Every year, approximately 50,000 Canadians sustain brain injuries.

If a brain injury is the result of a motor vehicle accident, those victims are entitled to significant compensation. But being designated as catastrophically injured by a brain injury has become more difficult in Ontario – making it more difficult to receive the compensation you deserve.

If you or a loved one sustained a brain injury in a motor vehicle accident, you need to know how that’s defined. Knowing the process will help you prepare and gives you the best chance at getting the financial help you’ll need.

The New Definition of CAT TBI

Under the Statutory Accident Benefits Schedule (SABS), anybody involved in a motor vehicle accident is entitled to some compensation, regardless of fault. For people who are deemed catastrophically injured (CAT), the benefits available are significantly greater.

However, the definition of CAT changed on June 1, 2016. Meaning that, accidents that occurred on or after June 1, 2016 are subject to new definitions.

These new definitions have a major impact on serious injuries such as brain injuries. Under the new definition, a traumatic brain injury (TBI) is defined using very different criteria than what was previously used. Specifically, it uses the Glasgow Outcome Scale (GOS-E) as well as brain imaging.

Determining TBI Under the New Definitions

Prior to June 1, 2016, the Glasgow Coma Scale (GCS) was used to determine whether or not an adult had a brain injury as the result of a motor vehicle accident. Under this criterion, adults with a GCS score of 9 or less automatically qualified for CAT benefits. This was the primary metric used to define brain injury.

For accidents that occurred on or after June 1, 2016, the GCS is no longer used to determine brain injury. Instead, GCS was replaced with GOS-E, which is highly specialized and involves a significantly longer time period for diagnosis. That’s because the GOS-E is intended to be administered 6 months after the injury is sustained. That means that individuals who have sustained a brain injury are made to wait 6 months before they can be assessed.

In addition to the GOS-E, another requirement has been added to determine TBI for the purposes of CAT designation. That additional requirement is the need for a positive finding on medical imaging.

 

The Process

To receive a TBI diagnosis, adults over the age of 18 must meet the two criteria described above. Here we describe these criteria in more detail.

First, the injury must show positive findings on medical imaging. Medical imaging may be a computerized axial tomography scan, magnetic resonance imaging, or any other medically recognized brain diagnostic technology that is capable of indicating intracranial pathology. That intracranial pathology includes intracranial contusions or hemorrhages, diffuse axonal injury, cerebral edema, midline shift, or pneumocephaly and must, of course, have been caused by the accident.

In terms of the GOS-E criteria, patients can be assessed at one, six, and twelve months as follows. They are determined to have a TBI if:

  • at one month or more after the accident, they’re in a Vegetative State
  • at six months or more after the accident, they have Upper Severe Disability or Lower Severe Disability
  • at one year or more after the accident, they have Lower Moderate Disability

In order to meet this criterion, proving disability requires critical documentation. That documentation involves information about the patient’s pre and post-accident functioning, which must come from family and friends, attendant care assessments, and/or registered social worker notes. Functional changes that determine TBI involve level of dependence, shopping, work, travel, socialization, and leisure pursuits.

The Problem

These sweeping changes to determining CAT TBI are rife with problems. The largest of which is the time period in which a patient must wait to be assessed.

Because it is rare to have a rating of Vegetative State in a traumatically injured person one month after an accident, most individuals now have to wait six months from the date of their injury to even be administered the GOS-E. While these individuals would have automatically qualified under the previous criterion, they are now made to wait six months.

For individuals requiring significant medical-rehabilitative services, the costs and the inability to access accident benefits is detrimental. These individuals will now have to pay a portion of these expenses out of pocket until they can be assessed, which takes away from their recovery and exposes victims to safety and health risks. This is especially true if they cannot afford attendant care services and have to rely on public healthcare, which is incapable of providing the same level of required care.

The second issue with these changes is related to medical imaging. Prior to the change, the medical community agreed that a positive finding through medical imaging doesn’t necessarily indicate functional impairment or structural abnormalities. Medical imaging is also incapable of accurately predicting what the future needs of the patient might be.

Have You Suffered a TBI?

If you or a loved on suffered a brain injury as a result of a motor vehicle accident, you are entitled to significantly higher compensation through the SABS. However, the changes applied to the SABS in regard to the criterion for defining a CAT TBI now make it more difficult to receive that compensation.

Your best chance at receiving the benefits you deserve is to talk to a professional with experience in this matter. Contact Sharma Law and let us help you through this difficult time.

