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Archive for the ‘Serious Injuries’ Category

A Depression Gene, Stigma, Psychotherapy, Relationship between Concussions and Depression

Monday, January 21st, 2013

The search for a depression gene came up empty. A group of 86 researchers were hoping to discover genetic influences linked to depression while studying approximately 34,500 volunteers. Since depression runs in families, many experts believe that there must be a genetic connection. Research failed to demonstrate any specific genes that cause depression. After raising the number of study subjects to over 51,000, only one spot in the whole genome was tied to depression, but it was not close to any genes. The study had focused on patients with symptoms of depression. The study’s authors are considering trying again on a larger scale, this time focusing on patients who have a confirmed diagnosis of depression.

What prevents people from seeking treatment for depression and mental health treatment? Psychotherapy takes time and effort. There is stigma attached to seeking treatment for mental illness. People are hesitant to admit that they attend therapy sessions. Society places illogical taboos and stigmas around mental illness, therefore many people feel ashamed about their diagnoses or symptoms. Another factor that can prevent someone from seeking treatment is severity- he or she may not realize how severe the symptoms are and may feel that therapy is not warranted. The will to get started and knowing how and when to start is another factor.

Research has shown that, in some instances, there are legitimate biological scenarios that cause secondary illnesses that would not exist in individuals otherwise. Researchers in Denmark at the University of Copenhagen were able to isolate an enzyme called C-Reactive Protein (CPR), that when present in high concentrations can cause depression, using a blood test to isolate a specific protein in the bloodstream. It was through this line of research that they found a relationship between depression and arthritis. It was noted in the past patients with inflammation or arthritis may have been simply “written off” by their doctors as upset due to the physical pain and limitations.

This new research has showed that those patients with higher levels of the CPR protein (which is released by inflammation/inflammatory conditions), were 2-3 times more likely to develop depression. It is not clear though, whether inflammation causes depression or the other way around.

An article released on the Time.Com website concerning the link between concussions and depression explains how sustaining a concussion can make one more vulnerable to depression. Two studies were conducted on  retired NFL players.  The first study, which has already been released found that the former players who are depressed or cognitively impaired have abnormal findings in a specific area of the white matter of their brains.  White matter is critical for transmitting signals. The American Academy of Neurology reports that a higher number of concussions equates to a higher likelihood of depression. Neurologist, Dr. John Hart, who was active in both studies, said that these studies apply to everyone who is affected by concussions, not just professional sports players. He said anyone who has suffered a concussion should be monitored for signs of depression. Depression is manageable, but only if doctors know how to diagnose and treat it properly.

 

Aaron Waxman and Associates is a Toronto Personal Injury Law Firm that focuses solely on the rights of injured persons. We advocate for your rights. We provide a free initial consultation.

 

Pastore v. Aviva Canada Inc. – Definition of Catastrophic Impairment broadens, victory for the plaintiff’s bar

Thursday, October 11th, 2012

The Ontario Court of Appeal finally released its decision in Pastore v. Aviva Canada Inc. It’s been referred to as a “landmark decision on chronic pain”.

The OCA ruled that chronic pain is a psychological condition that can produce a catastrophic impairment, thereby entitling accident victims to enhanced medical benefits.

The unanimous decision of the Court means will allow claimants with severe psychological impairments to access much-needed benefits beyond standard accident benefits.

The Court of Appeal overturned the lower court’s decision that would have denied the plaintiff, Anna Pastore access to extended benefits.

Pastore v. Aviva concerns a woman who was struck as a pedestrian in November 2002 and injured and broke her left ankle, which never healed properly, leading to numerous surgeries and an eventual knee replacement.

Prior to the accident, she was the primary caregiver to her husband of over 35 years, who was receiving chemo-dialysis.  The decision states that she is almost completely dependent on others for her most basis personal care needs.

Pastore applied for catastrophic determination in May 2005.

Pastore was assessed by a team of medical assessors to determine if she was catastrophically impaired. It was found that she had catastrophic impairment due to mental or behavioural disorder. She had class 4 or ‘marked impairment’ in terms of her activities of daily living and assigned her a class 3 (moderate impairment) with respect to social functioning, concentration, persistence and pace and deterioration or decompensation in work or work-like settings.

