Procedural Lessons Armstrong v. Intact Insurance Company (LAT)

When it comes to navigating the procedure of statutory accident benefits hearings under the Ontario Licence Appeal Tribunal (LAT), the case of Armstrong v. Intact Insurance Company offers valuable insights. This 2024 LAT ruling showcases the significant challenges faced by claimants seeking to advance their claims for accident benefits within the very limited time typically allotted to hearings.

Background of the Case

Ryan Armstrong, the applicant, suffered significant injuries in a 2019 automobile accident. His pursuit of statutory benefits under Ontario’s Statutory Accident Benefits Schedule (the Schedule) led to a dispute with his insurer, Intact. The two primary questions at the heart of the four-day hearing were:

1. Did Mr. Armstrong meet the definition of a catastrophic impairment under the Schedule?
2. Was he entitled to payment of the costs of a catastrophic impairment assessment?

Key Findings

Adjudicator Ludmilla Jarda found that Mr. Amrstrong suffered from a catastrophic impairment under Criterion 8 of the Schedule, based upon marked impairments in three functional domains: activities of daily living, social functioning, and adaptation. The adjudicator was heavily influenced by reports from Mr. Armstrong’s experts, emphasizing the comprehensive and credible evidence they provided. 

Despite success on the issue of catastrophic impairment, the Tribunal rejected the claims for the costs of the catastrophic impairment assessments, citing a lack of evidence supporting the reasonableness and necessity of the proposed costs. The particulars of the plan, such as its goals and scope, were not adequately presented in the evidentiary record.

Procedural Lessons

Perhaps most important are the procedural lessons learned from this decision:

• Adherence to Deadlines: Mr. Armstrong faced repeated setbacks due to late submissions. Whether it was filing supplementary briefs, introducing evidence mid-hearing, or failing to comply with pre-hearing requirements, these delays weakened his position, and relevant documentation and case law was excluded as a result.
• Documentary Completeness: The absence of critical documents, such as the treatment plan details, played a significant role in the Tribunal’s denial of the associated expenses.  In addition, the Tribunal refused to consider several of its own decisions because they were not included in the Book of Authorities.
• Expert Testimony: This decision highlights the weight placed on expert assessments and credibility of the experts and the applicant. Comprehensive, well-substantiated reports, together with credible testimony, can significantly influence outcomes.   

Broader Implications

This ruling serves as a cautionary tale for both applicants and insurers. For both parties, it highlights the need for strategic, meticulous preparation and adherence to procedural rules. For insurers, the case demonstrates the high bar of evidence required to dispute catastrophic impairment claims successfully.    

Ultimately, the Armstrong case confirms that while the LAT purportedly aims to provide fair resolutions in a timely manner, it will typically adhere to the strict guidelines and Rules applicable to such hearings.  Success often hinges on attention to detail and the strength of evidence. Whether you’re an applicant navigating the complexities of accident benefits or an insurer defending a claim, the importance of thorough preparation for LAT hearings in advance of the hearing cannot be overstated.