Derek Grant

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.

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

The respondent 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 and psychological impairments as a result of the accident, removing him from the MIG.

The Tribunal ordered the respondent to pay for several treatment plans for physical rehabilitation, a social work assessment, and a disability certificate, finding them reasonable and necessary.

However, the claim for a functional abilities evaluation was dismissed as the applicant had returned to work.

Interest was awarded on the overdue benefits.

The applicant was injured in a motor vehicle accident and sought 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 applicant argued for removal from the MIG due to pre-existing knee injuries, chronic pain, and psychological impairments.

The Tribunal found that the applicant failed to provide compelling medical evidence that his pre-existing conditions precluded recovery under the MIG, failed to establish functional impairment from chronic pain, and failed to prove a psychological impairment, preferring the respondent's psychological assessment which noted invalid testing and feigning of symptoms.

As the MIG limits were exhausted, the disputed treatment plans and interest were denied.

The applicant sought payment for two chiropractic treatment plans following a motor vehicle accident.

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

The Licence Appeal Tribunal found that the applicant failed to prove the treatment was reasonable and necessary, noting the lack of recommendation from his family physician and his own reports that his soft tissue injuries had resolved.

The Tribunal also dismissed the applicant's claims for a section 10 award and costs, finding that the applicant's failure to provide timely medical documentation impeded the respondent's ability to adjust the claim.

The applicant sought reconsideration of a Licence Appeal Tribunal decision denying her claims for a psychological assessment and a special award.

The adjudicator granted the reconsideration in part, finding an error of law in the initial decision regarding the psychological assessment.

Because the insurer provided its denial outside the 10-day period required by s. 38(8) of the Statutory Accident Benefits Schedule, the treatment plan was automatically payable under s. 38(11) without the applicant needing to prove the services were incurred.

However, the adjudicator upheld the initial decision denying a special award, finding the applicant failed to demonstrate an error of law or fact that would have changed the result.

The applicant was injured in a motor vehicle accident and sought medical benefits and cost of examinations from the respondent insurer under the Statutory Accident Benefits Schedule.

The adjudicator found that the chronic pain assessment and physiotherapy treatment plan were reasonable and necessary due to ongoing physical impairments.

However, the adjudicator dismissed the claims for the balances of the psychological assessment and psychological treatment plans, finding that the applicant had not met the burden of proving they were reasonable and necessary beyond what the insurer had already approved.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to two physiotherapy treatment plans and various medical expenses.

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

The Tribunal found that the applicant failed to meet his burden of proof, noting a lack of medical evidence connecting his ongoing pain complaints to the accident and a significant lapse in treatment history.

The application was dismissed, and no interest or awards were payable.

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

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

The applicant contended she should be removed from the MIG due to pre-existing knee pain and accident-related psychological impairments.

The Tribunal found insufficient medical evidence to support that the pre-existing knee condition would prevent recovery within the MIG, or that the applicant suffered a significant psychological impairment.

Consequently, the applicant's injuries were deemed predominantly minor, and the disputed treatment plans for psychological, chiropractic, and physiotherapy services were found not reasonable and necessary.

The applicant fell from the roof of his fifth wheel trailer while inspecting and cleaning it in preparation for a trip.

He sought statutory accident benefits from the respondent, who denied the claim on the basis that the incident was not an 'accident' under s. 3(1) of the Schedule.

The Licence Appeal Tribunal found that while the trailer met the definition of an automobile and the activity satisfied the purpose test, the incident failed the causation test.

The fall was caused by a loss of footing, an intervening act, and was not directly caused by the use or operation of the trailer.

The application was dismissed.

The applicant insurer sought repayment of $25,771.43 in income replacement benefits paid to the respondent following a motor vehicle accident.

The respondent failed to attend the hearing.

The Tribunal found that the respondent wilfully misrepresented her employment status by failing to notify the insurer that she had returned to work shortly after the accident, while continuing to receive benefits.

The Tribunal ordered the respondent to repay the full amount of the overpayment, plus interest calculated from the date of the repayment notice.

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

The respondent insurer denied several treatment plans and non-earner benefits, raising preliminary issues of limitation periods and non-compliance with insurer examinations.

