Yann Grand-Clement

The applicant sought accident benefits following a motor vehicle accident, arguing her injuries, including carpal tunnel syndrome, psychological impairments, and chronic pain, warranted removal from the Minor Injury Guideline (MIG).

The Licence Appeal Tribunal found the applicant failed to establish that her physical, psychological, or chronic pain impairments were caused by the accident or warranted removal from the MIG.

As the MIG limits were exhausted, the disputed treatment plans were not payable.

The Tribunal also dismissed the claim for non-earner benefits, finding the applicant failed to submit a required Disability Certificate and did not meet the test of suffering a complete inability to carry on a normal life.

The applicant was injured in a motor vehicle accident and sought payment for a physiotherapy treatment plan (aqua therapy) under the Statutory Accident Benefits Schedule.

The respondent insurer denied the benefit, arguing the applicant had reached maximum medical improvement and the treatment was for pre-existing fibromyalgia.

The Tribunal found the treatment plan reasonable and necessary, noting it was recommended by the applicant's family doctor and an orthopaedic surgeon for accident-related injuries.

The applicant was awarded the cost of the treatment plan and interest on overdue payments.

The applicant's request for costs under Rule 19 was dismissed, as the Tribunal found the respondent did not act unreasonably or in bad faith.

The applicant sought statutory accident benefits following a motor vehicle accident, including non-earner benefits and funding for psychological and neurological assessments.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove a complete inability to carry on a normal life under the Heath test.

The Tribunal also found the proposed assessments were not reasonable and necessary, noting a lack of corroborating medical evidence and the fact that a neurological assessment had already been completed through OHIP.

Claims for interest and a special award were consequently dismissed.

The applicant sought payment for various treatment and assessment plans following a motor vehicle accident, including a chronic pain assessment, attendant care assessment, neuropsychological assessment, physiotherapy, chiropractic, and massage therapy.

The respondent denied the benefits.

The Tribunal dismissed the application, finding that the applicant failed to meet the burden of proving the plans were reasonable and necessary.

The Tribunal noted a lack of supporting medical evidence, found the chronic pain assessment to be duplicative of existing treatment, and concluded that no interest was payable as no benefits were overdue.

The applicant sought entitlement to statutory accident benefits for physiotherapy, massage, and assistive devices following a 2019 motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to establish on a balance of probabilities that the disputed treatment plans were reasonable and necessary.

The Tribunal noted a lack of contemporaneous medical evidence supporting the treatment plans and found that the applicant relied on outdated records that did not endorse the specific goods or services claimed.

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

The applicant sought statutory accident benefits following a 2019 motor vehicle accident.

The Tribunal found the applicant was barred from disputing the denials of an assistive devices plan and a chiropractic plan because she failed to commence the application within the two-year limitation period under section 56 of the Schedule, and declined to extend the time under section 7 of the LAT Act.

On the substantive issues, the Tribunal denied the psychological services plan for lack of medical evidence but approved the orthopedic assessment plan, finding the applicant's complex and persistent musculoskeletal complaints warranted further investigation.

Claims for a special award were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, including an income replacement benefit (IRB), physiotherapy, and various assessments.

The Tribunal found the applicant was entitled to an IRB for the period between her early retirement and her planned retirement date, as accident-related pain substantially prevented her from performing the essential tasks of her employment.

The Tribunal also approved the treatment plans for physiotherapy, a psychological assessment, and a chronic pain assessment, finding them reasonable and necessary.

The neurological assessment was approved because the insurer's denial failed to comply with the medical reasons requirement under s. 38(8) of the Schedule.

The claim for a special award was dismissed as the insurer's conduct was not unreasonable.

The applicant sought statutory accident benefits following a motor vehicle accident, specifically claiming entitlement to two treatment plans for dental services and one for a psychological assessment.

The Licence Appeal Tribunal found that the applicant failed to prove the dental treatment plans were reasonable and necessary, noting a significant gap in treatment and lack of ongoing complaints in the clinical notes and records.

The Tribunal also denied the psychological assessment, finding the applicant's anxiety was pre-existing and adequately managed by her family doctor.

The application was dismissed in its entirety, and no interest was payable.

The applicant sought entitlement to statutory accident benefits following a motor vehicle accident, including chiropractic services, acupuncture, an attendant care assessment, and a catastrophic impairment assessment.

The Tribunal found that the applicant failed to prove the treatments and assessments were reasonable and necessary.

The Tribunal also found the respondent provided sufficient medical reasons for denying the treatment plans under s. 38(8) of the Schedule.

All claims, including requests for an award and interest, were dismissed.

The applicant sought entitlement to an income replacement benefit (IRB) and a physiotherapy treatment plan following a motor vehicle accident.

The respondent had terminated the IRB based on multidisciplinary assessments concluding the applicant did not suffer a substantial inability to perform the essential tasks of her pre-accident employment as a restaurant server.

The Tribunal found the applicant failed to provide supporting medical documentation to meet her onus for both the IRB and the treatment plan, relying instead on perceived deficiencies in the respondent's evidence.