Aviva did not accept the findings of the assessment centre and this led to mediation and arbitration.

One major issue was whether marked impairment in one category was enough to lead to a catastrophic designation.

The arbitrator and the Director’s Delegate upheld the decision of the assessment centre and found that Pastore was catastrophically impaired. Aviva appealed this decision and the Divisional Court sided with Aviva, stating that the Guides portion of the Statutory Accident Benefits Schedule (SABS)  requires all four categories to be considered as marked impairments in order for a person to be deemed as catastrophically impaired.

The Ontario Court of Appeal disagreed and overturned the Divisional Court’s decision, siding with the original decision, stating that the American Medical Association’s Guides to the Evaluation of Permanent Impairment language did not specifically require all four categories to be considered marked impairments for a catastrophic impairment designation.

The role of pain was addressed within the context of the marked impairment test. The OCA concluded that a cumulative approach should be taken where it is not possible to factor out the impact of discrete physical impairment and associated pain limitations.

What the court is saying, is that pain can be considered within the marked test in cases where the pain is not cleared related to physical causes, but may be related to a mental disorder.

Aaron Waxman & Associates is a Toronto Personal Injury Law Firm that handles personal injury claims, including catastrophic cases.

Ontario Coroner’s Report on Pedestrian Deaths: No Jaywalking and Reduce Speed Limits

Thursday, September 20th, 2012

Ontario’s Deputy Chief Coroner, Dr. Bert Lauwers issued his report on pedestrian deaths on Wednesday, September 19, 2012, in collaboration with the Office of the Coroner.

The Report reminds us that we are all pedestrians.

According to the Coroner’s office, approximately 113 Ontarians die annually from pedestrian accidents.

The Coroner’s office suggested the following:

  1. Pedestrian deaths are more likely to occur during the months when daylight is shorter. (e.g. November to March).
  2. Pedestrian deaths are more likely to occur when a pedestrian and/or driver is using a mobile entertainment/communication device. (e.g. cell phone, ipod, etc.).
  3. Pedestrian deaths are more likely to occur when one or more persons involved in the collision are under the influence of alcohol and/or drugs.
  4. The vast majority of pedestrian deaths are preventable.

According to the Review on Pedestrian Deaths, in Canada, characteristics of pedestrian traffic are as follows:

  • 75% of pedestrian traffic fatalities occurred on urban roads;
  • 60% of pedestrians killed in traffic crashes were trying to cross the road;
  • 35% of fatally injured pedestrians were aged 65 or older even though they represent only 13% of the population;
  • 63% of pedestrians killed at intersections were 65 or older;
  • 6% of fatally injured pedestrians were under the age of 16 and of these, 20% ran out into the street;
  • 33% of fatally injured pedestrians acted in a manner which caused or contributed to the crash;
  • 33% of fatally injured pedestrians were struck by a driver who had committed a traffic infraction prior to the crash;
  • 60% of pedestrians were killed at night or during dim light conditions when they were not seen by drivers; and
  • 40% of fatally injured pedestrians had been drinking

The Coroner’s Office made 26 recommendations in the Report. Highlights of the recommendations include:

  • lowering speed limits in residential areas to 40 km/h
  • installing side guards on heavy trucks to help prevent people from falling beneath and getting crushed by the rear wheels
  • implementing a complete streets approach to guide the development of new communities and redevelopment of existing ones
  • creating an educational program for senior citizens and other adult pedestrians
  • creating an educational program for drivers

The Coroner found that 67% of pedestrian fatalities occurred on streets with a posted speed limit of above 50km/h.

Other significant factors for pedestrian deaths included jaywalking, inattentive motorists and distracted walkers.

It was found that nearly one third of pedestrians died while jaywalking.

The Report notes that in 14% of the deaths, driver inattention was noted.

Pedestrian distractions including dogs, smartphones and cellphones may have contributed to 20% of the fatalities.

Canada has a Road Safety Strategy according to the Report. The vision of the Strategy is to make Canada’s roads the safest in the world. Currently, Canada is ranked 10th in terms of fatalities per billion vehicle kilometers travelled compared to other member countries of the Organization for Economic Cooperation and Development.

