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Archive for category: Automobile Safety and Insurance

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The GOS-E and Catastrophic Determination – Gathering EVIDENCE of Pre-Accident Function

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Over the last few months we have had the privilege of presenting to a multitude of Personal Injury Lawyers on the June 1, 2016 changes to catastrophic determination, most specifically on the Glascow Outcome Scale Extended (GOS-E).  If you are working in motor vehicle accident (MVA) rehabilitation or personal injury law, this scale is one you need to be familiar with.

To qualify for catastrophic under the GOS-E, it speaks openly about changes to QUALITY and FREQUENCY of participation in pre-accident tasks under the facets of independence in and outside the home, travelling locally and abroad, productivity, social / leisure participation and relationships.  Within this, it considers HOW OFTEN someone did something, but even bigger than that is FOR HOW LONG and at WHAT INTENSITY.

As OT’s working in this sector, it is important that we gather this information in great detail during our initial assessment to not only get a better picture of pre-accident lifestyle and function, but to create early records that could relate to catastrophic determination at 6 months, 1 or 2 years’ post-accident.

During a presentation, one lawyer questioned the “qualitative way” by which pre-accident information is usually gathered (by asking family or through client self-report).  He asked if there was better evidence, “proof” if you will, that could speak objectively to “pre-accident function”.  This was a great question because right now the only pre-accident “evidence” the industry tends to gather are medical records and these speak to health, not function (and the two can be very different).  Function is best outlined by finding out how people spent their time – something that one would think would be difficult to objectively measure for the purpose of “evidence”, but let’s think again.

The evidence of how people spend their time is actually everywhere.  My morning dog walk and sleep habits are tracked on my fit bit and transferred to my computer and phone.  My car logs the kilometers I drive, and the repair shop inputs these with every oil change.  The gym tracks my attendance.  My phone apparently stalks me by recording everywhere I take it, the websites I visit, the apps I use and the people I speak to, text and email.  The photos in my phone also tell the story of my life and where my time is spent.  My computer records the number of emails I send and receive and the places I visit online.   My emails are sorted and can detail the time I spend organizing and taking trips (local and abroad), socializing, and even my relationship communication habits.  If I had a personal Facebook account this would detail for you the people I chat with, how often, and the places I visit, take photos and upload.  Twitter, Instagram and Snapchat would do the same.  But honestly most of the information about my time spent would be easily revealed through my financial records.  Most of the things I do cost money.  My credit card and bank statements will show you the frequency by which I get a latte, the costs for my gym program, the amount of shopping I do, the people I pay to help manage aspects of my house, the places I eat or indulge, the number of times I visit the movies or do something fun, the things I enroll my children in, etc.  These will even tell you the therapies or treatments I might get privately that my doctor doesn’t even know about.

We know that being involved in the insurance system exposes aspects of people’s lives that they may not want to share.  All privacy is forgone when you want and need help from an insurer, or when you want and need to sue someone who was at-fault for causing you injury and harm.  Unfortunately, with the changes to Catastrophic Determination, the gap just widened in terms of the information that needs to be gathered and the “proof” that needs to be provided to access the benefits an injured person may need.  However, the information is out there – little is sacred or private anymore. 

If this is helpful, here is a list of information that could be gathered to support changes to FREQUENCY and QUALITY of participation in most activities before and after an accident.   Getting someone’s personal records for the year prior to an accident, and then for the first-year post, will be highly informative, helpful and revealing…if they are agreeable to share:

Bank Statements / Financial Records will show MOST purchases related to social / leisure activities:

Memberships / clubs / subscriptions
Dinners / coffees / movies
Vacations
Shopping habits
Sports / fitness
Gas / driving / parking habits

Other places will also have records:

Gym / rec center attendance
Schools / school records
Employment records
Evidence of trips / vacations / social events on SM – FB, Twitter etc (before the accident)
Car / vehicle records – how often the car was driven based on KM’s
Points cards for anything like movies, Starbucks, Airlines, etc
Call / cell records and communication habits
Medical records

I hope this helps the lawyers and injured people of the insurance system to find the “evidence” they might need to really demonstrate to an insurer how their life has been impacted following an accident.  And for the OT’s gathering similar data subjectively, be specific and thorough in your questioning under the GOS-E spheres.  Your reports are highly important and may become the difference between someone being deemed catastrophic or not.

