Insurers Keep Trying to Put the CAT Back in the Bag. Don’t Let Them.

The accident benefits maze is difficult to navigate at the best of times. This is especially true for victims of a traumatic brain injury (TBI). The Ontario Government recognized this special vulnerability with a 2010 regulation that declared that any individual with a Glasgow Coma Scale (GCS) reading of 9 or less (as the result of a collision) is automatically deemed to be catastrophically impaired.

The purpose of this regulation was to create a “bright line” so that individuals with a GCS reading of 9 or less, did not have to jump through further hoops to be declared catastrophically impaired. That is not to say that TBI victims with a GCS above 9 are precluded from applying for a catastrophic determination, but merely that they will have a more difficult evidentiary burden when doing so.

Not surprisingly, insurers have been reluctant to accept the automatic catastrophic designation of TBI victims with a GCS of 9 or less. Insurers consistently dispute catastrophic designations, even in cases where there is a clear GCS reading of 9 or less.

Read more…