The key elements of the Strategy are:

  • a downward directional trend in fatality and serious injury rates over the 2011 to 2015 period;
  • jurisdictions will adopt a holistic (Safer System) approach addressing the vehicle, the road infrastructure, and road users based on the primary risk groups;
  • an evidence-based Best Practice Framework will be adopted in choosing interventions;
  • a fluid and flexible approach will allow jurisdictions to adopt best practices appropriate to their situation; and
  • jurisdictions will own their road safety plans.

To achieve this, the Strategy seeks to target:

  • young drivers (16 to 24);
  • medically-at-risk drivers (e.g. those with heart disease or cognitive disorders such as Alzheimer’s Disease);
  • vulnerable road users (i.e. pedestrians, motorcyclists, bicyclists);
  • motor carriers (e.g. managers of carrier operations, truck and bus drivers);
  • high risk drivers (e.g. those who don’t wear seat belts or who speed, drive impaired, or drive without a valid license) and the general population.

Dr. Andrew McCallum, Chief Coroner for Ontario stated “A road safety paradigm shift will be necessary”, acknowledging that the rising cost of fuel will result in an increase in cyclists and pedestrians.

 

Aaron Waxman and Associates is a Toronto personal injury law firm. We handle various types of personal injury claims including motor vehicle accident, pedestrian, long term disability and critical illness claims.

Pre-existing conditions and Critical Illness Claims – Duke v. Clarica Insurance

Wednesday, September 5th, 2012

The Alberta case of Duke v. Clarica Insurance involves the denial of a critical illness insurance claim.

Mr. Duke was diagnosed with Parkinson’s Disease. He applied for critical illness through Clarica in 2001 and purchased a policy for critical illness coverage in the amount of $500,000. He submitted a critical illness claim on May 15, 2003, accompanied by an Attending Physician’s Statement. The Statement was completed by a neurologist.

He was advised that his claim was denied in September of 2003.

Parkinson’s Disease was a covered critical illness under the policy. Clarica stated that according to reports they had received, Mr. Duke’s medical history revealed symptoms of Parkinson’s Disease as early as 1997,  before the policy came into force, therefore they were denying the claim.

The Court was faced with the task of deciding two crucial issues, which can be applied to critical illness claims:

1. Is the Exclusion Clause Ambiguous?

2. Does the Plaintiff Qualify for Benefits?

The Court found that neither Mr. Duke or any of his treating physicians or assessors had associated his earlier symptoms with Parkinson’s disease prior to issuing the policy. The Court also found that the Plaintiff had no obligation to disclose these physical concerns at the time. They were generalized symptoms. The wording of the exclusion clause was found to be ambiguous and the Court found that it did not apply and that Clarica improperly denied the CI benefit.

With respect to the second issue, the Court deemed that Mr. Duke required substantial assistance in order to perform his activities of daily living and satisfied the criteria needed to require a critical illness benefit.

Mr. Duke was awarded damages in the amount $500,000, the amount of the critical illness insurance claim benefit.

Clarica appealed the decision and lost.

The judgement states: “Finally, it is agreed that the respondent was completely honest and forthright in his disclosure and did not in any way misrepresent or conceal his condition or his general state of health from the appellant, nor did he attempt to mislead the appellant.”

The full case can be found here: http://www.canlii.org/en/ab/abca/doc/2008/2008abca301/2008abca301.html

Aaron Waxman and Associates is a Toronto Personal Injury Law Firm. We handle critical illness insurance claims. If your critical illness insurance claim has been denied, contact us for a free, no obligation consultation.

Road Trips – Do You Drive Fatigued?

Saturday, July 28th, 2012

Road trips are very popular, especially in the summer.

Fatigued driving is known to be just as dangerous, if not more dangerous than driving while under the influence.

Angus Reid conducted the survey, known as the “Neglected Drive Survey’ and polled 1003 parents online from June 19-23, 2012 and found that 30% of men nod off behind the wheel, compared to only 14% of women. According to the poll, one quarter of men have swerved because they were tired, one third were worried about getting their family into a car accident because they were tired while driving.

