Yann Grand-Clement

The applicant sought a non-earner benefit and payment for two chiropractic treatment plans following a motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to provide submissions or evidence to establish entitlement to the non-earner benefit.

Furthermore, the applicant did not demonstrate that the proposed chiropractic treatments were reasonable and necessary, as he failed to identify treatment goals, provide contemporaneous medical evidence, or explain why further treatment was required after the insurer had recently approved identical treatment.

The applicant requested a reconsideration of a previous Tribunal decision denying various assessments and a special award.

The applicant argued the Tribunal erred in denying the balance of a catastrophic assessment and that new evidence supported a special award.

The Tribunal found it had erred regarding the catastrophic assessment balance, but noted the respondent had already paid the outstanding HST amount.

The Tribunal also found the alleged new evidence regarding the special award was already before it and would not have changed the outcome.

The request for reconsideration was dismissed.

The applicant sought various statutory accident benefits following a motor vehicle accident, including attendant care benefits, assistive devices, chiropractic services, and multiple assessments.

The Tribunal denied the claim for attendant care benefits, finding that the applicant's significant functional limitations were attributable to an intervening stroke rather than the accident.

The Tribunal partially approved the claim for assistive devices and fully approved the claims for chiropractic services, finding them reasonable and necessary for the applicant's accident-related neck and back injuries.

The claims for neurological, orthopaedic, attendant care, and SIE/FAE assessments were denied for lack of supporting medical evidence.

Interest was awarded on overdue payments for incurred assistive devices and chiropractic services.

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

The respondent insurer denied benefits and argued the applicant was barred from proceeding to the Tribunal because she failed to submit an application for benefits (OCF-1) within 30 days of receiving the forms, as required by section 32(5) of the Schedule.

The applicant claimed she had submitted the form and alternatively argued her pre-existing brain injury provided a reasonable explanation for any delay.

The Tribunal found the applicant's explanation was not credible, noting a further six-month delay in submitting the OCF-1 even after she retained counsel and was explicitly advised the form was missing.

The application was dismissed pursuant to section 55(1) of the Schedule.

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 removal from the MIG based on psychological impairment and chronic pain.

The Tribunal found the applicant failed to prove on a balance of probabilities that he suffered from a psychological impairment or chronic pain with functional impairment caused by the accident.

The medical evidence indicated soft tissue injuries and the applicant maintained an active lifestyle.

The application was dismissed, and the applicant was not entitled to the disputed treatment plans, an award, or interest.

The applicant requested a reconsideration of a prior Tribunal decision denying certain treatment plans and assessments, relying on over 180 pages of new medical evidence.

The Tribunal dismissed the request, finding that the applicant failed to establish that the new evidence could not have been obtained previously.

The Tribunal noted that a reconsideration is not an opportunity to correct shortcomings in submissions or evidence after a decision has been rendered.

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

At the outset of the hearing, the respondent agreed to fund the disputed medical benefits and income replacement benefits.

The hearing proceeded on the issues of interest, a special award, and costs.

The Tribunal found that the respondent unreasonably delayed the payment of benefits by failing to make a determination after receiving requested disclosure and completing an examination under oath, ordering a 15% special award.

Interest was awarded on the overdue benefits, but the applicant's request for costs was denied as the respondent's conduct did not meet the high threshold of being unreasonable, frivolous, vexatious, or in bad faith.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing her injuries warranted removal from the Minor Injury Guideline (MIG) due to a head injury, chronic pain, and pre-existing conditions.

The Licence Appeal Tribunal found that the applicant's cerebral contusion fell within the definition of a minor injury and rejected the assertion that she suffered a traumatic brain injury or concussion.

The Tribunal also found insufficient evidence of chronic pain causing functional impairment, noting the applicant returned to work within two months and failed to meet the criteria under the AMA Guides.

Finally, the applicant failed to provide compelling evidence that her pre-existing conditions prevented maximal recovery within the MIG.

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

The applicant was injured in a motor vehicle accident and sought statutory accident benefits, including a non-earner benefit and various treatment plans for chiropractic and psychological services.

The respondent denied the benefits.

The Licence Appeal Tribunal found that the applicant suffered a complete inability to carry on a normal life due to chronic pain and psychological impairments, entitling her to the non-earner benefit for the maximum 104-week period.

The Tribunal also partially approved several treatment plans for physical rehabilitation, acupuncture, and a psychological assessment, finding them reasonable and necessary.

Claims for an award under s. 10 of Reg. 664 were dismissed, but interest on overdue benefits was granted.

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

The insurer denied the claims, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG) and that he was no longer disabled from working as a restaurant manager.

The Tribunal found that the applicant's partial thickness shoulder tear constituted a minor injury under the MIG, and there was no evidence his age precluded recovery within the guideline limits.

The Tribunal also dismissed the claim for income replacement benefits, finding the applicant failed to demonstrate a substantial inability to perform the essential tasks of his employment as a restaurant manager.

