Glossary of personal injury claim terms

Accident Benefits

Financial or assistance benefits provided to individuals injured in a motor vehicle accident, regardless of who is in the wrong. Accident benefits may be awarded for a number of reasons, including: medical and rehabilitation expenses (equipment, treatment, therapy, etc.), attendant care, income replacement benefits, and housekeeping expenses. Learn more about Accident Benefits here.

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Accident Report

Detailed documentation recorded from the scene of the incident by an authority figure, such as a police officer or member of hospital staff.

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Acquired Brain Injury (ABI)

Damage that is inflicted upon the brain any time after birth and is not related to congenital or degenerative disorder (e.g., Alzheimer’s disease). Damage can result from a traumatic (physical) injury to the head, strokes, tumours, infections, allergic reactions, anoxia or hypoxia (lack of oxygen), or metabolic disorders.

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Activities of Daily Living (ADL)

The activities in a daily routine that are needed to maintain personal hygiene and health (e.g., bathing, dressing, feeding) as well as operating a household (e.g., cleaning).

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Act of God

An event or accident resulting from natural causes. The act could not have been prevented with reasonable precaution or care and occurred without human intervention or assistance. Examples include floods, lightning strikes, earthquakes, and storms.

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Adjuster

An investigator of insurance claims and claims for damages. He or she will also recommend an effective settlement.

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Alternative Dispute Resolution

Methods other than litigation used to resolve legal disputes (e.g., mediation and arbitration). See Mediation and Arbitration for more information.

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Ambulation

The ability to walk.

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Answer

A formal written response to a legal complaint filed by a defendant. Also known as a legal response.

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Aphasia

The loss of one’s ability to express themselves and/or to understand language as a result of damage to the brain.

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Appeal

When one party does not agree with the decision of a trial court, they can request a higher court to overturn that decision.

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Apraxia

The inability of an individual to carry out a complex or skilled movement as a result of paralysis, sensory changes or deficiencies in understanding.

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Arbitration

An alternative process for settling a legal dispute. Arbitration negates the need for an ordinary trial. It is generally considered more efficient and less expensive than litigation. See Litigation.

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Assignment of Benefits

The transfer of benefits provided to an individual by an insurance company to another party. This transfer can only be completed with the written consent of the insured. This process usually involves an individual assigning their medical benefits to a hospital or doctor to ensure they get paid directly.

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Ataxia

A neurological condition caused by brain lesions that affect muscle coordination. Can cause interference with an individual’s ability to walk, talk, eat, and perform other self-care tasks.

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Atrophy

The degeneration of a cell, tissue, organ or part of the body as a result of loss of nerve supply or lack of nourishment.

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Attendant Care

The action of assisting an individual with a disability in completing activities that are part of a daily routine. These activities cover a broad array of tasks including bathing, dressing, feeding, toileting, transferring, mobility, cooking, cleaning, laundering, dispensing of medications, and more. Generally, these tasks are ones, which the individual is unable or struggles to physically perform on their own.

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Bad-Faith Claim

In the event of an insurance provider unreasonably denying or delaying a claim, or for refusing to pay out a full insurance claim without cause, the insured individual can file an assertion. This is generally filed once an individual’s claim has been denied, but there is reason to believe they should have been covered.

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Benefit

Financial assistance awarded to a party from an employer, insurance company, or social program (e.g., social security) in a time of illness, disability, or unemployment. Financial compensation for lost wages or the cost of surgery is considered a benefit.

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Bodily Injury

Any damage inflicted on an individual’s body. This includes bruises, burns, cuts, poisonings, broken bones, nerve damage, etc. Bodily injury can occur in a variety of ways, such as an accident, negligence, or an intentional act. Intentionally causing bodily harm is a crime (e.g., assault, battery, etc.). A lawsuit could also result from accidental or negligent harm.

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Burden of Proof

An individual’s obligation to prove that a claim is accurate and true. This individual must show that their claim is factual. With regards to personal injury law, a plaintiff might have the burden of proof to show that a driver was being negligent behind the wheel or to show that a claim was made in bad-faith, etc.

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Case Manager (CM)

A professional in the field of rehabilitation that coordinates rehabilitation services for an individual following an injury.