These are frightening statistics, because you are only in charge of your own vehicle. The statistics are as follows:

  • 64% of men have continued driving on a road trip when tired
  • 24% of men said they have not paid close attention to the road because they were tired
  • 17% of men said they hoped they wouldn’t get into an accident and kept driving even though they were exhausted
  • 10% of men almost got into an accident because they were tired

When you notice your eyes are getting heavy, you  have to recognize the signs of fatigue and consider the safety of your family, and other drivers on the road.

Don’t fill up on coffee or short breaks. Caffeine is simply not a solution.

The survey results also noted that younger parents are more likely to continue driver vs. older parents, especially if their children aren’t in need of a break. Dads do most of the driving and are not keen on stopped unless a break is needed.

Aaron Waxman and Associates is a Toronto Personal Injury Law Firm. Contact us today for a free no obligation consultation.

 

Are You Prepared for Winter?

Tuesday, January 3rd, 2012

Although late, Winter has certainly arrived. Besides snow, we have to worry about freezing rain and what it does to our roads, both as a driver and as a pedestrian.

Driving in the Canadian Winter is hazardous if you are not prepared for it. In Quebec, it is mandatory to have winter tires on your vehicle. In Ontario, it is not. And we certainly see the rise of car accidents and pedestrian injuries and deaths in the winter time.

All Season Tires may sound like the right solution for driving in a country/province where we see “all seasons” but if you are using your tires all year round, you are wearing down the treads and reducing how well your tires work.

Winter tires help you stop fast, prevent your car from spinning and in essence, help prevent accidents. Winter tires have deeper treads to allow for better performance in snow, slush, on ice and wet and dry roads.

According to the Ministry of Transportation, All Season tires can begin to lose their grip below 7 degrees Celsius. Most people probably are not even aware of this fact. The MTO reccommends that you install 4 Winter tires, even on four-wheel drive vehicles, for best control of your vehicle.

How else can you drive safely this winter?

Useful Tips:

  1. Install 4 matching Winter Tires.
  2. Clean off all snow from your car- including your side mirrors.
  3. Defrost car thoroughly before leaving your driveway or parking lot- better to be safe than sorry.
  4. Be aware that it will take longer to stop in poor driving conditions and allow for extra stopping room.
  5. Avoid using overdrive and cruise control on slippery roads.
  6. Make sure your windshield wipers are in good condition and that you have enough windshield wiper fluid.
  7. Make sure your brakes are in good working condition.

Aaron Waxman and Associates is a personal injury law firm in Toronto that aims on providing quality services to our clients and useful, helpful information to our blog readers.

 

Chronic Pain in the News Part IV

Monday, January 2nd, 2012

In Germany, a new Pain Initiative has been developed with respect to treating chronic pain. Pain is a multi-dimensional condition that requires the involvement of a multidisciplinary team of healthcare professionals. The guide that was developed, by the CHANGE PAIN Advisory Board, called “Towards a multidisciplinary team approach in pain management” provides guidance for healthcare professionals on how to set up a multidisciplinary team. The guide is endorsed by the European Federation of IASP (International Association for the Study of Pain). According to the IASP guidelines, the team should include at least 2 physicians from 2 medical specialties and a clinical psychologist if one of the physicians is not a psychiatrist.  A pre-condition for a successful multidisciplinary team approach is clear referral pathways for primary care physicians. The primary care physician plays a large role in the treatment of the chronic pain patient.

The protocol is known as “CHANGE PAIN” and the guide is found here.

NBA Superstar Kobe Bryant travelled to Germany twice during the off season to seek treatments for his chronic pain in his knee and ankle. A new type of treatment has been developed for pain management. Bryant visited Dr. Peter Wehling, a molecular orthopedist in Dusseldorf for a new type of blood treatment. Dr. Wehling is the founder of the Centre for Molecular Orthopedics in Dusseldorf.  He developed a gene test to genetically screen patients to personalize their treatment and claims to have achieved a 90 percent success rate.

