James Douglas Armstrong

The applicant sought statutory accident benefits following a rear-end motor vehicle collision, claiming entitlement to income replacement benefits (IRBs), attendant care benefits (ACBs), and various medical assessments.

The Tribunal found that the applicant suffered a temporary exacerbation of pre-existing shoulder and neck issues, entitling her to IRBs for a closed period until December 31, 2024.

However, the quantum payable was reduced to zero because the applicant received employment insurance sickness benefits that fully offset the IRB amount.

The claims for ACBs and medical benefits were dismissed, as surveillance evidence and medical assessments demonstrated the applicant could perform her pre-accident activities and did not require the claimed assistance or further assessments.

The applicant was injured in a severe motor vehicle accident and sought various statutory accident benefits, including attendant care benefits (ACB) and medical expenses, which the respondent insurer denied.

The Licence Appeal Tribunal found the applicant was entitled to ACB at the non-catastrophic maximum of $3,000 per month for a closed period, deeming the expenses incurred because the insurer unreasonably withheld payment during that time.

The Tribunal also approved a treatment plan for optometric services to investigate ongoing vision impairments and awarded partial reimbursement for prescription medications, an ambulance bill, and replacement glasses submitted on various OCF-6 forms.

Claims for an award under s. 10 of Regulation 664 were dismissed, but interest was awarded on all overdue benefits.

The applicant sought statutory accident benefits following a 2017 motor vehicle accident, claiming catastrophic impairment, income replacement benefits, attendant care benefits, and various treatment plans.

The Licence Appeal Tribunal found that the applicant did not meet the threshold for catastrophic impairment under Criterion 7 (55% whole person impairment) or Criterion 8 (mental and behavioural disorders).

The Tribunal preferred the respondent's medical evidence, noting the applicant's pre-existing conditions and post-accident functioning, including international travel.

Claims for income replacement and attendant care benefits were dismissed as the applicant failed to prove a substantial inability to perform his pre-accident employment and the benefits had expired past the 260-week mark.

The application was dismissed in its entirety.

The applicant, who was catastrophically impaired following a 2013 motor vehicle accident, sought non-earner benefits and payment for private school tuition.

The Licence Appeal Tribunal dismissed the application, finding the applicant failed to prove she suffered a complete inability to carry on a normal life within 104 weeks of the accident or continuously thereafter.

The Tribunal also denied the claim for private school tuition, as the applicant failed to establish it was reasonable and necessary, and the treatment plan was unsigned.

Claims for interest and a special award were consequently dismissed.

The applicant was struck by a reversing snow plow tractor (a backhoe with a snow plow attached) in a mall parking lot and sought statutory accident benefits.

The insurer denied benefits on the basis that the incident was not an 'accident' under the Schedule because the snow plow was not an 'automobile'.

Applying the three-part test from Adams, the Tribunal found that the backhoe was not an automobile in ordinary parlance, was not defined as such in the insurance policy, and did not meet the enlarged definition in any relevant statute.

The application was dismissed.

The applicant was injured in a motor vehicle accident and sought various statutory accident benefits, including treatment plans for physiotherapy, psychological services, and several medical assessments.

The Licence Appeal Tribunal found the applicant was entitled to six physiotherapy treatment plans, a chronic pain assessment, and a neurological assessment, noting ongoing pain and post-concussive symptoms supported by the medical record.

Claims for a neuropsychological assessment, an MRI, transportation expenses, and an award under s. 10 of Reg. 664 were dismissed for lack of supporting evidence.

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

The respondent denied treatment plans for chiropractic services, a chronic pain assessment, and a psychological assessment.

The applicant filed an application with the Tribunal more than two years after the denials.

The Tribunal found the denials were clear and unequivocal, triggering the two-year limitation period.

The Tribunal declined to exercise its discretion to extend the limitation period under s. 7 of the Licence Appeal Tribunal Act, finding the delay excessive (over 22 months) and prejudicial to the respondent.

The Tribunal also held it lacked jurisdiction to determine whether the applicant's injuries fell within the Minor Injury Guideline as a standalone issue, since all substantive benefit claims were statute-barred.

The application was dismissed.

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

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

The Tribunal found that the applicant was statute-barred from disputing four treatment plans because she failed to apply within the two-year limitation period under s. 56 of the Schedule, and declined to extend the time under s. 7 of the LAT Act.

On the substantive issues, the Tribunal held that the applicant's injuries fell within the Minor Injury Guideline (MIG).

The applicant failed to prove that a pre-existing condition, chronic pain, or psychological impairment warranted removal from the MIG.

Consequently, the remaining treatment plan for chiropractic services was denied, and no interest was payable.

The application was dismissed.

The applicant sought statutory accident benefits following a motor vehicle accident, claiming entitlement to an income replacement benefit (IRB), an award for unreasonable delay, and interest.

The Tribunal found that the applicant was employed as a machine operator at the time of the accident and that the accident caused pre-existing degenerative changes in his lumbar spine to become symptomatic.

The Tribunal preferred the evidence of the applicant's physiatrist over the respondent's, noting it was based on more comprehensive medical records including an MRI.

The Tribunal concluded the applicant suffered a substantial inability to perform the essential tasks of his employment and awarded IRBs at $384 per week for the first 104 weeks.

However, the applicant failed to prove a complete inability to engage in any suitable employment after 104 weeks.

The claim for a special award was dismissed, but interest on overdue benefits was granted.

The plaintiff sought an order to exclude co-defendant police officers from each other's examinations for discovery and to prohibit communication between them until the conclusion of discoveries.

The plaintiff argued this was necessary due to a risk of tailored or parroted testimony, citing the officers' prior conduct in criminal proceedings where they admitted to obstruction of justice.

The defendants opposed, asserting their right to attend and arguing no sufficient risk of tailoring existed.

