Definition
Acquired brain injury due to external trauma means a definite diagnosis of new damage to brain tissue caused by traumatic head injury, resulting in newly developed significant neurological deficit that:
- results from an external trauma severe enough to have prompted the insured to seek a medical consultation in less than a week after the occurrence of said trauma
- is present and verifiable on clinical examination
- is corroborated by abnormal magnetic resonance (MR) and/or computed tomography (CT) brain imaging studies, that confirm brain trauma, and
- persists for more than 180 consecutive days following the date of diagnosis.
The diagnosis of acquired brain injury due to external trauma must be made by a specialist.
New neurological deficits must be detectable by a physician and may include, but are not restricted to:
- measurable loss of hearing,
- objective loss of sensation,
- paralysis, localized weakness,
- dysarthria (difficulty with pronunciation),
- dysphasia, (difficulty with speech)
- dysphagia (difficulty in swallowing),
- measurable visual impairment,
- impaired gait (difficulty walking),
- difficulty with balance,
- lack of coordination,
- new onset seizures undergoing treatment or measurable changes in neuro-cognitive function.
Headache or fatigue will not be considered a neurological deficit.
Headache or fatigue will not be considered a neurological deficit.
Exclusions
No benefit will be payable under this condition for:
- an abnormality seen on imaging studies of the brain without corresponding clinical impairment;
- neurological deficit without corresponding imaging study lesions,
- a concussion that does not have abnormal imaging studies.
Toronto Star article
Living with an ‘invisible disability’
Reprinted with permission - Torstar Syndication Services
