Yann Grand-Clement

The applicant sought statutory accident benefits following a rear-end motor vehicle collision, claiming entitlement to a non-earner benefit (NEB) and several treatment plans for physiotherapy and psychological services.

The Licence Appeal Tribunal dismissed the application, finding that the applicant failed to demonstrate a complete inability to carry on a normal life, as she continued to perform most of her pre-accident activities, albeit with some pain and modifications.

The Tribunal preferred the evidence of the insurer's assessors over the applicant's assessors, noting the latter failed to review medical records or diagnostic imaging.

The Tribunal also found the disputed treatment plans were not reasonable and necessary, and the insurer's denial notices were compliant with the Schedule.

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

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

The Tribunal found that the applicant's injuries were predominantly minor, noting the family physician's records of soft tissue injuries and lack of pre-existing or psychological impairments.

The Tribunal also found that the respondent's denial letters complied with the notice requirements under s. 38 of the Schedule.

Furthermore, a psychological treatment plan submitted more than five years after the accident was statute-barred under s. 20(1)(a).

The application was dismissed.

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

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

The applicant argued she should be removed from the MIG due to chronic pain syndrome and a psychological impairment.

The Tribunal found the applicant failed to meet her burden of proof to establish either chronic pain with a functional impairment or a psychological impairment warranting removal from the MIG.

The Tribunal ordered that the applicant remains within the MIG but is entitled to the disputed treatment plans, if already incurred, up to the remaining MIG limit pursuant to s. 40(8) of the Schedule.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including a neurological assessment, a chronic pain assessment, physiotherapy, and assistive devices.

The Licence Appeal Tribunal found that the neurological and chronic pain assessments were duplicative of previous OHIP-funded assessments and therefore not reasonable and necessary.

The Tribunal granted entitlement to one physiotherapy treatment plan based on the recommendations of neurologists who diagnosed radicular pain, preferring their evidence over the respondent's physiatrist.

The claims for a second physiotherapy plan and assistive devices were dismissed for lack of supporting evidence.

Interest was awarded on the overdue physiotherapy benefits.

The applicant sought an income replacement benefit (IRB) following a motor vehicle accident.

The respondent denied the benefit on the basis that the applicant had returned to his pre-accident employment as a seasonal window cleaner for four months before a regular seasonal layoff.

The Tribunal found the respondent's denial notice complied with the Schedule.

On the merits, the Tribunal held the applicant failed to prove he suffered a substantial inability to perform his essential work tasks within the first 104 weeks, or a complete inability to engage in suitable employment thereafter.

The application was dismissed.

The applicant sought payment for a chronic pain program following a motor vehicle accident, which the respondent insurer partially denied.

The Tribunal found the physical rehabilitation sessions were reasonable and necessary based on the applicant's established chronic pain syndrome and the recommendations of her family physician and orthopaedic surgeon.

However, the applicant failed to prove the necessity of the remaining proposed services, including educational procedures and transportation costs.

The Tribunal awarded $5,785.50 for the physical rehabilitation sessions with interest, but declined to order a special award, finding the insurer did not act unreasonably in its handling of the claim.

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

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

The Tribunal found that the applicant suffered from chronic pain syndrome caused by the accident, warranting removal from the MIG.

The Tribunal ordered the respondent to pay the disputed physiotherapy treatment plan and interest on overdue payments, but denied the applicant's requests for a special award and costs.

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 argued for removal from the MIG based on psychological impairments and chronic pain.

The Tribunal found the applicant failed to provide compelling evidence of a psychological impairment or chronic pain syndrome that would warrant removal from the MIG, preferring the evidence of the respondent's experts and the applicant's family doctor.

As the applicant remained subject to the MIG limit, the disputed treatment plans were not payable.

The claims for interest and an award were also dismissed.

The applicant sought entitlement to statutory accident benefits for an orthopaedic assessment and physiotherapy following a 2015 motor vehicle accident.

The Licence Appeal Tribunal found that the orthopaedic assessment was duplicative of two prior assessments and therefore not reasonable and necessary.

The Tribunal also denied the physiotherapy treatment plan, noting the applicant had reached maximum medical improvement and failed to demonstrate how the treatment goals would be met.

Claims for interest and a special award were consequently dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, arguing that his pre-existing lumbar back pain and a psychological impairment warranted removal from the Minor Injury Guideline (MIG).

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

Furthermore, the Tribunal preferred the respondent's psychological assessment, concluding that the applicant did not suffer a psychological impairment caused by the accident.

As the applicant's injuries were deemed predominantly minor and the full $3,500 MIG limit had already been approved, the disputed treatment plans and claims for interest were dismissed.

The applicant sought $2,200 for a psychological assessment following a motor vehicle accident.