The therapy is called “Regenokine Therapy”, and it involves removing a small amount of blood from a patient.  Natural anti-inflammatory and pain inhibiting proteins are harvested from the blood, processed, and then injected back into the affected part of the body. Dr. Wehling calls the proteins the “body’s own medicine” and claims they can “stop inflammation of joints and nerve roots, regenerate joint cartilage and accelerate healing of fractures.” The therapy is not available in North America.

Bryant visited Wehling last summer to get treatment for his arthritic right knee. Bryant’s knee has troubled him for several years and he’s had three knee surgeries. The Lakers star returned to Dusseldorf in October to get his ankle treated.

Aaron Waxman & Associates is a Toronto Personal Injury Firm that handles all types of personal injury cases.

Bad Faith Claims Part 2: Duties of the Insurer and the Insured

Friday, December 30th, 2011

Previously we blogged about Bad Faith Claims, which are claims that arise when an insurance company has grossly mishandled the claim of its insured, the policy holder/policy member.

In this blog post, we will take a closer look at what duties the insurer has/is supposed to follow and look at what duties an insured person has as well.

Insurer’s Duties:

Duty to Assess the Evidence in a Balanced and Reasonable Manner: The insurer should assess the merits of the claim in a balanced and reasonable manner. The insurer cannot dismiss credible, alternative evidence that does not support its pre-conceived ideas.

Duty to Reasonably Interpret the Policy: Policy language must be reviewed and checked, the policy should actually be read.

Duty to Adequately Investigate: A timely and thorough investigation of the claim should be made before a claim is denied, this is essential where a claim for disability is being made under a long-term disability policy. Medical investigations are to be made and all reports are to be considered, from the insured person’s doctors as well.

Duty to Inform: The insurer has to inform the insured person of the nature and extent of the benefits that are payable to him/her, and assist the insured in the completion of the necessary documentation (provide instructions). When an insurer decides to deny a claim, there is a duty to properly inform that the denial has been made, the insured person should not be told or misled by stating “the matter is under investigation”.

In a lot of cases, we do see that insurance companies write to our clients and postpone the actual denial of benefits by saying that a final decision has not been made, the matter is under investigation pending further documentation etc. This is incredibly frustrating to our clients!

Duty not to misinform: For example, not providing a copy of the actual policy.

Duty not to Take Advantage of an Insured’s Economic Vulnerability: E.g. Submission- by trying to get the insured person to settle at an early stage in the claim, for a lesser amount than the claim is worth.

Duties of the Insured:

The insured person, as this is a contractual relationship has duties as well, to act in “Good Faith”.

Duty to be Honest: For example, in any type of disability policy, to disclose all relevant health information, all employment details, all previous claims, details of WSIB claims, anything that may be relevant. You do not want the insurance company to find out information about you any way except from you yourself.

Duty to Rehabilitate and Mitigate: You have the duty to attend rehabilitation (physiotherapy, massage etc), whatever type of therapy that helps you try to feel better. You must actively be under the care of a physician and actively be trying to get better. Mitigation refers to the attempt to return to work. You must try to return to work, and advise the insurance company of your attempts, even if unsuccessful.

Duty to Give Notice of a Claim in a Timely Manner: If you are seriously injured and believe you qualify for LTD benefits, you should not wait too long to apply. Most policies allow you to apply after a 6 month waiting period. Sometimes people apply after 2 years and their claim is accepted. But reasonable notice of a claim should be given if you want your application to be considered and not denied from the outset.

At Aaron Waxman & Associates, we handle many disability claims. We are experienced lawyers who are able to help you with your fight against insurance companies.

We offer free no obligation consultations.


 

 

Chronic Pain in the News Part III

Sunday, December 18th, 2011

Aaron Waxman & Associates LLP specializes in personal injury claims and helping clients receive the compensation they deserve.  Our “Chronic Pain in the News” series is meant to be a source of information for our readers and clients. We keep apprised of the latest medical developments with respect to chronic pain, and fibromyalgia.

Lyme Disease is a chronic disease that causes chronic pain. The Vancouver Sun recently reported that the government of British Columbia pledged $2 million for a new clinic where those with Lyme Disease and other complex and chronic diseases could go for help in managing their symptoms. The BC Women’s Hospital has been named as the home for the new clinic.

