GCS of 9 or Below as a Basis for Catastrophic Injury After an Ontario Accident

The Ottawa personal injury team at Auger Hollingsworth was recently successful at having our client identified as having suffered a catastrophic injury on the eve of a FSCO arbitration.  The insurer had denied that our client was catastrophically injured, despite the fact that she was noted to have suffered a GCS of 9 and below in the initial period after the accident.  The following is an excerpt from the legal argument we filed at FSCO.


The primary issue in this arbitration is whether Client  has suffered a catastrophic impairment under the Statutory Accident Benefits Schedule – Accidents on or after November 1, 1996, (“SABS”). Subsection 2(1.1)(e) of the SABS sets out the definition for catastrophic impairment as follows:

(1.1)  For the purposes of this Regulation, a catastrophic impairment caused by an accident that occurs before October 1, 2003 is, …

e.       brain impairment that, in respect of an accident, results in,

                                i.      a score of 9 or less on the Glasgow Coma Scale, as published in Jennett, B. and Teasdale, G., Management of Head Injuries, Contemporary Neurology Series, Volume 20, F.A. Davis Company, Philadelphia, 1981, according to a test administered within a reasonable period of time after the accident by a person trained for that purpose, or [emphasis added]

ii.      a score of 2 (vegetative) or 3 (severe disability) on the Glasgow Outcome Scale, as published in Jennett, B. and Bond, M., Assessment of Outcome After Severe Brain Damage, Lancet i:480, 1975, according to a test administered more than six months after the accident by a person trained for that purpose;

Source:            Statutory Accident Benefits Schedule – Accidents on or after November 1, 1996, O.Reg. 403/96, s. 2(1.1) (e) [Book of Authorities at Tab 1].


Issue 1: Catastrophic Impairment

 The opinion of the Riverfront assessors and the insurer in this arbitration is incorrect both in medicine (as set out by Dr. Marshall) and in law, as described herein.


  1. A.    The test for catastrophic impairment is a legal test, not a medical test.

The case law is clear that the test to be applied to identify catastrophic impairment is a legal test, not a medical one. The leading case on this issue is the decision of the Court of Appeal for OntarioLiu v.1226071 Ontario Inc. It is clear from this decision that the interpretation of the relevant subsection of the SABS requires the application of a legal definition, not a medical test.


Source:            Liu v.1226071 Ontario Inc, 2009 ONCA 571 at para. 27 [Book of Authorities at Tab 2].


In Liu, the Court of Appeal rejected the insurer’s argument that the fact that the claimant’s GCS rose from 3 to 12 within 33 minutes somehow took the claimant out of the section.  The Court stated:

[27]         In my view the answer to the respondents’ objection is the plain language of the legislation.  Provided there is a brain impairment, all that is required is one GCS score of 9 or less within a reasonable time following the accident.  It is a legal definition to be met by a claimant and not a medical test.


[28]         I agree with the appellant’s submission that the fact that there may have been other higher scores also within a reasonable time after the accident is irrelevant.


[29]         In my view the trial judge fell into error in equating the statutory test to a medical one.  It is not.


[30]         Any notion of catastrophic injury, other than the specific meaning ascribed to that term by the legislation must be discarded when considering whether a claimant meets the statutory test.   The statutory scheme creates a bright line rule which is relatively easy to apply. This enhances the ability of those looking to the definition to know what injuries will and will not be considered catastrophic. Having the same definition for both no fault and third party liability claims avoids inconsistency. The ease with which the rule can be applied adds an element of predictability which will facilitate the settlement of claims.


[31]         It matters not that there is some evidence – albeit disputed evidence – that the appellant is capable of managing his property, clothing, hygiene, shelter, safety and taking two trips toChina. Nor does it matter that his head injury was described as “moderate to severe” or “moderately severe”.


[32]         All that is required is a brain impairment and a GCS reading of 9 or below within a reasonable period of time after the accident. The appellant met both criteria on the trial judge’s findings and is entitled to recover damages for health care costs in accordance with the verdict of the jury [emphasis added].


Source:            Liu v.1226071 Ontario Inc, 2009 ONCA 571 at paras. 27-32 [Book of Authorities at Tab 2].


