Challenges of Securing Accident Benefits for a Traumatic Brain Injury

doctor with print out of brain mrisTraumatic brain injuries (TBI) are some of the most common car accident injuries. These injuries can range from mild concussions to more severe injuries leading to permanent and irreversible brain damage.

However, current law makes it harder for Ontario car accident victims to obtain accident benefits for life-altering brain injuries. There are a lot of hurdles victims must jump through for their TBI to be considered a catastrophic impairment.

Below, we discuss the challenges in securing accident benefits for a traumatic brain injury in greater detail. Our lawyers are well-versed in Ontario’s statutory accident benefits and know what it takes to file a successful claim for compensation. The initial consultation is free of charge so there is no risk to you.

Talk to a lawyer today. Ph: (866) 320-4770.

Accident Benefits in Ontario for Traumatic Brain Injuries

Ontario’s Insurance Act outlines the Statutory Accident Benefits Schedule (SABS). The SABS is important when determining the amount of compensation available for car accident victims, including those who sustain a traumatic brain injury. However, you must prove your TBI is a catastrophic impairment.

Before June 1, 2016, legislation relied on the Glasgow Coma Scale, a simple test used to assess and define a brain injury. If a victim was distraught or unconscious after a car accident, he or she would be granted a catastrophic impairment designation and given access to accident benefits.

The current definition of a catastrophic impairment has since changed, limiting benefit amounts. Car accident victims with significant brain injuries no longer automatically qualify for a catastrophic impairment designation and access to medical, rehabilitation and attendant care benefits.

When is a TBI Considered a Catastrophic Impairment?

Since June 1, 2016, the criteria for a catastrophic impairment can be found under section 3.1(1) of the SABS. For a traumatic brain injury to be considered a catastrophic impairment, it must be confirmed by medical imaging and a Glasgow Outcome Scale assessment.

Medical imaging and the assessment must provide objective proof that the TBI has resulted in:

  • A vegetative state one month or more since the car accident
  • Upper or lower severe disability for six months or more since the car accident
  • Lower moderate disability one year or more since the car accident

Proving your injury fits these criteria can be challenging for car accident victims because the acceptable medical imaging required may vary based on the type of traumatic brain injury sustained. For instance, a victim with an intracranial contusion may need different brain imaging scans than a victim with cerebral edema.

Some victims who have sustained TBIs, especially in remote areas, may not have access to brain imaging technology after a serious car accident. This can limit their ability to get prompt and appropriate medical care. Any delay in treatment can be problematic. The brain injury may not only get worse and become life-threatening, but the insurance company may think you are not taking your injury seriously.

Additionally, the Glasgow Outcome Scale is generally only used six months post-accident to assess outcomes of a brain injury by degree of recovery. Depending on the severity of your TBI, this may mean an assessment at the six-month mark or twelve months post-accident.

If there are disagreements between a car accident victim and his or her insurance company over which standard applies, the assessment may need to be repeated later. This can also delay the claims process and your ability to secure accident benefits for your traumatic brain injury.

Making a Traumatic Brain Injury Catastrophic Impairment Claim

Proceeding with a brain injury catastrophic impairment claim can take a considerable amount of time and resources. That is why you should have an experienced and knowledgeable lawyer on your side.

A lawyer can help gather the evidence you need to build a strong case for compensation and guide you throughout the entire claims process from start to finish. For instance, he or she can help make sure that your traumatic brain injury is assessed six months post-accident and that you submit the catastrophic impairment designation certificate to the insurance company for examination in a timely manner.

Your lawyer could also have your TBI re-assessed if the insurer denies the designation. If it is necessary, he or she could file a dispute on your behalf with the Licence Appeal Tribunal (LAT). The LAT helps resolve disputes concerning compensation claims regulated by the provincial government.

Call to Learn More About Your Eligibility for Accident Benefits

If you have sustained a traumatic brain injury in a car accident, our Windsor-based vehicle accident lawyers at Greg Monforton & Partners are here to help. We have helped many car accident victims and their loved ones over the years secure accident benefits. To date, we have recovered millions of dollars on behalf of our clients. This includes $6.3 million for the victim of a severe brain injury.

Contact our firm today to schedule your free initial consultation. This meeting comes with no obligation to hire our firm. If you have a viable case, we charge nothing up front. We only get paid if you get paid.

Millions Recovered. Proven Results. (866) 320-4770