherapy treatment plan and a plastic surgery assessment.

The respondent denied the claims on the basis that they were not reasonable and necessary.

The Tribunal found that the balance of the physiotherapy plan, specifically for massage therapy, was reasonable and necessary for pain relief, preferring the evidence of the applicant's medical assessor.

However, the Tribunal dismissed the claim for the plastic surgery assessment, finding no compelling medical evidence to justify the referral.

Interest was awarded on the overdue physiotherapy payments.

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

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

The applicant argued that her pre-existing psychological conditions and chronic pain warranted removal from the MIG.

The Tribunal found that the applicant failed to demonstrate that her physical or psychological impairments required treatment beyond the MIG limits.

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

The application was dismissed.

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

The respondent denied several treatment plans 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 and did not warrant removal from the MIG, dismissing claims for physiotherapy, chiropractic services, and orthopaedic/neurological assessments.

However, the Tribunal preferred the applicant's psychological evidence over the respondent's section 44 assessor, finding that the applicant suffered from severe depression and anxiety directly resulting from the accident.

Consequently, the applicant was removed from the MIG on psychological grounds, and the treatment plans for a psychological assessment and psychological treatment were deemed reasonable and necessary, with interest payable.

The applicant sought statutory accident benefits 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 applicant argued her pre-existing conditions, including chronic pain and psychological impairments, were exacerbated by the accident and prevented recovery under the MIG.

The Tribunal found the applicant failed to provide compelling medical evidence that her physical or psychological injuries fell outside the MIG or that her pre-existing conditions precluded recovery within the MIG limits.

The application was dismissed.

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

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

The Tribunal found that the applicant failed to demonstrate on a balance of probabilities that her physical or psychological injuries warranted removal from the MIG.

The Tribunal preferred the evidence of the respondent's section 44 assessors over the applicant's treating practitioners and psychological report.

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

The claim for IRBs was also dismissed as the applicant failed to establish a substantial inability to perform the essential tasks of her employment.

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

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

The Tribunal found that the applicant suffered from chronic pain, removing him from the MIG.

The Tribunal approved several treatment plans for chiropractic treatment, medical services, and an orthopaedic assessment as reasonable and necessary, but denied an expense for an MRI because no treatment plan was submitted prior to incurring the expense.

Interest was awarded on the overdue benefits.

The applicant sought reconsideration of a decision denying a psychological assessment, arguing the adjudicator made errors of fact and law regarding her pre-accident medical history, the nature of her assessment interview, and the requirement for objective testing.

The adjudicator acknowledged a minor factual error regarding the interview format but found it would not have changed the outcome.

The adjudicator concluded there was no significant error of law or fact that would warrant varying the initial decision, as the medical evidence did not support the necessity of the psychological assessment.

The request for reconsideration was denied.