B.     The presence of hypotension does not invalidate the GCS reading


In Young v. Liberty Mutual, Arbitrator Allen rejected the notion that GCS readings obtained in the presence of confounding factors such as intubation, sedation and post-accident seizures were invalid.  The Arbitrator held that the legislature was presumed to understand that GCS readings would be influenced by post-trauma complications and yet chose not to create exclusions for these situations. As she held:

I find one must be able to assume the legislature was aware of these features of the GCS score when it chose it as a means to assess catastrophic brain impairment. Surely the legislature would not have intended to provide the GCS score as a measure of catastrophic impairment under circumstances where the very characteristics of this tool would rule it out as an appropriate measure. It cannot be intended by the legislature that the most seriously injured might not have the enhanced benefits available to them soon after the accident because their GCS scores were confounded by the severity of their injury. In the end, however, the GCS score is a tool medical assessors and adjudicators must work with in assessing catastrophic brain impairment.

I accept the Applicant’s view that a GCS score is not intended to project into the future the medical status of an applicant, but is rather a tool employed among medical practitioners to communicate the level of consciousness of a person who has sustained head trauma. It is employed under the Schedule as a measure of an injured person’s states of consciousness for a reasonable time after the accident in order to assess the level of brain impairment [emphasis added].


Source:            Young v. Liberty Mutual, 2003 FSCO A02-000695, at pp. 25 and 28 [Book of Authorities at Tab 4] aff’d 2005 FSCO Appeal Order P03-00043 [Book of Authorities at Tab 5] and 2006 CanLII 7286 (ON SCDC) [Book of Authorities at Tab 6].


Accordingly, in this case, the Riverfront assessors’ opinion that Client ’s significant hypotension would somehow invalidate her GCS reading is incorrect in law.


C.    The prognostic value of the GCS reading is not relevant


On appeal, the Director’s Delegate in Young v. Liberty Mutual, rejected the notion that a GCS reading would only be the basis for a finding of catastrophic impairment where the GCS reading was predictive of outcome. In that decision, it was held:

I agree with the arbitrator. Again, to return to the definition, “catastrophic impairment” means brain impairment that, in respect of an accident, results in a score of 9 or less on the Glasgow Coma Scale. None of the other provisions of the definition require a forecast of the insured’s future condition, so it is unclear why a forecast should be part of the GCS test. The definition on its face requires that the low scores result from a brain impairment, and accordingly the “reasonable period of time” requirement focuses on that point and not on a forecast. The matter would be different if, for instance, catastrophic brain impairment meant brain impairment resulting from GCS scores of 9 or less taken after a reasonable period of time. However, that would then start to resemble the GOS [subclause e(ii)] test, which does indeed look at the outcome of the insured after six months.

Source:            Young v. Liberty Mutual, 2005 FSCO Appeal Order P03-00043 at 25, 26 [Book of Authorities at Tab 5].

In Tournay v. Dominion of Canada General Insurance Company, it was held:

[The GCS] is not intended to be administered in the manner of an insurer’s examination by someone retained to give the insurance company an independent opinion on neurological function.  The GCS is a clinical test, pure and simple.  Thus, if a medically appropriate GCS test registers a score of “9 or less” within a reasonable time after the accident, where the brain impairment as a result of the accident is not contested, then, in my view, that must be taken as satisfying Section 2(1.1)(e)(i) of the schedule.

Source:            Tournay v. Dominion of Canada General Insurance Company, 2006 FSCO A05-000507 at 16 [Book of Authorities at Tab 8].


D.    A broad reading is to be given to the section


A broad and inclusive interpretation of this subsection of the SABS is appropriate.  The Honourable Mr. Justice Keenen in Holland v. Pilot Insurance Company states “This type of regulation is adopted by the legislature after extensive consultation with interested parties, including insurers.  If restricted meaning is to be assigned to the regulation, it should clearly be recited in the regulation itself.”

Source:            Holland v. Pilot Insurance Company, 2004 CanLII 13787 (ON SC) at para 24 [Book of Authorities at Tab 6].


It is respectfully submitted that Client  meets the test for catastrophic impairment. She sustained a brain impairment, which continues to impair her. She had a GCS reading of 9 or less in respect of an accident. The GCS reading was administered within a reasonable time after the accident. The readings were taken by persons trained for that person. Accordingly, all of the statutory pre-requisites are met.

