Derek Grant

The applicant was injured in a motor vehicle accident and sought payment for three treatment plans (OCF-18s) for chiropractic and psychological services, which the respondent insurer denied in whole or in part.

The Tribunal found that the applicant failed to prove the balances of the first two treatment plans were reasonable and necessary, as they exceeded maximum guideline amounts or lacked supporting evidence for report writing fees.

However, the Tribunal partially approved the third treatment plan for chiropractic, massage, and physiotherapy, finding it reasonable and necessary based on consistent medical evidence of ongoing pain and functional improvement.

Interest was awarded on the overdue benefits.

The applicant sought reconsideration of a decision that dismissed his claim for a chronic pain assessment, neurological assessment, and interest.

The applicant argued the Tribunal made errors of fact and law, including failing to properly consider the AMA Guides criteria for chronic pain and various medical reports.

The Tribunal found no error, noting the lack of ongoing pain complaints in the family physician's records, the applicant's return to modified work and pre-accident activities, and the fact that the objective medical findings contradicted a chronic pain diagnosis.

The request for reconsideration was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the insurer's determination that her injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found that the applicant failed to comply with section 33 requests for medical records, relieving the insurer of liability to pay the disputed benefits.

Furthermore, the applicant failed to provide sufficient medical evidence to demonstrate that her physical or psychological injuries warranted removal from the MIG.

The application for treatment plans, interest, and an award was dismissed.

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

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

The Licence Appeal Tribunal found that the applicant failed to prove his injuries warranted removal from the MIG.

Furthermore, the applicant failed to demonstrate a substantial inability to perform the essential tasks of his pre-accident employment, disentitling him to IRBs.

Claims for an accounting report, interest, and an award were also dismissed.

The applicant sought statutory accident benefits for psychological treatment to address post-traumatic stress disorder following a motor vehicle accident.

The respondent partially denied two treatment plans, arguing that the proposed length and number of sessions were excessive and that a local treatment provider should be used to reduce travel expenses.

The Tribunal found that the applicant's treating psychologist was the preferred option due to his extensive experience and established patient-psychologist relationship, and that surveillance evidence did not undermine the applicant's psychological impairments.

The Tribunal concluded that the treatment plans were partially reasonable and necessary, awarding portions of the claimed amounts along with interest on overdue payments.

The applicant was injured in a motor vehicle accident and sought payment for two chiropractic treatment plans for chronic shoulder pain.

The respondent insurer denied the plans based on an insurer's examination report.

The Tribunal found the treatment plans reasonable and necessary, preferring the evidence of the applicant's treating physicians and chronic pain program over the insurer's assessor.

The Tribunal also awarded a 10% special award under s. 10 of O. Reg. 664, finding the respondent unreasonably withheld benefits by failing to adjust the claim when presented with updated medical records.

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

The insurer denied the treatment plans, arguing they were not reasonable and necessary.

The Tribunal found that the physiotherapy and chronic pain assessment were reasonable and necessary, noting the insurer's failure to comply with the notice requirements under section 38 of the Schedule for the chronic pain assessment.

The orthopaedic and psychological assessments were denied.

The Tribunal also awarded $300 to the applicant due to the insurer's unreasonable delay in responding to the treatment plans and failure to adjust the file with new medical evidence.

The applicant sought statutory accident benefits following a 2014 motor vehicle accident, specifically claiming a chronic pain assessment and a chronic pain treatment program.

The Licence Appeal Tribunal dismissed the claims.

The Tribunal found the assessment expense was incurred prior to the submission of the treatment plan, contravening section 38(2) of the Schedule.

Furthermore, the Tribunal held the applicant failed to prove she suffered from an accident-related chronic pain condition, preferring the respondent's medical evidence which showed she had reached maximum medical improvement and maintained a normal life.

Claims for a Regulation 664 award and interest were also dismissed.

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

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

The Tribunal found that the applicant failed to prove his physical or psychological injuries fell outside the MIG, noting a lack of objective medical evidence supporting a chronic pain diagnosis or significant psychological impairment.

As the applicant's injuries were predominantly minor and the MIG limit had been exhausted, the claims for additional treatment plans and interest were dismissed.

The applicant was injured in a motor vehicle accident and sought pre- and post-104 week income replacement benefits (IRBs), which the respondent insurer denied.

The Tribunal found that the applicant suffered a substantial inability to perform the essential tasks of his pre-accident employment as a sheet metal fabricator and airplane mechanic due to ongoing pain from a right leg fracture.

Furthermore, the Tribunal concluded that the applicant met the more stringent post-104 week test, as his chronic pain and physical limitations resulted in a complete inability to engage in suitable employment.

The Tribunal also ordered a 10% award against the insurer under s. 10 of O. Reg. 664, finding that the insurer unreasonably withheld benefits by failing to adjust the claim after receiving compelling medical reports supporting the applicant's ongoing impairments.

