The 3 Under-Examined Injuries That Can Justify More Than “Minor Injury” Compensation

Healthcare professionals play a key role in helping their patients recover from the injuries they receive in a motor vehicle accident.

Whether you are a physician, chiropractor, occupational or physical therapist, psychologist, optometrist, or speech therapist, you play a key part in the recovery of an injured person. You must not only assess the injuries but determine their extent and recommend both, a treatment plan as well as an assessment of the long-term impact of the injuries.

From the standpoint of your patients, the law creates roughly four broad categories of the types of injury someone sustains as part of the process of determining the damage they suffered. Given that the legal landscape of Ontario’s Statutory Accident Benefits Schedule, commonly called SABS, keeps shifting we thought it would be useful to update you on a patient’s right to access treatment based upon your diagnosis and assessment.

SABS divides a patient’s injuries into four broad categories: Minor, Concussions, Chronic Pain, and Psychological.

What Are Minor Injuries?

According to SABS, a minor injury results from a sprain, strain, whiplash-associated disorder, contusion, abrasion, laceration or subluxation, and any clinically associated “sequelae.”

From the perspective of a healthcare professional, the Minor Injury Guidelines (Guideline) limits access to treatment.

Furthermore, the objectives of this Guideline are set out by the Financial Commission of Ontario (FSCO), in summary, the purpose of the Guideline is to:

• Provide speedy access to rehabilitation;
• Improve the utilization of health care resources;
• Provide certainty around cost and payment for insurers and regulated health professionals; and also
• Be more inclusive in providing immediate access to treatment without insurer approval for people with minor injuries.

This is the framework by which compensation for more major injuries are determined. Moreover, treatment for some “in-between” injuries fall under OHIP guidelines and, beyond this, some conditions will satisfy an insurer that your patient’s injuries are beyond MIG.

1. Concussions

As professional football and hockey leagues are discovering, Post-Concussion Syndrome is not only a complex medical issue but can have long-lasting effects on the brain. Not only is someone who suffers a concussion more likely to suffer another one, but there seems to be more than a causal link between multiple concussions, and both permanent brain injury and the early onset of dementia.

After a patient has been in a motor vehicle accident, obviously it’s important to discover early on whether the head suffered any impact because early detection of concussion symptoms is critical to your patient receiving treatment as part of their recovery without having to endure what can be lengthy delays under OHIP. As part of your patient’s recovery team, we need to have you make detailed clinical notes regarding their symptoms.

As a practical matter, an insurer and the court will look at how quickly your patient tried to mitigate the damages they endured as a result of suffering a concussion. Clinical notes help demonstrate this and will persuade an insurance company that the medical benefits a patient is entitled to go beyond those established in MIG.

2. Chronic Pain

Legally, chronic pain is broadly defined as lasting more than three months; while there are some technical exceptions to this, in most cases it is a reliable guideline.

Your ongoing reporting of a patient’s pain symptoms is crucial in the diagnosis of chronic pain syndrome. Frequently, patients will be unaware or unsure of how their physical injuries will have on their long-term recovery and well-being. The joint effort of both you and your patient during this process is key in understanding and identifying chronic pain syndrome. 

An insurer will want to see what steps a patient takes to mitigate their symptoms such as seeking second opinions from a chronic pain specialist or even a physiatrist. These will help substantiate the basis for a claim beyond the boundaries of MIG. The sources of medical benefits available to your patient once they are outside MIG require appropriate assessments, physical therapy, psychotherapy, and prescription medicine.

Unresolved chronic pain can be used to persuade insurers that your patient’s claim falls outside of MIG. This allows immediate access to treatment options available to chronic pain syndrome sufferers. We always encourage health practitioners to explore the effects of chronic pain on your injured patient as well as investigating other underlying symptoms that may stem from your diagnosis such as the psychological side effects of being in chronic pain.

3. Psychological Conditions

While the common perception of Post-Traumatic Stress Disorder (PTSD) is that someone suffers from it as a result of seeing someone killed, being in an area plagued by war or famine, or perhaps surviving an airplane crash, PTSD can occur after a serious car accident even if they survived.

Your patient may complain of psychological issues such as an inability to sleep well, anxiety, anger, and even the fear of driving or being a passenger. Such conditions warrant immediate assessments and access to treatments beyond MIG limits. Notably, OHIP does not cover psychological services for accident-related injuries.

In certain situations, early detection and diagnosis of psychological symptoms and impairments help accident victims recover faster from their injuries. In most cases, the initial assessment of a psychological impairment is provided by the family physician. This initial assessment is critical in paving the way towards addressing psychological injuries as a result of the accident.

In cases where psychological conditions go undiagnosed, they may result in serious, ongoing impairments such as the inability to return to work or your patient not being able to successfully reintegrate back into their social sphere. Health practitioners should be aware of leaving psychological injuries untreated. These might include depression, PTSD, mood disorders, an inability to concentrate, and headaches. Your role is essential in identifying the underlying cause and making appropriate recommendations and referrals.

Working with You

In many respects, the lawyers at Gosai Law are your partner in helping your patient recover as fully as possible from a motor vehicle accident. We each want to make sure that an individual has access to whatever medical benefits are appropriate to complete their recovery. If you have any questions, feel free to call us at 905.595.2225.

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