Ottawa Injury Lawyer: Understanding the Glasgow Coma Scale

Ottawa Injury Lawyer: Understanding the Glasgow Coma Scale

If you or someone you know has been diagnosed with Traumatic Brain Injury (TBI) in Ottawa, you may have heard of the Glasgow Coma Scale (GCS), which is a system used by doctors to evaluate and diagnose the symptoms associated with TBI.


GCS: An Overview

GCS is a 15-point scale that helps doctors determine the severity of a patient’s brain injury.


Patients are evaluated in the following categories:


  1. Motor Response: Scores range from 1 (no motor response) to 6 (obeys commands fully)
  2. Verbal Response: Scores range from 1 (no verbal response) to 5 (alert, coherent, and oriented)
  3. Eye Opening Response: Scores range from 1 (no eye opening) to 4 (eyes opening spontaneously)


Interpreting GCS Results

The patient’s three scores are added up, and the final score helps to diagnose the injury.


Generally, the scores can be classified as follows:

13 to 15: Mild brain injury

9 to 12: Moderate brain injury

3 to 8: Severe brain injury


Many medical practitioners consider 8 to be the critical score, meaning that patients with a score less than or equal to 8 are often in a coma.


TBI Symptoms: Mild vs. Severe

A patient who receives a GCS score of 13 to 15 is typically diagnosed with a mild brain injury. Their symptoms, however, can still last one year or more and have a serious impact.


Common symptoms of mild TBI include:

–   Fatigue

–   Headaches

–   Memory loss

–   Dizziness or lack of balance

–   Inability to concentrate or pay attention

–   Seizures

–   Mood changes, including irritability or feelings of depression


Patients who score less than 13 on the Glasgow Coma Scale are typically diagnosed with a moderate to severe brain injury. The symptoms of moderate or severe TBI are wide-ranging and can affect all areas of a patient’s life.


These symptoms may include:

–   Difficulties speaking, concentrating, or remembering

–   Loss of vision or blurred vision

–   Loss of hearing or ringing in the ears

–   Seizures

–   Paralysis

–   Chronic pain

–   Sleep disorders

–   Changes in appetite

–   Emotional difficulties, including irritability, depression, aggression, or lack of awareness


Treatment and Recovery

GCS is an important tool in accurately diagnosing traumatic brain injury. Once the patient’s injury has been classified as mild, moderate, or severe, a proper course of treatment can prescribed. If you or someone you know has suffered from TBI as a result of an accident, be sure to consult an injury lawyer as part of your recovery process. A good injury lawyer can help you understand and settle the legal aspects of your injury.


To speak with an Ottawa personal injury lawyer at Auger Hollingsworth, please call us at 613-860-4529, email us at [email protected], or use our contact form.

Ottawa Injury Lawyer: Preventing Traumatic Brain Injury

Traumatic brain injury (TBI) is a serious injury, typically caused by a severe blow to the head. TBI has many different symptoms and can cause a wide variety of problems and disabilities for those affected.

While TBI cannot always be completely cured, and while the recovery process can be long and challenging, there are some important prevention methods that everyone should be aware of.


TBI: Common Causes

Traumatic brain injury can be caused by a wide variety of incidents. Some of the most common causes include the following:


–   Car accidents

–   Other transportation accidents, including bicycles and motorcycles

–   Slips and falls, including falling down stairs, falling out of bed, or slipping in the bath

–   Sports-related injuries, particularly involving high-impact sports like football, boxing, or skateboarding

–   Work-related injuries, often caused by working with unsafe equipment or on unsafe surfaces


Preventing TBI

While some incidents of TBI are nearly impossible to prepare for or avoid, there are some basic methods of prevention that can help individuals avoid serious injury.