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Drugs or Driving? You Might Have to Choose

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

The Ontario Trial Lawyers Association (OTLA) Blog recently posted this very interesting and informative article on the legalization of marijuana and how this may specifically impact the drivers of Ontario.  The proposed reforms to Impaired Driving Laws, as listed in the article, include:

For the first time, the Government of Canada has proposed prescribing limits to the amount of THC – an inebriating component of cannabis – detected in a person operating a motor vehicle. The Government is also proposing prohibiting any detectable levels of many other drugs while operating a motor vehicle.

The proposed changes include attempts to close loopholes in our current laws and providing for easier roadside testing by authorities, including:

  • allowing mandatory roadside saliva swab testing;
  • allowing blood tests taken by professionals on the scene who are not doctors;
  • allowing breathalyser testing of any driver (omitting to the current requirement for “reasonable suspicion” of impairment); and
  • changing the definition of impaired driving with blood alcohol levels over 80mg/100ml from “while operating a motor vehicle” to “within two hours of operating a motor vehicle” (an attempt to close legal loopholes where people claim to have drunk alcohol immediately before driving or immediately following an accident to account for an anticipated failed sobriety test).

People operating motor vehicles will be committing a criminal offence if they are found to have THC levels in their blood above 2ng/ml. Drivers with levels above 5mg/ml or levels above 2.5ng/ml combined with blood alcohol levels over 50mg/100ml will face more significant penalties.

The penalties are also generally going up, especially in the case of repeat offenders who may now be sentenced up to 10 years (up from the current five), and will now be eligible to be deemed “dangerous offenders” in appropriate circumstances.

So why is this so significant?  As an Occupational Therapist it is common for many of my clients to require the use of medication to manage their symptoms.  While most (or all) would love to be able to go without regular use of these drugs, it is typical for medications to be prescribed to help people manage initial and acute symptoms for things like sleep, depression, anxiety, pain, headaches, and spasms.  Often, that usage continues beyond the acute phase of recovery to help with the management of more chronic and relentless problems that don’t resolve in time.  It is no secret then that people with disabilities tend to be high consumers of medication.

More recently, as the benefits of medical marijuana become studied and well known, my clients are choosing to forgo the gut-wrenching and highly addictive narcotics for the milder but often effective marijuana option.  My clients that use medical marijuana report better sleep and more stability in their symptoms without the intense side-effects they experienced on other drugs. 

So my clients tend to use medication, some are switching to marijuana, but most concerning with this legislation change is that most of my clients are also drivers.  Very few actually don’t resume driving and in fact returning to driving is often one of their main objectives.  Driving provides freedom and convenience, and people who end up stranded at home tend to decompensate emotionally due to the isolation that comes from not being able to enter the community often and independently.  Sure, many places offer public transit options, but try having pain, reduced tolerances for activity, standing or sitting restrictions and then be expected to walk to, wait for, and then sit on a bus that has jerky starts and stops every few blocks.  Public transit is just not a great option for people that don’t tend to feel well.

I am all for the safety of Ontario drivers and I can appreciate how the laws in Ontario need to evolve with the introduction of new policies that can impact driving.  However, I am concerned that these changes unfairly target an already marginalized portion of our population without providing suitable alternatives to allow people to get around their community.  How will my clients who currently drive while medicated be able to continue to get around? 

Further, there is also a potential change to the mandatory reporting requirements for professionals around driving.  Currently, only doctors are required by law to report potentially unsafe drivers to the Ministry of Transportation.  There is talk that Occupational Therapists will also have this responsibility soon.  So, if I know that my client is taking narcotic medication and also drives to work daily, will I be required to report this?  If that is the case, then what about the doctor that prescribes the medication in the first place?  Is he going to give people the option of:  drugs or driving? 

Personally, I think the bigger problem on the roads is non-prescription related.  Drinking and texting seem to be causing more injuries and deaths than the use of properly prescribed and consumed medications.  I hope the lawmakers of Ontario are considering all the risks on the roads and working to develop solutions fair to all of us.

 

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Be Prepared on the Road

While driving is usually simply an adventure of fighting traffic to get from point A to point B, sometimes circumstances beyond our control can get in the way.  Weather conditions, breakdowns, accidents and more can leave you stranded at the side of the road.  As a driver it’s important to be prepared for these situations by having emergency items in your vehicle at all times.  Many kits can be purchased online and at local retailers, or you can create your own emergency car kit, but ensuring you have these basic items in your trunk.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

For more helpful tools visit our Printable Resources Page.

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Ontario’s Auto Insurance Industry Needs More Than a Quick Pit Stop!