The court granted the exclusion order, finding a clear risk of tailored evidence given the officers' past dishonesty, and determined that the ends of justice required the exclusion to ensure fair examinations, despite the logistical challenges for common counsel.

The applicant sought various statutory accident benefits following a 2017 motor vehicle accident, including attendant care benefits, occupational therapy, assistive devices, and assessments.

The Licence Appeal Tribunal found that the applicant's ongoing impairments were caused by pre-existing degenerative conditions rather than the accident, relying on the respondent's orthopaedic assessment.

The Tribunal denied further attendant care benefits and most treatment plans, but approved a psychological assessment, an attendant care assessment, and an inner bathmat.

The claim for a special award was dismissed as the respondent did not act unreasonably or in bad faith.

The insurer appealed a Licence Appeal Tribunal decision finding that the insured's claim for income replacement benefits was not statute-barred, as the termination letter was not clear and unequivocal.

The insured cross-appealed the dismissal of her claim for post-104 week income replacement benefits, arguing the adjudicator failed to consider whether alternative employment was comparable in status and reward.

The Divisional Court dismissed both appeals, holding that the limitation issue was a question of mixed fact and law not subject to appeal, and that the post-104 test under the Schedule does not require alternative employment to be comparable in status and reward.

The applicant sought statutory accident benefits following a 2015 motor vehicle accident.

The respondent denied certain treatment plans and assessments, arguing the applicant's injuries fell within the Minor Injury Guideline (MIG).

The Tribunal found the applicant's credibility was undermined by his failure to report a subsequent 2016 accident and pre-existing pain to his expert assessors.

Preferring the respondent's physiatry and psychology experts over the applicant's, the Tribunal concluded the physical injuries were soft tissue strains and there was no diagnosable psychological impairment.

The Tribunal held the injuries were predominantly minor and the disputed treatment plans and assessments were not reasonable and necessary.

The application was dismissed.

The applicant filed a Request for Reconsideration of a Tribunal decision that denied her claim for post-104 week income replacement benefits (IRBs).

The applicant argued that the adjudicator made significant errors of law and fact by misapprehending the evidence regarding her volunteer work, wedding planning activities, and medical limitations, and that the decision violated procedural fairness.

The Tribunal dismissed the request, finding that the adjudicator had properly weighed the evidence, including the applicant's post-accident activities and the medical reports.

The Tribunal concluded that the applicant failed to demonstrate a complete inability to engage in any employment for which she was reasonably suited by education, training, or experience, and that no error was made that would have led to a different result.

The applicant sought a non-earner benefit following a motor vehicle accident.

The insurer requested the applicant elect between an income replacement benefit and a non-earner benefit.

The applicant filed an application with the Licence Appeal Tribunal before making an election or receiving a denial from the insurer.

The Tribunal held it lacked jurisdiction to adjudicate the claim because, under section 280 of the Insurance Act, there can be no dispute until a claim is denied by the insurer.

The application was dismissed.

The applicant sought income replacement benefits (IRBs) following a 2014 motor vehicle accident.

The Tribunal found the applicant met the test for a pre-104 week IRB, as her physical and psychological impairments caused a substantial inability to perform the essential tasks of her pre-accident employment as an educational assistant.

However, the claim for a post-104 week IRB was dismissed.

The Tribunal concluded the applicant did not suffer a complete inability to engage in any employment for which she was reasonably suited, noting her volunteer work in a retail setting, her training as a wedding planner, and medical evidence indicating improvement in her condition.

Claims for a special award were dismissed, but interest was awarded on overdue pre-104 week benefits.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits.

The insurer denied the claim for non-earner benefits and income replacement benefits in a clear and unequivocal explanation of benefits.

The applicant filed an application with the Licence Appeal Tribunal regarding income replacement benefits only, but later sought to change the issue to non-earner benefits after the two-year limitation period had expired.

The Tribunal found the application for non-earner benefits was statute-barred under s. 56 of the Statutory Accident Benefits Schedule.

The Tribunal declined to extend the limitation period under s. 7 of the Licence Appeal Tribunal Act, finding no bona fide intention to appeal within the time limit, excessive delay, prejudice to the insurer, and lack of merit to the claim.

The application was dismissed.

Aviva sought reconsideration of a Licence Appeal Tribunal decision that found M.R. was entitled to payment for a chronic pain assessment and a neurological assessment under the Statutory Accident Benefits Schedule.

The adjudicator dismissed the request regarding the chronic pain assessment, finding no significant error of law or fact in the original decision's reliance on the medical records and the assessor's recommendations.

However, the adjudicator granted the request regarding the neurological assessment, acknowledging an error in focusing on headaches rather than the cervicalgia noted in the treatment plan.

The original decision was varied to deny entitlement to the neurological assessment.

On the eve of a jury trial for a motor vehicle accident claim, the plaintiff brought a motion to exclude late-served video surveillance reports or, alternatively, for an adjournment.

The court found that the recent surveillance was not substantially different from previously disclosed surveillance and did not unfairly surprise the plaintiff.

The court dismissed the motion to exclude the evidence, granting the defendant leave to use the reports for substantive purposes subject to a mid-trial voir dire.

A short adjournment was granted to allow the plaintiff to review the new surveillance.

The applicant was injured in a motor vehicle accident and sought statutory accident benefits for a chronic pain assessment and a neurological assessment, which the respondent insurer denied.

The Licence Appeal Tribunal found that both assessments were reasonable and necessary given the applicant's ongoing complaints of pain and headaches, preferring the recommendations of the applicant's assessors over the insurer's medical examiner.

The Tribunal ordered the respondent to pay for the assessments and interest on overdue benefits, but declined to order an award under O. Reg. 664, finding the insurer had properly considered the claims.