Here are some simple things everyone can do to help prevent TBI:

–   Always wear a seatbelt when riding in a car or other vehicle

–   Never drive while under the influence of alcohol or drugs

–   Follow speed limits and take proper precautions while driving

–   Make sure that children are properly restrained in a car seat or booster seat while riding in a vehicle

–   Always wear a helmet when riding a bicycle or motorcycle

–   Always wear a helmet and proper protective equipment when participating in any kind of contact or extreme sports (including activities like skiing or skateboarding)

–   Hold onto railings when walking up or down stairways

–   Ensure there is adequate lighting when walking up or down stairways

–   Do not stand or sit on unsafe or unbalanced surfaces

–   Always be aware of your surroundings, and always use common sense


Unfortunately, even if you do everything right, accidents do happen and injuries like TBI cannot always be prevented. If you or someone you know has been affected by a traumatic brain injury as a result of an accident, be sure to contact an injury lawyer, who can help you navigate any complicated legal implications of your situation. A good injury lawyer will help ease some of the stress associated with a complex injury like TBI.


To speak with an Ottawa personal injury lawyer at Auger Hollingsworth, please call us at 613-860-4529, email us at [email protected], or use our contact form.

Ottawa Injury Lawyer: What is Traumatic Brain Injury?

Traumatic brain injury (TBI) is a serious injury caused by an external force severely damaging the brain. It can often lead to serious disabilities or even death. Because TBI affects the brain, it is completely different than injuring another organ or limb. Our brains are connected to all aspects of our being, including cognitive functions and our personalities. Thus, TBI is not just a matter of physical injury, but can also have severe mental implications, making the recovery process much more complicated and uncertain.



TBI is typically caused by a severe blow to the head. Common causes of TBI include:

–   Car accidents and other transportation accidents, including bicycles and motorcycles

–   Sports and recreation-related accidents

–   Slips and falls, particularly among children

–   Work-related accidents


Signs & Symptoms

Because TBI is such a complicated injury, its symptoms can be varied and widespread. However, some of the most common symptoms of TBI include:

–   unconsciousness

–   convulsions

–   headache

–   vomiting or nausea

–   dizziness or lightheadedness

–   lack of balance or coordination

–   blurred vision

–   fatigue or lethargy

–   slurred speech or difficulty speaking

–   weak or numb limbs


There are also non-physical symptoms that may occur, including:

–   changes in mood or behaviour

–   confusion

–   trouble concentrating or remembering

–   difficulty focusing, paying attention, or thinking



TBI is typically diagnosed by a doctor through a physical or neurological examination of the patient, often including verbal or cognitive tests to determine the mental implications of the injury. Doctors may also order an MRI or a CT scan to determine the extent of the injury.


The Glasgow Coma Scale is a system that evaluates a person’s conscious state and level of consciousness following a head injury. It can help determine the severity of a brain injury and help doctors prescribe the proper course of treatment. The Glasgow Coma Scale evaluates a patient’s visual, verbal, and motor response to different stimuli and assigns a score based on each response. This score helps doctors identify the severity of the patient’s brain injury and make an accurate prognosis.


Treatment & Recovery

Recovering from TBI can be a long and difficult process. It is crucial to begin treatment as soon as possible in order to minimize the damage to the brain. Treatment itself depends on the severity of the injury and the state of the patient.


Treatment options may include:

–   Antibiotics to prevent infection

–   Surgery to reduce swelling of the brain or remove broken skull fragments

–   Rehabilitation to help patients regain brain function, including speech and mobility


If you or someone you know has suffered from TBI as a result of an accident, it is important to consult a good personal injury lawyer. To speak with an Ottawa personal injury lawyer at Auger Hollingsworth, please call us at 613-860-4529, email us at [email protected], or use our contact form.

Ottawa Brain Injury Lawyer: Suffered a Brain Injury in Ottawa?

Ottawa Brain Injury Lawyer: Suffered a Brain Injury in Ottawa?

OTTAWA PERSONAL INJURY LAWYER – Have you suffered a traumatic brain injury in an accident caused by someone’s negligence?  Ottawa personal injury lawyer and brain injury lawyer Brenda Hollingsworth has posted some valuable information for brain injury victims.

If you or a loved one have an acquired brain injury as a result of a motor vehicle accident, a serious slip and fall accident, a mishap in a store or other act of negligence, you should speak to a brain injury lawyer without delay.  The accident lawyers at Auger Hollingsworth can assist you to advance a claim for damages and can help you to ensure that you receive all the statutory accident benefits to which you are entitled.

