Champions With Heart.

Accident Benefits Update: LAT Examines Glasgow Coma Scale As Category

In a recent decision of the Licence Appeal Tribunal, E.W. v Primmum Insurance Company, the applicant, E.W. had been seriously injured in a single vehicle collision while under the influence of alcohol.  He suffered extensive orthopedic injuries requiring ongoing rehabilitation to the point that he exhausted his monetary limits under the Statutory Accident Benefits Schedule (SABS).  As a result, he applied for a determination of Catastrophic Impairment (CAT), which if accepted, would provide greatly enhanced medical benefits.
Immediate grounds for a CAT determination exist where an insured suffers a brain impairment that results in a score of 9 or less on a test of cognition known as the Glasgow Coma Scale (GCS) within a reasonable time after the accident. E.W. based his CAT application entirely upon a GCS of 8T recorded immediately following his surgery.

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The Importance of Choosing the Right Team

In a recent decision of the Licence Appeal Tribunal (LAT), 17-007471 v RBC General Insurance Company (2018 CanLII 83526), the applicant, a pedestrian, was struck by a reversing car in a parking lot.  He suffered whiplash and other injuries, including aggravation of pre-existing shoulder pain.  RBC, his Accident Benefits insurer, determined that his initial injuries fell within the scope of the Minor Injury Guideline (MIG).  As a result, his medical benefits were subject to a cap of $3,500. Once the $3,500 was exhausted, the applicant sought additional treatment including ongoing Chiropractic care and a Psychological Assessment.  RBC denied these treatment plans, claiming that no evidence had been provided that the applicant’s ongoing impairments exceeded the definition of a “minor injury” under the MIG (which include a sprain, strain, whiplash associated disorder, contusion, abrasion, laceration or subluxation and any clinically associated sequelae).  The parties were unable to resolve their dispute which led to a hearing in writing.

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