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Catastrophic Impairment

The most severe of personal injuries. Examples of catastrophic impairment include quadriplegia; paraplegia; amputation of an arm or leg or impairment causing the total and permanent loss of use of an arm or leg; total loss of vision in both eyes; injuries resulting in an impairment of 55% or more of the whole person; brain impairment measured by a score of 9 or less on the Glasgow Coma Scale; marked or extreme mental or behavioural impairment; and severe disability from brain injury measured using the Glasgow Outcome Scale. An individual with a catastrophic impairment becomes entitled to maximum of $1,000,000.00 for medical/rehabilitation needs, plus $1,000,000.00 for attendant care plus housekeeping expenses, payable over the lifetime of the injured person. Learn more about Catastrophic Impairment here.

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Causation

The act or process of making something happen. In a case concerning negligence, the plaintiff must be able to show that their injury was a direct result of something the defendant did or did not do.

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Cerebellum

The portion of the brain which helps coordinate movement.

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Claim

A civil action that relates to the physical or mental harm suffered by the plaintiff, or on behalf of an injured victim, due to negligence of the defendant; a request to the insurance company by the insured requesting coverage and payment for damage or injury.

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Closed Head Injury

A traumatic injury that causes damage to the brain but does not penetrate or fracture the skull.

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Cognition

The mental process of gaining knowledge and then being able to understand it via thought, experiences, and other senses. This includes the ability to develop reason.

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Coma

A deep state of prolonged unconsciousness from which a patient cannot be awoken, even by powerful stimulation.

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Complaint

The first document filed with the court. A complaint is filed by a person or entity that claims legal rights against another party. This document represents the official start of a lawsuit.

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Concussion

A traumatic injury to the brain caused by a violent blow or jolt to the head. As a result, brain functions become altered. Concussions are commonly associated with a loss of consciousness, but this is not a prerequisite for a concussion. Concussion symptoms include nausea, dizziness, disorientation, headaches, and more. A series of multiple concussions can cause life-threatening issues. See Post-Concussion Syndrome.

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Contingency Fee

A fee for the legal services provided only when a favourable result is achieved.

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Contusion

Commonly known as a bruise, a contusion occurs when tissue or skin is injured and blood capillaries have been ruptured.

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CT Scan

The combination of x-ray images taken at different angles around the patient’s head. These are processed to create a series of cross-sectional images of the brain.

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Damages

The plaintiff’s losses suffered as a result of the defendant’s actions. Damages can represent a number of things including compensation for pain and suffering; loss of past, present and future income; health care costs; loss of social or familial relationships; etc.

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Deductible

A set amount of money that the insured must pay before the insurer will pay the claim.

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Defendant

An individual or corporate entity that is being sued by a plaintiff. Corporate defendants could be insurance companies, leasing companies, townships, restaurants, or even a hospital. Defendants in personal injury lawsuits are generally insured. It is the defendant’s insurer that will appoint a lawyer to act on their behalf.

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Diffuse Axonal Injury (DAI)

An injury where large nerve fibres in multiple areas of the brain are sheared.

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Disbursement

Expenses incurred by a law firm in order to advance your case. These fees generally include photocopying, mailing, requesting clinical notes and records or anything pertaining to the case. Rather than asking clients to pay upfront, disbursements are pair once your case is complete.

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Disclosure

Documents and other information that are released by request or sought out by the opposition.

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Disorientation

A state of mental confusion; not knowing the date, who or where you are.

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Distracted Driving

The practice of engaging in activities causing one to lose focus while behind the wheel of a motor vehicle. Talking on a cell phone, texting, using a navigation system, eating, and grooming are all actions that cause drivers to lose focus.

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Electroencephalogram (EEG)

A test that records brain activity using electrodes on an individual’s scalp.

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Examination For Discovery

A pre-trial examination where both parties are able to question the opposing party under oath. Sometimes referred to the “examination of discovery”, this process is a very important part of litigation.

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Expert Witness

An authority qualified in scientific, technical, or professional matters who is called in for testimony. This individual possesses special knowledge or proficiency in a particular field relevant to the case on trial.

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Frontal Lobe

The forward portion of the brain that is involved in planning, organizing, problem solving, selective attention, personality, and other cognitive functions.

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Glasgow Coma Scale (GCS)

A scoring system used to describe an individual’s level of consciousness after suffering a traumatic brain injury. It is a simple and reliable test that will help gauge the severity of a brain injury.