Though recent stats show Ontario’s rate of injury and fatality due to motor vehicle accidents are some of the lowest in the country, Ontario drivers are paying the highest rates of insurance in the country.  With high premiums you would think the benefits are the best possible, right?  Wrong.  As previously discussed in our post, The Government Gets it Wrong– AGAIN, premiums may be on the rise, but accident benefits have been cut once again.  A recent government report by David Marshall discusses these and other flaws in Ontario’s substandard auto insurance industry and provides recommendations on how it can improve.  Learn more about this report and its findings in the following Editorial from the Toronto Star.

The Toronto Star:  Time to fix Ontario’s broken auto insurance system

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Wash Your Car – Save a Life!

Julie Entwistle, MBA, BHSc (OT), BSc (Health / Gerontology)

Previously posted February 2014

Working in auto insurance makes me slightly paranoid about issues of vehicle safety.  Ideally, it would be great if car accidents could become extinct and people could go about their business without running the risk of becoming injured in their travels, but currently these remain one of the main causes of adult and child injury, death and disability.  May is National Car Care Month and maximizing car safety should be on the top of everyone’s list year-round.

Years ago, in the middle of winter, I was driving home from seeing a client at night.  I was on back roads that were not lit.  My headlights were on, but I could barely see the road in front of me.  I struggled with this, assuming I had a headlight out, and managed to get to a gas station.  There, I investigated the problem and realized my headlights were just covered in the road sludge so common in Ontario winters.  I cleaned up my headlights with a window squeegee and voila!  I could see again

Prior to this, the thought of washing my headlights never occurred to me.  Why would it?  Unless you encounter a problem, this is not something I remember being taught in driver’s ed, nor something my parents mentioned to look for as I was learning to drive.  Some things we just learn in life the hard way – hoping to not be hurt in the process.

I remember when cars started to be manufactured to have headlights on automatically and all the time.  I said to my brother “I don’t get why headlights should be on during the day, they won’t help a driver to see better” and he responded with “it is so other people can see you better”, I am sure adding a brotherly “dummy” in there too.

The other day I was reminded of these lessons again.  It was a sunny day, but the roads had been a mess a few days prior.  I was driving in the right lane and needed to change into the left lane to make an upcoming left turn.  I glanced in my dirty side mirror and my rear mirror which was looking out my dirty back window, and I didn’t see anyone.  I checked my side mirror again, and noticed something that looked odd.  I focused more clearly and realized that there was another car to the left of me after all.  This was a black car, covered in the grey muck from the roads.  The lights weren’t on, and what struck me was how much this car was essentially the color of the road.   The road was a grey, dirt covered mess, and this car blended right in.  Had the lights been on, or the car clean, I would have spotted this easily.

Really, both these issues with visibility when driving – to see and be seen – could be tackled with a simple car wash.  Even if this seems futile with changing weather conditions, the short-term benefits are immense.  A clean car is easier for others to see, gives you better visibility when the windows and side mirrors are clear, and washes your headlights to make sure these are most effective.  Besides, of course, the other benefits of washing road salt and dirt from your paint job.  Many gas stations have a quick car wash adjacent to the pump, and allow you to pay at the pump for convenience.  Or, some car washes are even a drive-thru format and you don’t even have to leave your car.  In the end, when it comes to road and driving safety, the added expense of giving your car a rinse could be “priceless”.

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The Role of Occupational Therapy in Trauma Recovery

Guest Blogger: Carolyn Rocca, Student Occupational Therapist, 2017

Motor vehicle accidents account for countless injuries annually and are one of the most common traumas individuals experience. Trauma can be understood as one’s unique experience of an extremely stressful event or enduring conditions that overwhelms their ability to cope. These experiences can often disconnect us from our sense of safety, resourcefulness, and coping. As a result, survivors of severe and traumatic motor vehicle accidents are at increased risk for experiencing mental health difficulties, with posttraumatic stress disorder, depression, and anxiety being the most common.

Post-traumatic stress disorder (PTSD) is a mental health condition that can follow a traumatic event involving actual or threatened death, serious injury, or threat to the physical integrity of oneself or others. Although every individual experiences PTSD differently, following a motor vehicle accident PTSD symptoms can involve:

·       Psychologically re-experiencing the trauma through distressing thoughts or dreams about the accident,

·       Avoidance of thoughts or situations associated with the accident, including a reluctance to return to driving,

·       Extremes in emotional responsiveness, by either having greatly reduced or heightened emotions, and

·       Increased physical arousal, such as hypervigilance, exaggerated startle, irritability, and disturbed sleep (Beck & Coffey, 2007).

