Acquired brain injury due to external trauma

Definition

Acquired brain injury due to external trauma means a definite diagnosis of new damage to brain tissue caused by traumatic head injury, resulting in newly developed significant neurological deficit that:

  • results from an external trauma severe enough to have prompted the insured to seek a medical consultation in less than a week after the occurrence of said trauma
  • is present and verifiable on clinical examination
  • is corroborated by abnormal magnetic resonance (MR) and/or computed tomography (CT) brain imaging studies, that confirm brain trauma, and
  • persists for more than 180 consecutive days following the date of diagnosis.

The diagnosis of acquired brain injury due to external trauma must be made by a specialist.

New neurological deficits must be detectable by a physician and may include, but are not restricted to:

  • measurable loss of hearing,
  • objective loss of sensation,
  • paralysis, localized weakness,
  • dysarthria (difficulty with pronunciation),
  • dysphasia, (difficulty with speech)
  • dysphagia (difficulty in swallowing),
  • measurable visual impairment,
  • impaired gait (difficulty walking),
  • difficulty with balance,
  • lack of coordination,
  • new onset seizures undergoing treatment or measurable changes in neuro-cognitive function.
    Headache or fatigue will not be considered a neurological deficit.

Headache or fatigue will not be considered a neurological deficit.

Exclusions

No benefit will be payable under this condition for:

  • an abnormality seen on imaging studies of the brain without corresponding clinical impairment;
  • neurological deficit without corresponding imaging study lesions,
  • a concussion that does not have abnormal imaging studies.

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