Post-Concussion Syndrome and Disability Claims

​​This blog will discuss concussions, what post-concussion syndrome is, safety issues, 15 safety tips you can use all year-round and what to do if your disability claim has been denied.

What is a concussion?

Most people associate concussions with contact sports or combat, but a concussion could also occur as a result of a car accident, bicycle accident, slip and fall or an event that causes a blow t the head or violent shaking or movement of the head.

A concussion is a considered to be a mild traumatic brain injury. It is felt that most people who experience a concussion will make a recovery, but there are people who do not fully recover and are left with residual symptoms that interfere with several aspects of their lives, including the ability to manage their duties at work. Generally, symptoms of a concussion occur within the first 7-10 days.

What is post-concussion syndrome?

According to the Mayo Clinic, you do not have to lose consciousness in order to have a concussion or experience post-concussion syndrome. As well, the severity of the blow to the head doesn’t appear to be related to the development of post-concussion syndrome.

Symptoms of post-concussion syndrome can include fatigue, irritability, anxiety, insomnia, headaches, dizziness, ringing in the ears, loss of concentration and memory, blurry vision, noise and light sensitivity.

There is no one specific treatment and doctors will usually treat the specific symptoms you are experiencing.

It is felt that certain factors have been found to be more common in those who do develop post-concussion syndrome including significant life stressors, a history of depression or anxiety, post-traumatic stress disorder, or poor coping skills.

Concussions and Safety

It is important to practice safe driving and cycling and always make sure your vehicle/motorcycle/bicycle is in proper working order. It is recommended that you wear a helmet while riding your bike. If you ride a motorcycle, you should be wearing an appropriate and properly fitting motorcycle helmet and proper protective clothing.

As we can sometimes have dramatic fluctuations in weather, it is important to consider safe walking. Even in the summer months, where we can experience severe thunderstorms and flooding due to heavy downpours, it is important to consider proper footwear. Wet weather can mean wet floors and wet carpeting inside malls and stores or other commercial premises, making it dangerous. Wet weather can make using an outdoor staircase dangerous, particularly if there is poor lighting. Poor visibility can also make it difficult to notice cracked or broken curbs or sidewalks outside your house, someone else’s house, a mall, a store or public facilities.

Safety Tips

Here are some general safety tips you can consider all year round, whether you are walking, cycling, driving a car or riding a motorcycle:

1. Make use of apps like Google Maps: Plan your route in advance so you won’t have to rush and so you are aware of areas with heavy traffic.
2. Always pay attention to your surroundings: Be on the lookout for hidden driveways and cyclists or pedestrians coming out of these driveways and pedestrians walking out from parked cars/between parked cars.
3. Watch out for debris on roads, driveways and in parking lots.
4. Watch out for debris on sidewalks, stairs or on floors.
5. Watch out for ice, snow, and untreated areas when walking outside and for wet or slippery surfaces inside a store/mall.
6. Watch out for slippery, untreated surfaces when driving.
7. Be visible to drivers when you are a pedestrian: Wear reflective clothing at night and cross at intersections and crosswalks and put the hood down.
8. See and be seen when operating a bicycle: Make sure you have a reflective light/reflective clothing.
9. See and be seen when operating a car: Make sure your lights are turned on and you use turn signals to indicate your intentions.
10. Keep your distance: Don’t drive too close to a car if you are operating a motorcycle or bicycle.
11. Wear a helmet when riding a motorcycle or bicycle.
12. Be distraction free: Don’t drive or ride distracted! When you are distracted, you put yourself and other road users at risk.
13. Don’t be a pedextrian: When crossing at an intersection or crosswalk, pay attention and put the phone down. It is important to watch where you are walking.
14. Turn down the music: If you are walking and listening to music, turn down the music or turn off the music while you are crossing the road.
15. Don’t drive or ride while impaired: You put yourself and other road users at risk.

So why would an insurance company deny your claim?

A traumatic brain injury is considered to be an “invisible illness” and when it comes to disability claims, it is not uncommon for claims to be denied on the basis of “lack of objective medical evidence” or because it is felt you are not receiving appropriate treatment. Post-concussion syndrome results in numerous symptoms, but there is no diagnostic imaging or bloodwork to confirm it.

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When a disability claim is for an “invisible illness”, it is important to show the insurance company that you have persistent, ongoing symptoms that interfere with your day to day functioning and that if there is recommended treatment, you are following the treatment. The insurance company wants to see that you are under the care of an appropriate doctor and following a course of treatment that makes sense for your condition.

What can I do about my denied claim?

• You do have the option to fight your insurance company’s decision to deny your claim, regardless of whether it was a denial at the outset of the claim, or at any point during the claim.
• You can appeal the decision with new medical information that has not been submitted, but this may prolong the process and you may end up being denied again and again. Usually, you have the right to appeal up to 3 times.
• You have the option of starting a court action against your insurance company once your claim has been denied if you retain a lawyer. You can do this without submitting an appeal first.
• You should keep a copy of all correspondence received from your insurance company (and any correspondence you may have sent) so you can provide this to your lawyer at the initial consultation so that he or she has all the details needed to start the court case.
• When you retain a lawyer as soon as possible, you can fight the insurer’s decision and your lawyer is able to issue what is known as a statement of claim against the insurance company to start the court action on your behalf.