The Tribunal found that the applicant failed to meet the burden of proving the assessment was reasonable and necessary, as the only evidence provided was the treatment plan itself without any objective or compelling supporting evidence.

The claims for the assessment, interest, and an award were dismissed.

The applicant was involved in a motor vehicle accident and received income replacement benefits (IRBs) from the respondent insurer.

The applicant later withdrew his claims, leaving only the insurer's claim for repayment of IRBs and interest.

The applicant failed to participate in the written hearing.

The Tribunal found that the applicant had returned to work on October 26, 2020, but continued to receive IRBs until December 2, 2020.

The Tribunal ordered the applicant to repay the overpaid amount of $2,114.29 plus interest, as the insurer had provided proper notice and the overpayment resulted from the applicant's failure to promptly notify the insurer of his return to work.

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

The respondent insurer limited the applicant to the Minor Injury Guideline (MIG) and denied several treatment plans.

The Tribunal found that the applicant suffered a right knee meniscus tear caused by the accident, which falls outside the MIG definition, and removed him from the MIG.

The Tribunal approved a $2,000 chronic pain assessment but denied other treatment plans for chiropractic services, a medical assessment, and a psychological assessment as they were either duplicative, premature, or not reasonable and necessary.

The applicant's claim for an award for unreasonable withholding of benefits was dismissed.

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

The respondent insurer held that the applicant's injuries fell within the Minor Injury Guideline (MIG) and denied certain treatment plans.

The applicant argued for removal from the MIG based on a pre-existing back condition and chronic pain.

The Tribunal found that the applicant failed to demonstrate that his pre-existing condition precluded recovery within the MIG or that he suffered from chronic pain with a functional impairment.

The applicant was held to remain within the MIG, and the application for the disputed treatment plans was dismissed, subject to any remaining funds within the $3,500 MIG limit.

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

The adjudicator denied the claims for medical cannabis and an in-home ergonomic assessment, finding them not reasonable and necessary.

However, the adjudicator approved a work site ergonomic assessment and physiotherapy services based on the recommendations of the applicant's treating physician and medical assessors.

The adjudicator also ordered the respondent to pay for a psychological treatment plan because the respondent's denial letter failed to provide sufficient medical and other reasons, breaching section 38(8) of the Schedule.

The claim for a special award was dismissed.

The applicant sought entitlement to various medical and rehabilitation benefits under the Statutory Accident Benefits Schedule following a motor vehicle accident.

The Licence Appeal Tribunal found that the applicant was entitled to $1,130.00 for PRP injections and $2,200 for a psychological assessment, as these were supported by the medical evidence and treating practitioners' recommendations at the time.

However, the Tribunal denied the claims for physical therapy, a chronic pain assessment, and massage therapy, finding that the applicant failed to prove they were reasonable and necessary given the lack of objective evidence of efficacy and the duplicative nature of the chronic pain assessment.

Interest was awarded on the overdue benefits.

The applicant sought entitlement to statutory accident benefits for a chronic pain assessment and various physiotherapy treatment plans following a 2016 motor vehicle accident.

The Licence Appeal Tribunal dismissed the application, finding that the chronic pain assessment was a duplication of previous assessments and therefore not reasonable and necessary.

The Tribunal also denied the physiotherapy claims, noting discrepancies in the treatment times invoiced versus the sign-in sheets, and finding the applicant failed to meet her burden of proof for the remaining treatment plan.

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

The Tribunal found the applicant was entitled to the balance of a treatment plan for driver rehabilitation therapy because the insurer failed to provide sufficient medical reasons for its partial denial, triggering the consequences of section 38(11) of the Schedule.

However, the Tribunal dismissed the claims for chiropractic services and a psychological assessment, finding them not reasonable and necessary based on the medical evidence, including section 44 insurer examinations.

The claim for physiotherapy was also dismissed as the expenses were incurred before a treatment plan was submitted, contrary to section 38(2).

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

The respondent denied funding for two chiropractic treatment plans, arguing the applicant's injuries fell within the Minor Injury Guidelines (MIG).

The applicant argued that pre-existing conditions and a rotator cuff injury removed him from the MIG.

The Tribunal found that the applicant failed to demonstrate that his pre-existing conditions precluded his recovery within the MIG framework, and the medical evidence indicated his injuries were predominantly soft tissue injuries falling within the MIG.

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

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

The Licence Appeal Tribunal found that the proposed cognitive training was reasonable and necessary based on a functional cognitive assessment.

However, the Tribunal dismissed the claims for a driver reintegration assessment, psychological services, and chiropractic treatment, preferring the respondent's medical evidence that the applicant's psychological and soft tissue injuries had resolved.

The Tribunal awarded interest on the overdue cognitive training benefit but declined to make a special award, finding no egregious conduct by the insurer.