In Bancroft, Ontario, council has joined the fight against Lyme Disease. A growing list of municipalities are petitioning the province of Ontario to improve awareness, detection and treatment of Lyme Disease in Ontario. Pressure is being put on the provincial government of Ontario to update its Lyme Disease protocols. The Lyme Disease Association of Ontario (LDAO) says that the disease is regularly is regularly is regularly misdiagnosed because it mimics a variety of other diseases and neurological disorders including autism, arthralgias, arthritis, autoimmune disorders, chronic fatigue syndrome, fibromyalgia, depression, multiple sclerosis, Parkinson’s Disease, Alzheimer’s, schizophrenia, sleeping disorders, Lou Gehrig’s Disease, Lupus and more.

Currently, OHIP does not cover all testing for Lyme Disease. There is dispute over how the disease is transmitted. If Lyme Disease is caught early, it can be successfully treated with antibiotics.

Canada Newswire posted a Press Release about Canada’s need for a National Pain Strategy. Chronic pain is an under-treated health crisis affecting 1 in 5 Canadians. It is said that pain is often poorly managed in Canada, has a major impact on the quality of life and the ability of people to function.

The Canadian Pain Society (CPS) and the Canadian Pain Coalition (CPC) have issued a blueprint to outline the social, economic and personal impact of chronic pain on Canadians.

On April 24, 2012, the first ever Canadian Pain Summit will take place in Ottawa.

 

Chronic Pain in the News- Part II

Monday, November 28th, 2011

Our firm handles many types of cases. We do handle many car accident claims. Often times, as a result of car accidents, our clients go on to develop a chronic pain syndrome. Chronic pain is not an imagined symptom.

A recent article in the Wall Street Journal proposed an alternative way for people suffering from chronic people to treat their pain, by using guided meditations and hypnosis. In fact, recent articles appearing on the Internet about treating chronic pain have focused on alternatives to pain medications.  According to the article, “Rewiring the Brain to Ease Pain“, chronic pain represents a malfunction in the brain’s processing centres and this actually be seen on brain scans. The pain signals take detours into areas of the brain involved with emotion, attention and perception of danger and can cause gray matter to atrophy. Studies were conducted, and brain activity was measured while subjects participated in a guided meditation. The results demonstrated that being distracted from pain and thinking about the pain was effective and the study subjects found a new way to look at their pain.

Locally, a chronic pain treatment centre in Vaughan, Ontario is receiving attention. Dr. Ron Nusbaum moved his Canadian Headquarters Clinic just north of Toronto. This is the first in Canada to offer the cutting edge Class IV K-Laser therapy, a unique, painless and side-effect free approach to treatment that stimulates healing, reduces inflammation and pain. Dr. Nusbaum is the founder of the Back Clinics of Canada. He has created a new comprehensive non-surgical, drug-free and integrative approach to diagnosing and treating those who have suffered for years from back pain and chronic pain- the “High Performance Healing System”. He offers an alternative to risky neck or back surgery.

How about talk therapy? Cognitive behavioural therapy is an effective way to help manage chronic pain.  A study in the United Kingston found that exercise and CBT were two successful alternatives to consuming pain medication. Introducing these interventions within the first six to nine months of treatment is preferable.

It is also worth mentioning that women who experience poor sleep are at elevated risk for developing fibromyalgia, according to a Norwegian study. Sleep disturbances and excessive fatigue are known symptoms of fibromyalgia. Sleep deprivation also has been linked with increased levels of circulating inflammatory markers and a loss of pain inhibition.

The company Medtronic received FDA approval for a device meant to help treat chronic pain. The device is called “AdaptiveStim with RestoreSensor” and is a Neurostimulator using innovative motion sensor technology, similar to that used in smartphones and gaming systems by automatically adapting stimulation levels to the needs of people with chronic back and/or leg pain. This device does away with manual changes, and instead is an automatic device that recognizes and remembers the correlation between a change in body position and the level of stimulation needed. It also records and stores the frequency of posture changes, and allows the doctor or therapist to understand how a patient’s individual stimulation requirements are changing over time. This device is also approved by the FDA for use in MRI head scans if recommended by a physician.