The Tribunal accepted the respondent's medical evidence that the applicant's injuries were transient soft tissue injuries and that her psychological issues did not prevent her from working.

The application was dismissed in its entirety, including claims for interest and an award.

The applicant requested a reconsideration of a Tribunal decision finding that her brain contusion fell within the Minor Injury Guideline (MIG).

The applicant argued the Tribunal erred in law by interpreting 'contusion' in the definition of 'minor injury' to include brain contusions, asserting this was incompatible with the catastrophic impairment definition.

The Tribunal dismissed the request, holding that the legislature did not exclude intracranial contusions from the minor injury definition, and a brain contusion remains a minor injury unless it results in a non-minor impairment.

The Tribunal also found no error of fact in its weighing of the medical evidence.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied Non-Earner Benefits and a physical therapy treatment plan.

The applicant argued the adjudicator made an error in law or fact by improperly weighing the evidence, including surveillance evidence.

The Tribunal dismissed the reconsideration request, finding that the original decision involved a proper weighing of the evidence and no error of law or fact was made.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to a non-earner benefit, removal from the Minor Injury Guideline (MIG), and funding for chiropractic and psychological treatment plans.

The Tribunal found that the applicant did not suffer a complete inability to carry on a normal life, preferring the respondent's multidisciplinary medical assessments over the applicant's evidence.

The Tribunal also concluded that the applicant failed to establish a psychological impairment warranting removal from the MIG.

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

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

The adjudicator found that the applicant was statute-barred from disputing a chronic pain assessment because she failed to file an application within the two-year limitation period after receiving valid denials from the insurer.

The adjudicator also dismissed claims for a psycho-vocational assessment, finding the applicant had returned to her pre-accident employment, and for psychological services, as the applicant failed to justify the need for longer sessions at a higher rate than approved.

A claim for chiropractic services was denied because the expense was incurred before a treatment plan was submitted.

Claims for interest and an award were consequently dismissed.

The applicant sought $1,696.00 for a physiotherapy treatment plan following a motor vehicle accident.

The respondent insurer denied the plan based on an Insurer's Examination by a physical medicine and rehabilitation specialist, who opined that active therapy and modalities like acupuncture or ultrasound would not provide rehabilitation benefits due to the applicant's pre-existing spinal fusion and pain, recommending aquatic therapy instead.

The Tribunal found the proposed treatment plan lacked details on the modalities to be used and how the goals would be achieved.

The Tribunal accepted the insurer's medical evidence and concluded the applicant failed to prove the treatment plan was reasonable and necessary.

The application was dismissed.

The applicant sought non-earner benefits and medical/rehabilitation benefits following a motor vehicle accident.

The Tribunal admitted late-filed surveillance evidence from the respondent but excluded a late-filed section 44 assessment report.

Applying the Heath test, the Tribunal found the applicant did not suffer a complete inability to carry on a normal life, preferring the respondent's assessors and surveillance evidence over the applicant's evidence.

The Tribunal also found the proposed chiropractic and acupuncture treatment plan was not reasonable and necessary, as the applicant had reached maximal medical recovery.

The application was dismissed in its entirety.

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

The insurer denied several treatment plans, and the applicant applied to the Licence Appeal Tribunal.

The Tribunal found that the claims for an OT neurocognitive assessment, physiotherapy, and a chronic pain assessment were statute-barred, as the applicant failed to file the application within the two-year limitation period following clear and unequivocal denials by the insurer.

The Tribunal also dismissed the claim for psychological services, preferring the insurer's section 44 assessment which concluded the applicant did not suffer from an accident-related psychological impairment at the time the plan was submitted.

The application was dismissed in its entirety.

The applicant sought statutory accident benefits following a motor vehicle accident, including treatment plans for physiotherapy, driving counselling, chronic pain, and a chronic pain assessment.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove the treatments and assessment were reasonable and necessary.

The Tribunal preferred the respondent's independent medical examination over the applicant's physiatrist, noting the applicant's self-reported full-time work and independence did not support a chronic pain diagnosis with functional impairment.

Claims for a special award and interest were also dismissed.

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

The respondent denied the benefits based on section 44 assessments.

The Tribunal found that the respondent's denial letter complied with the requirement to provide medical reasons under section 37(6) of the Schedule.

On the substantive issues, the Tribunal placed little weight on the applicant's expert reports due to inaccuracies and a failure to account for the applicant's significant pre-existing health conditions and prior accidents.

The Tribunal accepted the respondent's section 44 assessors' opinions that the applicant did not suffer a complete inability to carry on a normal life and did not require attendant care.

The application was dismissed in its entirety.

The applicant requested a reconsideration of a previous Licence Appeal Tribunal decision that denied her entitlement to a neurological assessment, a chronic pain assessment, a second treatment plan for physiotherapy, and assistive devices.

The applicant argued that the adjudicator made errors of fact and law and sought to introduce new evidence.

The Tribunal found that the applicant failed to establish any errors of fact or law, and that the new evidence did not meet the threshold for admission under Rule 18.2(c).

The request for reconsideration was dismissed.