Closed Automobile Insurance Third Party Liability Bodily Injury Claim Study in Ontario

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1 Page 1 Closed Automobile Insurance Third Party Liability Bodily Injury Claim Study in Ontario Injury Descriptions Developed from Newfoundland claim study injury definitions No injury Death Psychological impairment - This will include such diagnoses as post-traumatic stress disorder, depression, anxiety, insomnia. o Anxiety o Depression o Post Traumatic Stress Disorder (PTSD) Mental impairment Quadriplegia, Paraplegia, Hemiplegia, or other spinal injury - Quadriplegia includes complete and incomplete. Incomplete quadriplegia refers to partial motor and sensory loss. Complete quadriplegia refers to full motor and sensory loss. Paraplegia refers to paralysis of the legs and lower part of the body. Hemiplegia refers to paralysis of one side of the body. Head o Permanent brain injury - This condition occurs as the result of a head injury. It is the result of physical damage to the brain tissue. In this condition there is permanent impairment in the mental and emotional processes and their functioning. It imposes restrictions on the client s ability to carry out the activities of daily living. o Concussion - This refers to a head injury where there is post-traumatic loss of consciousness lasting less than 24 hours (usually much less). The individual is rarely unresponsive. This injury is of minor significance, although there may be minor deficits in memory, concentration, attention, and perception lasting up to three months. o Post-Concussion Syndrome - A constellation of symptoms that affects up to 50% of individuals following a mild head injury. These symptoms last beyond three months of the injury. Symptoms include persistent headaches, fatigue, balance disturbances, irritability, 1 P age

2 Page 2 impaired memory and concentration, etc. The cause of the condition is unknown and it may persist for months or years. It does not respond well to any kind of treatment. o Scalp Avulsion/Laceration Head/Brain Injury Face o Laceration with scar o Laceration with no scar o Jaw Fracture o Loss of Teeth o Temporomandibular Joint Dysfunction (TMJ) - This may impede chewing, affect speech, cause lower facial deformity, and produce pain. o Tooth/Jaw Other Injury Neck (choose the most severe applicable category) - This may be referred to using the following terms: whiplash, whiplash associated disorder (WAD), a cervical strain, soft tissue injury (STI), etc. Neck strains/sprains will be further broken down into three categories dependent on the severity of the symptoms and signs. o Mild strain, sprain or soft tissue injury - This includes WAD(Whiplash Associated Disorder) I and II. Neck symptoms only (WAD I) - Symptoms may include complaints of pain in the neck (one or both sides), stiffness, and tenderness. There are no physical signs. Symptoms may be delayed hours or to the next day. Resolution is expected to start in days. Recovery to usual activities is usually in six weeks or less. Neck symptoms and musculoskeletal signs (WADII) - Symptoms usually include pain in the neck, one or both sides, and there may be pain in the arms. These start within minutes to a few hours. Signs include muscle spasm and /or decreased range of motion. X-rays may show spasm. Resolution may linger for months, but most resolve in ninety days. o Moderate strain, sprain or soft tissue injury - Neck complaints and neurological signs (WAD III) - These may include absent reflexes, weakness and sensory deficits. Symptoms usually start immediately. Radiating shoulder and arm symptoms soon follow. Neurological deficits are found on examination. These symptoms may linger for months and there may be recurrences or chronic symptoms. Medical aid treatment may be required for up to one year. 2 P age

3 Page 3 o Severe strain, sprain or soft tissue injury - Neck complaints and fracture or dislocation (WAD IV) - In this case there is a fracture without spinal cord injury. Symptoms can start instantly. Neck weakness can be found. Radiation of symptoms to shoulder and arms are variable. The eventual outcome is variable ranging from complete recovery to long-term complications. Back (choose the most severe applicable category) - This includes injuries to the thoracic spine (upper back) or to the lumbar spine (lower back). Common terms to describe these injuries include soft tissue injury (STI), mechanical back pain, musculoligamentous injury, etc. Again we further divide this group into three categories according to the severity of the injury. o Mild strain, sprain or soft tissue injury - Back symptoms with or without musculoskeletal signs - Symptoms include complaints of pain in the back (upper and/or lower) with or without stiffness or tenderness. There may be buttock and/or leg pain. Symptoms may start within minutes or be delayed for hours or even the next day. Physical exam may show decreased range of motion and spasm. Resolution may start within days with most returning to usual activities in 90 days. o Moderate strain, sprain or soft tissue injury - Back complaints and neurological signs. This may include absent reflexes, weakness and/or sensory disturbances. Symptoms usually start immediately. Pain often radiates below the knee into the calf and/or foot. Symptoms may linger for months and there may be recurrences or chronic symptoms. Treatment may be required for up to a year. This will include disc injuries. Terms used in diagnoses include sciatica, nerve root impingement, disc prolapse, etc. o Severe strain, sprain or soft tissue injury - Back complaints and fracture or dislocation - In this case there is a fracture without spinal cord injury. Symptoms can start instantly. There may or may not be disc injury or nerve root impingement. Radiation of symptoms to the legs is variable. Again the eventual outcome is variable ranging from full recovery to long-term complications. Chest and Ribs Internal - e.g. lung, heart, reproductive organs, loss of spleen, gastrointestinal injury associated with loss of bowel, kidney damage o Internal organ injury where surgery was required 3 P age

4 Page 4 Shoulder o Strain/Soft tissue - This includes rotator cuff strains and tears, acromio-clavicular strains, shoulder dislocations, frozen shoulder, bursitis, tendonitis, etc. Arm o Laceration o Loss of one arm o Loss of both arms o Laceration arm injury Elbow Wrist and Hand of wrist or hand o Loss of one hand o Loss of both hands o Laceration of wrist or hands o Loss of fingers o Strain of the wrist or finger wrist or hand injury 4 P age

5 Page 5 Pelvis and Hip Leg Knee o Loss of one o Loss of both legs o Laceration o Soft Tissue/Sprain/Strain - This may include injuries such as meniscal tears, collateral ligament tears/strains, cruciate ligament tears, patellofemoral syndrome Ankle and Foot of ankle of foot o Loss of one foot o Loss of both feet o Sprain of ankle or foot o Laceration of ankle or foot ankle or foot injury Burns Fibromyalgia - A chronic musculoskeletal disorder of uncertain cause characterized by chronic widespread pain and multiple tender points. 5 P age

6 Page 6 Chronic pain - A term given to longstanding complaints of trauma-induced discomfort and pain that have persisted beyond the expected healing times and have resisted more conservative and traditional health care intervention strategies. Pain has lasted at least six months. Subluxation Permanent loss of a sense (taste, smell, sight, touch or hearing) Other disfigurement - This may be caused by the injury itself or be the result of surgery Other Injury 6 P age