The symptoms associated with PTSD can leave individuals to feel emotionally, cognitively, and physically overwhelmed. Naturally, this can result in difficulties in one’s daily functioning, including one’s ability to care for themselves and others, as well as their ability to successfully engage in their life roles of being a spouse, parent, employee, student, or volunteer, to name a few. For these reasons it is recommended that those experiencing PTSD seek help from a team of healthcare providers and consider occupational therapy.

Using a trauma-informed care approach, occupational therapists can support clients through the following three Phases of Trauma Recovery:

Phase I – Safety-stabilization:

Since trauma often results in a sense of helplessness, isolation, and loss of control, the aim is to restore a sense of safety and empowerment. Following trauma, creating a sense of safety is the foundation of one’s recovery process.

The first step to building and creating safety is to first identify things that help us feel safer. Occupational therapists can help their clients to identify objects that bring about a personal sense of safety and imbed them into their daily routines. These safety objects may include: special people such as a trusted friend, engaging in certain activities like looking at photographs or making crafts, or being in a certain place, such as being outdoors in the sunlight.

Occupational therapists can also assist in establishing safety through practices such as meditation, mindfulness, deep breathing exercises, yoga, and Thai chi, as these approaches have been shown to be effective at decreasing stress and soothing the nervous system (Manitoba Trauma Information & Education Centre, 2013).

Phase 2 – Remembrance and Mourning:

A traumatic event like a motor vehicle accident is often associated with a form of loss. One might feel they have lost their independence, sense of identity, or purpose following a car accident.

Counselors and occupational therapists are well-equipped to guide individuals on their recovery by allowing them time to grieve and morn their own personal losses. This is often achieved through individual or group-based therapy by processing the trauma, putting words and emotions to it, and making meaning of it.

Phase 3 – Reintegration:

The goal of the third stage of recovery is that the person affected by trauma recognizes the impact of their experience but is now ready to take concrete steps towards a lifestyle that is no longer controlled by the trauma. Recovery and reintegration will look different for everyone, but often involves resuming important life roles and responsibilities, and returning to a lifestyle that is meaningful to them.

Occupational therapists can assist during this phase of recovery by supporting their clients in re-establishing healthy routines, building strong support systems, learning and practicing coping strategies during their day to day activities, and gradually increasing their exposure to anxiety provoking triggers, ultimately enabling them to reintegrate into their communities and preferred lifestyles.

For more information about PTSD, trauma informed care, and how healthcare professionals can support someone following trauma, be sure to take a look at the Trauma Toolkit or call an Occupational Therapist to start the process of recovery.

 

References & Resources:

Beck, J. G., & Coffey, S. F. (2007). Assessment and treatment of posttraumatic stress disorder after a motor vehicle collision: Empirical findings and clinical observations. Professional Psychology: Research and Practice, 38(6), 629.

Manitoba Trauma Information & Education Centre (2013). Retrieved from http://trauma-recovery.ca/

The Trauma Toolkit: A resource for service organizations and providers to deliver services that are trauma-informed (2013). Retrieved from http://trauma-informed.ca/wp-content/uploads/2013/10/Trauma-informed_Toolkit.pdf

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Scary Study on Texting and Driving

Results from an ongoing study on texting and driving by the Sudbury District Health Unit and Laurentian University have produced scary results, but researchers are optimistic these results put them closer to improving strategies to reduce this dangerous behaviour.  Research shows: “They admit to doing it, but they feel bad about doing it, they know it’s wrong and they don’t feel safe when someone else is texting and driving. Learning that information gives us a bit of leverage to empower passengers to stand up and say, ‘No, this is wrong,’ against their peers.”  Learn more about this research and the ongoing efforts to reduce texting and driving in the following article from the Sudbury Star.

The Sudbury Star:  Sudbury researchers target distracted driving

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Recognizing Psychological Tramua in Kids Following An Accident

As Occupational Therapists we use a holistic approach to help our clients.  After an accident we assess and treat not only the physical effects, but the emotional impact such a traumatic experience can have on one’s life.  The following article by Roger Foisy, a Canadian Personal Injury Lawyer, discusses how approximately “15-25% of children involved in car accidents show symptoms of depression that remain even months after the accident.”  Take a look at the article to learn how to recognize the signs and some great ways to help children cope after the traumatic experience of a car accident.

