How Unclear Emergency Department Medical Records Can Lead To Denied Claims

05/28/2019 09:00 - Canada, Ontario, Toronto - (PR Distribution™)

According to a 2018 federal survey on sports-related concussions, Canadians are woefully uninformed about the risks, symptoms, and treatment practices. While 97% of Canadians understood that concussions were a serious medical concern, only 51% knew where to find information about them. Just 46% reported knowing what to do if someone becomes concussed, while just 40% believed they could recognize the symptoms. This all plays a large role in our public consciousness around concussions, how a diagnosis is carried out, and how we approach recovery.

Sophie M., is a perfect example of a lack of knowledge hindering recovery and limiting access to benefits. A senior investigator at a research institute, she hit her head on a summer long weekend. She slipped on her friend’s dock while getting out of their boat, and hit the back of her head against the wood, blacking out for nearly a minute. When she came to, her friends quickly took her to the hospital to make sure everything was alright. The emergency doctor did an ultrasound and found a minor contusion, but told Sophie all she needed was to rest for a day or two and then she could get back to work as normal.

Her symptoms immediately following the traumatic brain injury (TBI) included dizziness, nausea, confusion, and blurred vision. In the days following, the confusion started to settle, but she became more photosensitive and nauseated, with increased dizziness that made getting to work impossible. She couldn’t focus, was getting easily confused, and, for large periods during the day, couldn’t read or write.  

She took another week off and went to visit her family doctor who gave her some more information. The contusion was a visible sign of a concussion, and she should have been spending this entire time resting instead of returning to work. The doctor warned that, without adequate rest, the concussion could get worse and even lead to post-concussion syndrome (PCS) which can take several months to treat as opposed to several weeks.  

“Misinformation with certain conditions, especially invisible illnesses like a concussion, can lead to very dangerous, long-term problems,” said Wendy Share, Executive Director at Share Lawyers. “The majority of Canadians are grossly uninformed when it comes to concussions. Given this and that the federal survey only reflects sports-related injuries, approaching treatment incorrectly can put people who suffer a concussion at serious risk of post-concussion syndrome and, potentially, long-term brain damage.”  

The misinformation can also lead to denied disability claims. Sophie was referred to a neurologist and decided to apply for short-term disability. Unfortunately, her claim was denied with the insurance company stating there was insufficient medical evidence, unclear medical records from the emergency department that only mentioned a contusion of the brain, and that, by returning to work after the injury, she was not ill enough to merit the benefits.  

Unfortunately, insurance companies take returning to work very seriously, seeing it as a clear indicator of physical ability and wellness despite clients often returning to work due to incorrect diagnoses, or a lack of awareness as to their new limitations.

Knowledge is power in more ways than one. The more we know and understand about invisible illnesses such as concussions, the more carefully we can approach recovery and treatment. If you or someone you know has suffered a concussion, have them see a sports medicine doctor immediately in order to move forward with education and adequate treatment.  

*All client names and identifying details have been changed to protect the confidentiality of all involved. 

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