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Glasgow Outcome Scale (GOS)

A scoring system used to describe the outcome of head injury survivors. It is an assessment of a patient’s recovery in order to predict long-term rehabilitation.

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Hazard

A danger or risk. Hazardous conditions increase the probability of damage or injury occurring.

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Health Care Expenses

The cost of medical services that a health care provider offers to an injured person, which includes medical expenses, rehabilitation, and attendant care.

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Hemiparesis

Weakness on one entire side of the body.

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Incurred Expense

Incurred expenses require the claimant to pay or promise to pay the expense and requires that the service provider provides the service which the injured person would normally have completed before the accident or suffers an economic loss to provide the service for the injured person.

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Insurer Examination

This is also known as a Section 44 Assessment. The insurer may appoint health care professionals of their choosing, to perform assessments in order to determine whether or not they’ll pay a benefit.

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Judgement

Process of forming an opinion or decision based on an evaluation of the situation, using personal values, preferences, and insights.

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Liability

Legal responsibility of one’s actions or property, that one is legally bound to perform. This usually involves the payment of monetary damages.

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License Appeal Tribunal (LAT)

The LAT is responsible for making determinations on applications and resolving disputes about compensation claims and licensing activities.

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Limitation Period

A time frame after which a lawsuit can no longer be brought. When a person has suffered from an injury, there is a time period in which a Statement of Claim must be issued. If this time period has passed, it’s too late to take legal action.

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Litigation

The act of taking legal action or filing a lawsuit.

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Loss

The monetary value which is assigned to any injury or damage in a personal injury claim which includes past and future income, future medical care, current medical bills, pain and suffering, and more.

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Loss of Earnings

This applies to people who have had to take time off work, change professions or stop working completely due to their injuries and how it affects them financially.

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Malpractice

When a professional – such as a doctor or lawyer – fails to meet the standard of care or conduct that they have sworn to uphold that results in injury or damage. This can be the result of error, negligence or intent.

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Mandate

An order from a court with regards to judgement, sentence or decree.

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Mediation

A process performed with a third-party present, that both parties have agreed to, to help resolve conflict or dispute. Sometimes performed as a step before trial, to try and find a settlement or resolution that works for both parties.

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Medical Malpractice

Behaviour or action from a health care worker that deviates from the accepted standard of practice, resulting in injury to the patient. Can be a violation of the standard of care, an injury caused by negligence or an injury that results in significant damages. Learn more about Medical Malpractice here.

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Minor Injury

A less significant injury, normally one that will heal on its own without major medical intervention. Things like sprains, strain, whiplash, confusion, laceration, etc.

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Negligence

Failure to use reasonable care, resulting in damage or injury to another.

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Occipital Lobe

A part of the brain (located in the back) that is responsible for processing visual information. Damage to this lobe can cause visual insufficiencies.

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Occupational Therapist (OT)

A registered health care provider who retrains those with sufficient injuries to be able to perform self-care and day-to-day activities, so they can become self-sufficient again.

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Optional Benefit

Additional benefits that can be purchased from insurance, either by the insured or the insured’s family members.

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Paralegal

A professional who is employed or retained by a lawyer, law office, or another corporate entity to perform legal work either alongside a lawyer, or instead of a lawyer when a lawyer is not required.

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Paraplegia

Complete paralysis of the lower half of the body, usually caused by damage to the spinal cord and including both legs. Learn more about paraplegia and spine injury here.

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Parietal Lobe

Damage to the right lobe in the brain causing visual-spatial deficits.

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Parties

The participants in a lawsuit or other legal proceedings that have a direct interest in the outcome, such as but not limited to the plaintiff and defendant. Can be persons, corporations or associations.

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Personal Injury Law

An area of law whereby the person bringing the suit has suffered physical or mental harm. This could include motor vehicle accidents, slip and falls, medical malpractice, assault, etc.

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Physical Therapy (PT) or Physiotherapy

The treatment of a disease, injury or illness through physical methods such as massage, heat treatment and exercise, that doesn’t involve surgery or drugs.

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Physiotherapist (PT)

A health care profession which helps people affected by injury, illness or disability through physical methods, movement and exercise to increase strength, function, and/or movement.

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Plaintiff

The person or party that

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brings forth the lawsuit. The person or party being sued is referred to as the defendant.

