If someone has suffered a concussion and requires a diagnosis to prove it, there are many things Canadians need to know. First and foremost, if you are experiencing symptoms after a physical injury, visit your doctor as a concussion can only be diagnosed by a physician, nurse practitioner, or neuropsychologist. [1]
A concussion is a brain injury caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. In contrast, in an Accident Benefits claim, the insurer defines a concussion as an injury which has been explicitly diagnosed by a doctor. In a nutshell, this definition invariably seeks to deny a concussion has occurred if there is not a definitive diagnosis of concussion in a claimant’s medical file.
Brain Injury Classification
Brain injuries are classified as mild, moderate or severe. While severe and moderate brain injuries are often diagnosed by neuroimaging and/or severity scales, mild traumatic brain injuries (mild concussions) do not typically result in structural brain injury identified on diagnostic imaging such as CT or MRI scans[2]. As imaging is often unable to detect a mild traumatic brain injury, it is crucial for an individual to accurately report how they feel and for their healthcare practitioners to accurately record the complaints.
Common Symptoms of Mild Traumatic Brain Injury (Mild Concussion)
According to the Ontario Neurotrauma Foundation, there are common symptoms after a mild brain injury/concussion. These symptoms usually go away within a few days or weeks.
- Mild headaches (that won’t go away)
- Having more trouble than usual with attention and concentration
- Having more trouble than usual with remembering things (memory difficulties/forgetfulness)
- Feeling dizzy or sick without vomiting (nausea)
- Balance problems
- More difficulty than usual with making decisions and solving problems, getting things done or being organized
- Feeling vague, slowed or ‘foggy’ thinking
- Balance problems
- Tinnitus (ringing in the ears)
- Irritability/mood swings (losing your temper and getting annoyed easily)
- Anxiety or depression
- More sensitive to lights or sounds
- Change in sleep patterns (trouble sleeping or sleeping too much)
- Reduced tolerance to alcohol[3]
Please note: Most people will not experience all symptoms.
Please also note that: the above noted symptoms may be caused by internal/external factors other than a mild brain injury/concussion.
Self-Advocacy Resources
It is important for patients to honestly report their symptoms as fully and as accurately as possible to their healthcare professionals. As those who are suffering from a concussion may not be aware of the extent of their symptoms, having a family member or friend who can comment on unusual behaviour and symptoms attend healthcare appointments with the injured patient provides a significant benefit in accurate reporting and diagnosis.
When completing their clinical notes, many doctors note that a patient “may have suffered a concussion” and/or make a notation indicating “query concussion”. In both instances, these records fail to definitively diagnose a concussion. In many instances, when challenged by their insurer and/or the defendant, the client is unable to confirm a definitive concussion diagnosis as these notations consider the possibility that a concussion has occurred but do not confirm a concussion has occurred.
To assist healthcare professionals in accurately recording and diagnosing acute concussions, Dr. Gerard Gioia and Dr. Mickey Collins developed an Acute Concussion Evaluate (ACE) form which focuses a clinician’s assessment of a patient on concussion characteristics, symptoms, and risk factors.[4] If completed by a treating clinician, this would be a strong diagnostic tool for the proper assessment of a mild concussion. Should you wish to bring this assessment tool with you to a medical appointment, it can be found here.
Legal Team Advocacy
While you and your healthcare providers manage your care, early retention of legal counsel provides significant advantages for needed assessments and treatments which are typically not covered by OHIP and often quickly exceed collateral insurance coverage limits. With mild concussions typically resolving in two to four weeks, adjusters are anticipating early resolution of their files and will seek to end benefits as soon as reasonably possible. Reach out to our Personal Injury legal experts for any additional questions on the important of self-advocacy and definitive diagnosis if you or a loved one has had a concussion.
[1] Diagnosis & assessment of concussion/MTBI – Brain Injury Guidelines. (n.d.). Retrieved October 20, 2022, from https://braininjuryguidelines.org/concussion/fileadmin/Patient_Version_-_Updates_PDFs2019/1.Diagnosis_and_assesment_New__.pdf
[2] Rachel. (2020, December 11). Concussion. Brain Injury Canada. Retrieved October 20, 2022, from https://braininjurycanada.ca/en/concussion/
[3] Appendix 1 – Brain Injury Advice Card. (n.d.). Retrieved October 20, 2022, from https://braininjuryguidelines.org/concussion/fileadmin/media/appendices/appendix-1-3.pdf
[4] Gioia GA, Collins M, Isquith PK. Improving identification and diagnosis of mild traumatic brain injury with evidence: psychometric support for the acute concussion evaluation. Journal of Head Trauma Rehabilitation. 2008;23(4):230-42 as reproduced in: Acute Concussion Evaluation (ACE): Physician/Clinician Office Version, Guideline for Concussion/Mild Traumatic Brain Injury & Prolonged Symptoms, 3rd Edition, For Adults Over 18 Years of Age, Ontario Neurotrauma Foundation, appendix-1-1.pdf (braininjuryguidelines.org)
