Did the accident cause the problem. What is the standard of proof?
The government and case law precedent redefine words and concepts which provide a context in which your reports
are read. Survivors can be deprived of the compensation
their injuries warrant when report writers fail to apply the
correct test for burden of proof to their opinions.
Proof that an injury is caused by an accident is not
based on certainty or beyond a reasonable doubt;
it is based on probability.
If your patient/client had a pre-existing condition or
circumstance which complicate the situation, the test
is whether the accident materially contributed to
the occurrence of the presenting problem.
When you are speaking of future developments
such as early retirement or surgery, the standard of
proof is "real risk" or "substantial possibility".
Future losses do not have to be certain or probable
to be compensable.
For insurance purposes, "Catastrophic" no longer has its ordinary dictionary meaning
Catastrophic is defined very specifically in the
regulations to the Insurance Act, as assessed in three
different time frames:
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Immediate post trauma:
GCS 9 or less, recorded in a reasonable time
by a qualified person
Paraplegia
Quadriplegia
Total & permanent loss of use of both arms or
both legs
Total & permanent loss of use of one arm and
one leg
Total loss of vision, both eyes
After six months:
vegetative or
GOS, severe disability:
Dependent for daily support by reason of
mental or physical disability,
Dependent on some other person for some
activities during every 24 hour period
After two years or once stable and not likely to improve with
treatment:
55% impairment of the whole person, or Class 4 or 5
impairment due to mental or behavioural disorder,
pursuant to the American Medical Association's guides
to Evaluation of Permanent Impairment, 4th edition.
When your patient/client meets one of the post-trauma
definitions of catastrophic, it is imperative that the
Application for Catastrophic be completed immediately
because access to and funding for services hinge on that
determination.
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