Roger Foisy:   Helping Children Overcome Psychological Trauma after Car Accidents

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Promoting Safe Driving In Older Adults

In our previous blog, Senior Safety– Occupational Therapy Can Help!, we included information on how there are now almost 6 million seniors over age 65.  With this growing population, how can we ensure older adults are safe, secure, and maintain independence, especially on the road?

Seniors are the fastest growing segment of the driving population. Driving helps older adults remain mobile and independent in their community. This form of transportation provides the most convenient means to access the places and people that are important to them. Unfortunately, as seniors grow older they are more likely to experience age and health-related changes that can impact their medical fitness to drive.  However, not every senior is affected; hence, understanding the impact on functional abilities, rather than age, is key to preventing crashes and injuries.

Occupational Therapy can help seniors who drive by:

·        Educating seniors and family members on proper driving techniques

·        Assisting them to properly “fit” their vehicles. Ensure you have a clear line of sight over the steering wheel

·        Creating solutions to barriers through developing programs to improve safe driving

·        Consult on different forms of transportation

·        Recommend adaptive equipment to enhance your driving habits

Driving is an important part of mobility and independence for Canadian seniors.  Entwistle Power and McMaster University partnered together this past spring to host a CarFit event that was aimed at educating seniors about their personal vehicles.

What is CarFit?

CarFit is an educational program that offers older adults safety information along with the opportunity to verify how well their personal vehicles “fit” them and their needs. The event consists of 12 stations which will assist older adults to learn how well their vehicle fits them and their needs.

The Carfit program was designed to:

·        Promote continued safe driving and mobility among older drivers through education not evaluation

·        Create an open environment that promotes conversations about driving

·        Provide information, education and community based resources to older drivers in a quick and easily accessible manner.

Why do we need CarFit?

CarFit programs help drivers assess and adjust their seat position, mirrors, head restraints, and controls. Many people buy cars, and just jump in and drive off. Most often, they do not and are unaware of how to adjust all the safety features to their maximum effectiveness. With the technological advances of the automotive industry, automakers have been making strides to designing vehicles that are beneficial for older adults. Designing controls with larger buttons, blind spot detection systems, rear – backup cameras, lane departure warning systems have all had a profound impact on the safety and convenience of technology for senior drivers. However, with some design changes, they’ve created smaller windows, thicker windshields and roof pillars, which limit a senior’s visibility. Complicated technology control systems can be distracting or difficult to use and may be distracting. With older adults representing the fastest growing population of drivers, it’s important to understand the proper fit of vehicles to promote safety for older drivers.  CarFit helps to provide education and strategies on how to achieve the safest fit.

CarFit is a community-based program which consists of working through a 12-item checklist to provide participants with information about on how well they and their car work together. These stations include tips on the following:

·        Proper use of seat belt

·        Position of steering wheel tilt/ head restraint

·        Proper distance between chest and steering wheel

·        A clear line of sight above steering wheel

·        Proper positioning to gas pedal

·        Proper positioning to the brake pedal

·        Adjusting mirrors

·        Appropriate Neck mobility to check blind spots

·        Safe use of ignition key

·        Operation of vehicle controls

·        Overall use of the vehicle

Does your vehicle fit you?  What can you do?

Finding out if you have the proper fit for your vehicle is essential for both your safety and the safety of others around you.  Do you have a clear view out your window? Can you reach and manage all of your controls? Is your seatbelt secure and properly fitted? Making these small adjustments can provide a huge impact through improving your comfort, control and confidence behind the wheel!

During our CarFit event, we provided education to help twelve older adults adjust their vehicles to their own unique needs. Participants left with:

·        Recommendations on car adjustment and adaptations

·        Education on the benefits of occupational therapy

·        Information regarding local resources and assistive equipment

This was the first CarFit event hosted in Hamilton, Ontario. While much was involved with hosting the event and getting things organized, our participants expressed satisfaction with being part of this experience – we hope we have started a tradition!

Interested in learning more?

If you or someone you know is interested in attending a CarFit event in the future, you can:

·         Visit CAOT’s CarFit Page, or contact your nearest CAA store for future CarFit event listings

·         Connect with us on Social Media, and keep an eye out for topics related to older adults

·         Explore www.candrive.ca for driving research and resources for older adults

·         Phone Entwistle Power Occupational Therapy at 1-866-683-0345 or email us to inquire about our occupational therapy services that can support you and/or your loved ones to age well.