Post-Traumatic Amnesia (PTA)

A period of time after an accident or injury, that can last from hours to days, where the victim experiences short-term memory loss.

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Post-Concussion Syndrome (PCS)

After a concussion, some symptoms such as headaches, nausea, irritability and dizziness can last for weeks, sometimes even months.

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Post-Traumatic Stress Disorder (PTSD)

A mental health condition that can be triggered by witnessing or experiences a traumatic or terrifying event. Symptoms can include flashbacks, nightmares, uncontrollable thoughts and anxiety.

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Pre-Claim Examination

Your accident benefit insurer may request an assessment from a doctor or health care professional of its choosing, following an injury before applying for benefits. As the injured person, you have a right to deny the examination and may do so without facing penalty.

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Prognosis

A medical term used for the prediction made by a doctor of the anticipated change of recovery from illness or injury, based upon symptoms and statistics.

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Psychiatrist

A medical practitioner that specializes in the diagnosis and treatment of mental illnesses.

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Psychologist

A professional who studies normal and abnormal mental states and is an expert in the diagnosis, management and prevention of emotional and/or behavioural problems.

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Quadriplegia

Paralysis of all four limbs. Learn more about Quadriplegia and other spine injuries here.

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Quality of Life

A quality of life assessment looks at how daily living and existence has changed for a person since suffering from an accident or injury. The assessment looks at the physical, psychological and social functioning of a patient.

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Ranchos Los Amigos Scale

This is a medical scale used to assess individuals after a traumatic brain injury or coma based on cognitive and behavioural presentations. It’s named after the Rancho Los Amigos National Rehabilitation Center in Los Angeles.

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Range of Motion (ROM)

The measurement of the movement around a specific joint or body part that is commonly performed during physical therapy.

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Rehabilitation

The process of restoring someone back to health or normal life activities following injury.

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Rehab Support Worker

An unregulated hospital and/or community care professional who helps implement rehabilitation goals given by physiotherapists, occupational therapists, speech pathologists, psychologists, etc.

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Retrograde Amnesia

Inability or trouble recalling events leading up to an accident or injury. Can either be a period of time or a specific type of information.

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Settlement

An official agreement or arrangement made between the parties involved in a lawsuit in order to resolve it, usually made out of court and often before the court hears the case.

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Slip and Fall

A personal injury case where a person slips, falls or trips resulting in injury, often due to negligence or poor design, on someone else’s property who is legally responsible.

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Social Worker (SW)

Professionals responsible for helping individuals, families and/or groups of people deal with their social, emotional and financial needs by either providing or locating services.

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Speech and Language Pathologist (SLP)

A professional who works to prevent, assess, diagnose and/or treat speech, language, communication and/or swallowing disorders in their patients.

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Statement of Claim

The document that explains the plaintiff’s allegations and damages against a defendant’s acts or omissions. These are generally prepared by a lawyer and begins the lawsuit.

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Statement of Defence

The response a defendant makes to the Statement of Claim, denying the allegations put forth by the plaintiff. These are generally prepared by a lawyer.

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Temporal Lobes

There are two temporal lobes in your brain. The right temporal lobe is responsible for visual memory and the left temporal lobe is responsible for verbal memory.

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Threshold

A minimum requirement for further action to take place. In the case of personal injury, this involves the level of impairment or disfigurement sustained by the plaintiff. It must be proven and must meet the threshold in order to obtain compensation.

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Tort

An area of civil law where one party sues (seeks monetary compensation) another party for damages, injury or losses caused by wilful action, negligence or other circumstances involving strict liability. Learn more about Tort Claims here.

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Traumatic Brain Injury (TBI)

Damage to the brain caused by external forces such as a blow to the head, causing injuries that can range from mild concussions to severe permanent brain damage. Common causes of TBI include car accidents, sports injuries, and slip and falls.

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Trial

When an agreement can’t be reached in mediation, a case will continue to trial, where the evidence is presented in front of a judge and sometimes a jury to decide guilt.

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Verdict

A formal decision made by a jury about the outcome of a case.

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Wrongful Death

A civil action claim against a person who can be held liable for someone’s death. Often brought forward when someone has died as the result of wrongful conduct or negligence. The claim is brought by the survivors or beneficiaries of the deceased, often spouses, children or close relatives. Learn more about Wrongful Death claims here.