A brain injury may fundamentally alter the course of your life.  Make sure you receive professional advice on your legal rights.  Call us at 613 860-4529 or email us at [email protected]

Ottawa Car Accident Injuries – Brain Injury

Ottawa Car Accident Injuries – Brain Injury

Common Symptoms of Traumatic Brain Injury

Physical Symptoms

  • seizures of all types
  • muscle spasticity
  • double vision, blurred vision or low vision
  • blindness
  • loss of smell or taste
  • slow or slurred speech
  • headaches or migraines
  • fatigue, increased need for sleep
  • balance problems

Cognitive Symptoms

  • short or long-term memory loss
  • slowed ability to process information
  • trouble concentrating or paying attention for periods of time
  • difficulty keeping up with a conversation, other communication difficulties such as problems finding words
  • spatial disorientation
  • organizational problems and impaired judgement
  • unable to do more than one thing at a time
  • a lack of initiating activities, or once started, difficulty in completing tasks without a reminder

Emotional Symptoms

  • increased anxiety
  • depression and mood swings
  • impulsive behavior
  • more easily agitated
  • egocentric behaviors, difficulty seeing how behavior can affect others

To learn more about brain injuries, visit any of the following links:


Contact the personal injury lawyers at Auger Hollingsworth by calling 613-233-4529 or completing our contact form.  We are happy to assist you with your brain injury compensation.

Ottawa, Ontario Brain Injury Lawyer, Acquired Brain Injury, Traumatic Brain Injury

Ottawa, Ontario Brain Injury Lawyer, Acquired Brain Injury, Traumatic Brain Injury

The Ontario brain injury lawyers at Auger Hollingsworth have excellent experience representing people who have sustained traumatic brain injuries (TBI) and closed head injuries. Our Ottawa injury lawyers understand how these injuries affect the victims and the victims’s families.

Our Ottawa brain injury lawyers understand the causes and symptoms of traumatic brain injuries, mild, moderate and severe. We know how to deal with insurance adjusters, insurance assessors and others whose mandate it is to terminate your accident insurance benefits (Ontario statutory accident benefits).

Here are some of the symptoms commonly associated with a traumatic brain injury or closed head injury:

· Coma

· Cognitive Impairment

· Language and Speech Impairment

· Memory Loss and Impairment

· Conduct Disorder

· Personality Disorder

· Loss of Concentration

· Loss of Problem Solving Skills

· Perception Problems

· Sleep Disturbance

· Headaches

· Blurred Vision

· Seizures

A traumatic brain injury or closed head injury happens when your head is struck or when a force creates an acceleration-deceleration movement of the head, akin to whiplash.

Your brain may make contact with the inside of your skull bones, creating damage. It is important to note that often a person who suffers a traumatic brain injury may not lose consciousness.

Closed head injuries have several causes, including automobile accidents, truck accidents, bicycle accidents slip and fall accidents, motorcycle accidents, and other accidents..

Even if your MRI or CAT scan show normal results, you may still have a traumatic brain injury. Sometimes, a brain injury is diagnosed by a neuropsychologist followind different types of tests.

The Ottawa brain injury lawyers at Auger Hollingsworth understand that brain or head injuries take a serious toll on an individual’s ability to lead a normal life. Activities of dailing living are impacted. Changes in personality, whether subtle or severe, can impact your marriage, your family, and your friendships.

Some head injury patients cannot return to work, or return to work in a reduced capacity. The result is of course a serious loss of income and earning potential. Our Ottawa lawyers know how to develop your case to maximize your loss of income claim to ensure you are fairly compensated.

If you suffer a brain injury, you will also likely have future care costs. For example, you may need attendant care to assist you with your activities of daily living. If the injury was caused by a car accident, motorcycle accident, truck accident, bicycle accident, or pedestrian accident, there is often an Ontario Statutory Accident Benefits Claim (also called Ontario no-fault benefits) that will cover some or most of these expenses. The lawyers at Auger Hollingsworth can assist you to obtain the maximum compensation under the accident benefits.

The injuries from traumatic brain injuries are often permanent. Cases involving diagnosed brain injuries may result in substantial damages at trial or on a settlement.

If you or a loved one has sustained a traumatic brain injury in Ottawa or Eastern Ontario, contact Auger Hollingsworth to determine your legal rights. There is no obligation and the consultation is free.

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