M.M. v. Guarantee Company of North America

M.M. was hit by a car at the age of five and suffered multiple injuries. A Glasgow Coma Scale (GCS), a commonly used scoring system that describes the level of consciousness in a person following a traumatic brain injury, was taken by paramedic’s minutes after the accident and she received a score of 9 indicating a moderate injury. She was in the Hospital for Sick Children for almost three months, and then a children’s rehabilitation hospital. 

Her Insurer argued there was no evidence of brain injury and the low initial GCS score of 9 was caused by a hemodynamic instability (cardiovascular impairment caused by abnormal or unstable blood pressure).

M.M.’s lawyer argued that her score of 9, her brain impairment is by definition sufficient to meet the designation of catastrophic and she should be entitled to further benefits.

The arbitrator in the case found that M.M. did in fact suffer a brain impairment from the accident as indicated by her GSC score of 9, specifically her brain suffered a loss of function for several minutes due to hypoxia (lack of oxygen) and hemorrhage pressure on the right hemisphere.

This case is important for the reason that previously it was thought that hemodynamic instability would not count when considering GCS scores. This decision looks at the process by which someone's GCS scores drops when insufficient blood flows to the brain, causing an impairment of the brain. Brain damage is not a requirement as the test is not based on outcomes.

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