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

The insurer denied a treatment plan for physiotherapy on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The adjudicator found that the applicant's injuries, primarily soft tissue sprains and strains, were predominantly minor and that there was insufficient evidence of chronic pain or functional impairment to warrant treatment beyond the MIG limit.

As the MIG limit was exhausted, the treatment plan was not payable, and claims for interest and a special award were dismissed.

The applicant witnessed the aftermath of a motor vehicle accident involving his family members and sought statutory accident benefits for psychological impairments two years later.

The insurer denied the claim on the basis that the applicant failed to notify it of his intention to apply within the prescribed seven-day period under section 32 of the Schedule.

The Tribunal found that the applicant had sufficient knowledge and ability to apply earlier and failed to provide a reasonable explanation for the delay under section 34.

The Tribunal concluded that the prejudice to the insurer outweighed any hardship to the applicant, and therefore the applicant was statute-barred from proceeding with his claim.

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

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

The applicant argued that a pre-existing condition warranted removal from the MIG.

The Tribunal found that the applicant failed to provide compelling medical evidence of a pre-existing condition that would prevent recovery within the MIG.

The Tribunal also found that the applicant failed to prove the proposed treatment plans were reasonable and necessary.

The application was dismissed.

The applicant sought statutory accident benefits following a 2016 motor vehicle accident, including funding for chiropractic treatment, a social work assessment, and a neurological assessment.

The Licence Appeal Tribunal found the chiropractic treatment plan to be reasonable and necessary, relying on the respondent's own assessors who acknowledged the applicant's chronic pain and potential benefit from facility-based treatment.

However, the Tribunal denied the social work and neurological assessments, finding them duplicative and unsupported by the medical evidence.

Claims for an award for unreasonably withheld benefits and costs were also dismissed.

The applicant sought reconsideration of a LAT decision that denied her claims for psychological, chiropractic, and massage therapy benefits.

She argued the adjudicator erred in fact and law, violated procedural fairness, and sought to introduce a new letter from her supervising psychologist to validate her psychological assessment report.

The adjudicator waived the late filing of the reconsideration request but dismissed it on the merits.

The adjudicator found the new letter did not meet the test for new evidence and would not have changed the outcome, as the original decision reasonably relied on the applicant's own statements to the insurer's assessor that she did not want or need the claimed treatments.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming $9,903.00 for dental treatment and $11,700.00 for a hot tub.

The Tribunal found the dental treatment was reasonable and necessary to repair accident-related damage, ordering payment with interest.

However, the claim for the hot tub was denied because the applicant incurred the expense prior to submitting the treatment plan, contrary to section 38(2) of the Schedule.

The Tribunal also declined to make an award for unreasonable delay, finding the insurer reasonably relied on its assessor's reports.

The applicant sought medical benefits for chiropractic services and a psychological assessment following a motor vehicle accident.

The respondent insurer denied the benefits on the basis that the applicant's injuries fell within the Minor Injury Guideline (MIG) and the $3,500 limit had been exhausted.

The Tribunal found that the medical evidence, including the applicant's own treatment records and the insurer's examinations, confirmed the physical injuries were predominantly minor.

The Tribunal also found insufficient evidence of a psychological impairment that would warrant removal from the MIG.

As the MIG limit was exhausted, the treatment plans were deemed not reasonable and necessary.

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 claimed she suffered a concussion and psychological impairments warranting removal from the MIG.

The Tribunal found insufficient medical evidence to support a concussion or a psychological impairment, noting the applicant's pre-accident medical history of similar complaints.

The Tribunal concluded the injuries were predominantly minor, and since the MIG limits were exhausted, the disputed psychological assessment was not reasonable and necessary.

The claim for a special award was also dismissed.

The applicant sought payment for a chiropractic treatment plan in the amount of $2,670.00 following a motor vehicle accident.

The insurer denied the claim based on a section 44 assessment indicating that further passive facility-based treatment was not reasonable and necessary.

The Tribunal found that the applicant failed to meet her burden of proof, noting her significant pre-accident history of chronic pain and the lack of evidence showing the proposed treatment provided benefit.

The claims for the treatment plan, interest, and an award for unreasonable delay were dismissed.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for physiotherapy, psychological treatment, clinical notes, and a chronic pain assessment.

The respondent insurer denied the treatment plans.

The Licence Appeal Tribunal found that the insurer's initial denials for the physiotherapy and psychological treatment plans were non-compliant with section 38 of the Schedule, but subsequent denials cured the defects.

On the merits, the Tribunal held that the psychological treatment and chronic pain assessment were reasonable and necessary, relying on the applicant's ongoing symptoms and the reports of his treating practitioners.

The claims for physiotherapy and clinical notes were dismissed.

Interest was awarded on the overdue payments for the approved plans.