The Role of Expert Opinion in a Claim for Catastrophic Brain Injury
Classification of injuries. Hundreds of thousands of dollars in medical and rehabilitation benefits (up to $1 million dollars) – and other compensation – are at stake for those who have sustained catastrophic brain injuries.
Expert opinion and objective verification of injuries are essential for those who wish to pursue compensation for catastrophic brain injuries. An injury claim should provide extensive medical documentation and physician statements to substantiate your right to catastrophic-level benefits.
The Financial Incentive for Proving Your Loved One’s Claim
The Statutory Accident Benefits Schedule (SABS), under Ontario’s Insurance Act, classifies accident injuries into three categories:
- non-minor; and
The SABS provides guidelines in which claimants with catastrophic injuries have access to significantly more compensation and for a longer duration. Ensuring an accurate classification of your or your loved one’s catastrophic brain injury has a substantial financial impact.
- catastrophic brain injuries qualify for up to $1 million in the Medical and Rehabilitation Benefit (those with minor and non-minor injuries are limited to $3,500 and $50,000, respectively);
- minor injuries do not qualify for the Attendant Care Benefits, whereas those with a catastrophic injury may receive up to $1 million in benefits (non-minor injuries are limited to $36,000);
- there are no time limitations on receiving the Attendant Care Benefit for those with a catastrophic brain injury (non-minor injuries are limited to 104 weeks after the accident); and
- those with a catastrophic injury qualify for additional compensation, such as travel expenses and housekeeping.
With so much money on the line, the insurance companies demand substantial proof of injury. This includes expert opinion from medical professionals qualified to speak on the severity of your loved one’s injury.
How Expert Opinion Impacts the SABS Classification of Brain Injuries
Proving the existence of a catastrophic brain injury is particularly challenging because this injury may not visibly/physically manifest as other catastrophic injuries, such as spinal cord trauma or an amputation. Your claim must include medical evidence to illustrate the impact and extent of the injury.
The SABS use the GCS of under 9 and the Glasgow Outcome Scale (GOS-E) to determine whether a claimant has suffered what can be classified as a catastrophic brain injury.
This universal evaluation tool measures such things as:
- a patient’s responsiveness/consciousness;
- a patient’s ability to participate in independent activities; and
The medical experts involved in your claim must be able to speak to your loved one’s condition and likelihood of recovery. These points are crucial when classifying an injury.
Seek qualified experts with the training and credentials to diagnose and treat traumatic brain injury. Ensure the medical team understands the legal burden of proof involved in a motor vehicle accident claim.
You should be aware the insurance company may provide its own medical experts to verify the extent of brain injury and whether it qualifies as catastrophic. You may schedule a free case evaluation with a brain injury lawyer to discuss your loved one’s case and determine how to substantiate your claim. Call the Preszler Injury Lawyers in Ontario at 1-800-JUSTICE® today.