The Tribunal found that the applicant failed to dispute the 2017 treatment plans within the two-year limitation period and declined to extend the time under s. 7 of the LAT Act due to the applicant's failure to attend s. 44 insurer examinations.

The Tribunal also found the applicant was barred from receiving non-earner benefits due to this non-compliance.

Finally, the Tribunal concluded the 2018 and 2019 treatment plans were not reasonable and necessary, preferring the evidence of the respondent's chronic pain specialist over the applicant's chiropractor.

The applicant sought reconsideration of a Licence Appeal Tribunal decision that dismissed his claims for aquatic therapy, physiotherapy, and a chronic pain assessment.

The applicant argued the adjudicator erred in law by applying the doctrine of res judicata to his treatment plans and by improperly weighing the medical evidence of his expert.

The Tribunal dismissed the reconsideration request, finding no error of law or fact.

The adjudicator correctly applied res judicata as the core issues had been previously decided, and properly exercised discretion in preferring the evidence of an orthopaedic surgeon over the applicant's medical expert.

The applicant sought medical and rehabilitation benefits following a motor vehicle accident, which the respondent insurer denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The applicant argued her physical injuries, chronic pain, and psychological impairments warranted removal from the MIG.

The Tribunal found the applicant's physical injuries were soft-tissue in nature and she failed to provide a medical diagnosis of chronic pain.

The Tribunal preferred the respondent's psychological assessment over the applicant's, finding no clinically significant accident-related psychological impairment.

The application was dismissed, and the disputed treatment plans were found not reasonable and necessary.

The applicant sought statutory accident benefits for three physiotherapy treatment plans and one chronic pain assessment following a motor vehicle accident.

The respondent denied the benefits on the basis that they were not reasonable and necessary, relying on a section 44 assessment.

The Tribunal found the physiotherapy treatment plans were reasonable and necessary, preferring the evidence of the applicant's treating nurse practitioner over the contradictory section 44 report.

However, the Tribunal dismissed the claim for a chronic pain assessment, finding no objective evidence or reasonable possibility that the applicant suffered from chronic pain.

Interest was awarded on the overdue physiotherapy benefits.

The applicant was injured when he was struck by his own stolen vehicle while attempting to recover it.

He sought statutory accident benefits for treatment plans and transportation expenses to a clinic in Scarborough, despite living in Windsor.

The Tribunal found the treatment plan fees were duplicative and not reasonable and necessary.

The Tribunal also denied the transportation expenses, finding it was not reasonable and necessary to travel from Windsor to Scarborough for treatment when similar options were available locally.

The application was dismissed.

The applicant sought medical benefits following a motor vehicle accident, which the respondent denied on the basis that the injuries fell within the Minor Injury Guideline (MIG).

The applicant failed to provide any medical evidence or objective evidence to support his claim that his injuries warranted treatment beyond the MIG framework.

The Tribunal found that the applicant did not meet his burden of proof and dismissed the application for a chronic pain assessment, chiropractic treatment, interest, and an award.

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

The parties participated in a case conference and subsequently advised the Tribunal that the disputed issues had been resolved.

The Tribunal ordered the file closed.

The applicant insurer sought repayment of income replacement and medical benefits paid to the respondent, alleging he wilfully misrepresented his involvement in a motor vehicle accident.

Surveillance evidence showed the respondent working at his place of employment, contradicting his claims of inability to work.

The police report and testimony from the at-fault driver and responding officer confirmed the respondent was not a passenger in the vehicle.

The Tribunal found the respondent wilfully misrepresented his involvement in the accident and ordered repayment of $22,677.59 plus interest.

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

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

The adjudicator found that the applicant failed to establish that her injuries warranted removal from the MIG, noting a lack of corroborative medical evidence, functional disability, or psychological impairment.

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

The application was dismissed, and claims for an award and interest were denied.

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

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

The Tribunal found that the applicant failed to provide sufficient medical evidence or analysis to demonstrate that her injuries warranted removal from the MIG.

As the MIG limits had been exhausted, the Tribunal held the applicant was not entitled to the disputed treatment plan or interest.

The application was dismissed.