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.