Over time, you may notice a worsening of the harm you initially suffered in connection with your traffic accident, or even start to experience new symptoms entirely. However, you should know that these scenarios of relapse, recurrence or aggravation of a damage recognized by the SAAQ are also compensable, in the same way as your initial sequelae, even several years after your road accident.
Relapse, recurrence or worsening of your health
The notions of relapse, recidivism and aggravation mean that a SAAQ file is never really closed. Indeed, they allow a constant reassessment of your file, whether it is a month, a year, or even 10 years following your initial accident. However, it is obviously easier to submit a complete SAAQ file from the outset than to demonstrate a relapse, recurrence or aggravation afterwards.
On the one hand, it is necessary, each time a new diagnosis is determined, to have a progress report written by your doctor. This report will attest to your relapse, recurrence or aggravation situation, and will be used to demonstrate that there has indeed been a change in your situation since the initial assessment of your sequelae carried out by the SAAQ.
The doctor who has been following you since the beginning of your accident is particularly well placed to demonstrate a worsening of your state of health. Indeed, it benefits from an overview of your file and has been able to see your condition before and after the aggravation. On the other hand, the diagnosis of your attending physician, for example, will not benefit from such probative value and will have to be confirmed by an expert or by medical evidence.
On the other hand, this aggravation must also be significant. Thus, it is understood that it is not enough to demonstrate that there has been an objective worsening of your condition, but also that it harms your daily and professional activities.
In addition, it is important to understand that a worsening is not a persistent and regular condition, but a deterioration of the recognized sequelae. Indeed, it requires the presentation of an evolutionary and degenerative documentary evidence. Thus, a loss of range of motion measured by a health professional, for example, could effectively demonstrate a worsening of your sequelae.
It is therefore understood that three elements are necessary in order to successfully plead a worsening of your condition, namely:
- a change in your situation;
- causing a significant increase in functional limitations resulting from your accident;
- and which can be supported by medical evidence or by means of an expert report.
Indeed, it will not be possible to demonstrate an aggravation in your file in the absence of each of these elements.
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How to establish a change of situation?
To establish a change of situation, at the level of joint amplitudes, for example, it will usually be necessary to perform a comparison exercise. More specifically, it will be necessary to compare the current situation of the victim with his situation assessed at an earlier date. Thus, it will be possible to demonstrate that there is an objective and significant difference in your condition.
However, there are some diagnoses for which it will be more difficult to claim a worsening, including that of head trauma. Indeed, although it was long considered that a head injury (“TBI”) cannot worsen, current medical knowledge allows a certain relaxation in this regard. Thus, it is now possible to have the aggravation of a major head injury recognized upon presentation of appropriate evidence. Nevertheless, medical course still does not recognize that a minor concussion can deteriorate over time.
Similarly, the abundant jurisprudence of the Administrative Tribunal of Québec teaches, to date, that the natural evolution of a sprain is to improve and, in general, to stabilize, without there being a recurrence. Thus, it will also be difficult to demonstrate a significant change in situation in the event of a sprain.
Aggravation of a personal condition (the fragile skull theory)
It is not uncommon for the victim of a road accident to already be struggling with recognized personal limitations prior to his accident. However, these can obviously worsen as a result of an accident.
It is therefore important to know that these aggravations of a pre-existing condition recognized due to a road accident are also compensable by the SAAQ.
Indeed, it will then be necessary to determine, in application of the theory of the fragile skull, if there has indeed been a significant worsening of your condition, and if so, if it was caused by your accident. However, only a positive answer to each of those questions will justify compensation.
As a result, a victim who was already suffering from mental health problems before their accident, for example, will not have their claim automatically rejected, and they may even be compensated to the extent of the aggravation suffered, upon presentation of the appropriate evidence.
Causal link: sequelae and road accident
It is common for the SAAQ not to immediately recognize the causal link between your physical or psychological sequelae and the road accident of which you were a victim.
For example, the SAAQ may refuse to recognize
your depression
or its worsening as being directly related to your accident, especially when new symptoms appear after your accident or when you already had a certain fragility before it.
However, the causal link is a logical and factual question, which must be assessed on a case-by-case basis, in a broad and liberal manner.
Thus, it must be determined whether the victim would have suffered this new damage had it not been for his initial accident and the permanent sequelae that result from it. If not, this new damage must be recognised as being linked to the accident.
Challenging the SAAQ’s decision
In cases of
relapse, recurrence or worsening of your condition, the burden of proof normally lies with the applicant, and this proof can be difficult to establish.
Indeed, the SAAQ is very likely to refuse to take into account your relapse, recurrence or aggravation, even if you submit convincing evidence to them.
It is therefore important to consult a lawyer in order to properly build your case with complete and appropriate evidence.
Indeed, it happens too often to see victims representing themselves alone, believing they have a good record with the medical certificates of their family doctors. However, establishing a Complete medical evidence
is
unfortunately much more complex than simply reiterating your attending physician’s opinion in court.
Contact us now. We offer you a free initial consultation if you have a decision to challenge.
The SAAQ file
- SAAQ lawyer in Montreal
- Request for reimbursement from the SAAQ
- Compensation for bodily injury
- Compensation for psychological damage
- Income Replacement Indemnity Claim
- Return to work after a road accident
- Your complete compensation file at the SAAQ
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