Every year, approximately 50,000 Canadians sustain brain injuries.

If a brain injury is the result of a motor vehicle accident, those victims are entitled to significant compensation. But being designated as catastrophically injured by a brain injury has become more difficult in Ontario – making it more difficult to receive the compensation you deserve.

If you or a loved one sustained a brain injury in a motor vehicle accident, you need to know how that’s defined. Knowing the process will help you prepare and gives you the best chance at getting the financial help you’ll need.

The New Definition of CAT TBI

Under the Statutory Accident Benefits Schedule (SABS), anybody involved in a motor vehicle accident is entitled to some compensation, regardless of fault. For people who are deemed catastrophically injured (CAT), the benefits available are significantly greater.

However, the definition of CAT changed on June 1, 2016. Meaning that, accidents that occurred on or after June 1, 2016 are subject to new definitions.

These new definitions have a major impact on serious injuries such as brain injuries. Under the new definition, a traumatic brain injury (TBI) is defined using very different criteria than what was previously used. Specifically, it uses the Glasgow Outcome Scale (GOS-E) as well as brain imaging.

Determining TBI Under the New Definitions

Prior to June 1, 2016, the Glasgow Coma Scale (GCS) was used to determine whether or not an adult had a brain injury as the result of a motor vehicle accident. Under this criterion, adults with a GCS score of 9 or less automatically qualified for CAT benefits. This was the primary metric used to define brain injury.

For accidents that occurred on or after June 1, 2016, the GCS is no longer used to determine brain injury. Instead, GCS was replaced with GOS-E, which is highly specialized and involves a significantly longer time period for diagnosis. That’s because the GOS-E is intended to be administered 6 months after the injury is sustained. That means that individuals who have sustained a brain injury are made to wait 6 months before they can be assessed.

In addition to the GOS-E, another requirement has been added to determine TBI for the purposes of CAT designation. That additional requirement is the need for a positive finding on medical imaging.

The Process

To receive a TBI diagnosis, adults over the age of 18 must meet the two criteria described above. Here we describe these criteria in more detail.

First, the injury must show positive findings on medical imaging. Medical imaging may be a computerized axial tomography scan, magnetic resonance imaging, or any other medically recognized brain diagnostic technology that is capable of indicating intracranial pathology. That intracranial pathology includes intracranial contusions or hemorrhages, diffuse axonal injury, cerebral edema, midline shift, or pneumocephaly and must, of course, have been caused by the accident.

In terms of the GOS-E criteria, patients can be assessed at one, six, and twelve months as follows. They are determined to have a TBI if:

  • at one month or more after the accident, they’re in a Vegetative State
  • at six months or more after the accident, they have Upper Severe Disability or Lower Severe Disability
  • at one year or more after the accident, they have Lower Moderate Disability

In order to meet this criterion, proving disability requires critical documentation. That documentation involves information about the patient’s pre and post-accident functioning, which must come from family and friends, attendant care assessments, and/or registered social worker notes. Functional changes that determine TBI involve level of dependence, shopping, work, travel, socialization, and leisure pursuits.

The Problem

These sweeping changes to determining CAT TBI are rife with problems. The largest of which is the time period in which a patient must wait to be assessed.

Because it is rare to have a rating of Vegetative State in a traumatically injured person one month after an accident, most individuals now have to wait six months from the date of their injury to even be administered the GOS-E. While these individuals would have automatically qualified under the previous criterion, they are now made to wait six months.

For individuals requiring significant medical-rehabilitative services, the costs and the inability to access accident benefits is detrimental. These individuals will now have to pay a portion of these expenses out of pocket until they can be assessed, which takes away from their recovery and exposes victims to safety and health risks. This is especially true if they cannot afford attendant care services and have to rely on public healthcare, which is incapable of providing the same level of required care.

The second issue with these changes is related to medical imaging. Prior to the change, the medical community agreed that a positive finding through medical imaging doesn’t necessarily indicate functional impairment or structural abnormalities. Medical imaging is also incapable of accurately predicting what the future needs of the patient might be.

Have You Suffered a TBI?

If you or a loved on suffered a brain injury as a result of a motor vehicle accident, you are entitled to significantly higher compensation through the SABS. However, the changes applied to the SABS in regard to the criterion for defining a CAT TBI now make it more difficult to receive that compensation.

Your best chance at receiving the benefits you deserve is to talk to a professional with experience in this matter. Contact Sharma Law and let us help you through this difficult time.