Claims for a physiotherapy treatment plan, interest, and a section 10 award were consequently dismissed.

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

The applicant was removed from the Minor Injury Guideline due to psychological impairment.

The applicant sought payment for two outstanding physiotherapy treatment plans and one chiropractic treatment plan.

The Tribunal dismissed the claims for the physiotherapy plans because the applicant provided no evidence to support them.

However, the Tribunal granted the claim for the chiropractic treatment plan, finding it reasonable and necessary as part of a multi-disciplinary approach to treat the applicant's physical and psychological injuries.

Interest on the overdue payment was also awarded.

The applicant sought entitlement to multiple treatment plans for physical therapy, psychological services, and various multidisciplinary assessments following a motor vehicle accident.

The Licence Appeal Tribunal found the applicant was entitled to a chronic pain assessment and the HST portion of a partially approved psychological assessment, but denied the remaining treatment plans due to insufficient medical evidence.

The Tribunal also held the applicant was statute-barred from disputing a neuropsychological assessment because she failed to attend a scheduled insurer's examination without reasonable explanation.

The claim for an award under s. 10 of O. Reg. 664 was dismissed as the insurer's denials were not unreasonable.

The applicant sought payment for two treatment plans for chiropractic services following a 2017 motor vehicle accident.

The respondent denied the plans on the basis that the applicant had reached maximum medical improvement.

The adjudicator found that the applicant failed to demonstrate the treatments were reasonable and necessary, noting that the applicant only experienced temporary pain relief and that the respondent's orthopedic assessment found no ongoing accident-related physical impairment.

The application was dismissed and no interest was payable.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing his injuries warranted removal from the Minor Injury Guideline (MIG) due to chronic pain with a functional impairment and a psychological condition.

The Tribunal found the applicant failed to prove on a balance of probabilities that he suffered from either condition, noting his family doctor and psychiatrist consistently attributed his anxiety to his daughter's health rather than the accident.

As the applicant remained within the MIG, his claims for various treatment plans exceeding the funding limits, as well as claims for a special award and interest, were dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the denial of treatment plans for physiotherapy, psychotherapy, and multiple assessments.

The Tribunal found that the applicant failed to prove the physiotherapy and assessments were reasonable and necessary, noting a lack of clinical notes and preferring the respondent's medical assessments.

However, the Tribunal granted the outstanding balance for psychotherapy services, finding the proposed 1.5-hour sessions reasonable as recommended by the assessing psychologist.

Interest was awarded on the overdue psychotherapy benefits.

The applicant was injured in a motor vehicle accident and sought various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule.

The insurer denied treatment plans for a catastrophic impairment assessment balance, case management assessment, psychological assessment, dietetic assessment, and attendant care assessment.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to prove the treatment plans were reasonable and necessary.

Specifically, the catastrophic assessment balance exceeded the $2,000 limit per assessment, case management services were not available without a catastrophic designation, and the other assessments lacked persuasive medical evidence to support their necessity.

Claims for interest and a special award were also dismissed.

The applicant sought entitlement to statutory accident benefits for three treatment plans (chiropractic, physiotherapy, and aquatherapy) following a motor vehicle accident.

The respondent denied the benefits.

The Tribunal found that the applicant failed to establish a causal link between the accident and her ongoing complaints, noting that her pre-existing conditions were similar to her post-accident complaints and that objective medical evidence did not support an accident-related impairment.

The application was dismissed and no interest was payable.

The applicant requested a reconsideration of a Licence Appeal Tribunal decision that denied his entitlement to an income replacement benefit.

The applicant argued the Tribunal erred in law by applying the reasoning from Varriano to section 36(4)(b) of the Statutory Accident Benefits Schedule, contending the respondent failed to provide a medical reason for its denial.

The adjudicator dismissed the request, finding no error of law or fact, as the respondent was permitted to rely on non-medical reasons for denying the benefit and the initial decision correctly interpreted the denial notice.

The applicant sought statutory accident benefits following a motor vehicle accident, disputing the respondent's denial of treatment plans for physiotherapy, assistive devices, an attendant care assessment, and a driver evaluation.

The Licence Appeal Tribunal found that the applicant failed to provide objective medical evidence to establish that the physiotherapy, assistive devices, and attendant care assessment were reasonable and necessary, noting the respondent's unchallenged orthopaedic assessment.

However, the Tribunal granted the treatment plan for a driver evaluation, as it was specifically recommended by the applicant's psychological assessors and uncontradicted by the respondent.

The applicant was also awarded interest on the overdue payment.

The respondent insurer requested a reconsideration of a Tribunal decision that found the applicant entitled to a treatment plan for 108 sessions of physiotherapy.

The respondent argued the Tribunal made an error of fact by failing to address the excessive number of sessions proposed.

The adjudicator dismissed the request, finding that the original decision had considered the medical evidence, including a recommendation from the applicant's family doctor specifically supporting the 108-session plan, and that no error of fact was established.