Mother 'devastated' daughter's claim denied by insurance

A mother is speaking out after her daughter, who lives with seizures and the emotional aftermath of a serious brain injury, was denied an income supplement by Saskatchewan Government Insurance. 

Tamara Courtney says her daughter Sarah was 14 when, on Dec. 23, 2012, she was a passenger in a speeding vehicle that slammed into a telephone pole before hitting a tree.

"Before the accident she was university material," she said of her daughter, who is now 18. 

"She was smart. She was intelligent. She had tons of friends. Now she's alone."

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Courtney said a claim was opened for her daughter with SGI shortly after the accident, but the family has spent years waiting for answers and some type of compensation for Sarah. 

Fit to work, says SGI

Courtney said Sarah was hospitalized in an intensive care unit for several weeks following the crash, and had to undergo a 13-hour surgical procedure to have her face reconstructed.

She suffered contusions in the front lobes of her brain, and facial and skull fractures. 

According to Courtney, Sarah has started having seizures and has suffered from anxiety and depression since the accident. 

In order to achieve some type of independence, Sarah moved in with a roommate near her family's home in Melfort, Sask. 

Courtney said the family thought Sarah would qualify for some kind of income supplement once she turned 18. They applied for assistance around her birthday in June 2016.

A letter came in the mail last week denying the request, saying that based on Sarah's medical information on file, she was deemed able to do eight hours of light work per day for a 40-hour work week. 

Courtney called it devastating news. 

"Sarah is in no way shape or form ready to be working a full-time job. And what do I do with this girl now?" she said.

"Where do we go from here?"

Courtney believes her daughter's emotional difficulties and recent epilepsy diagnosis inhibit her ability to work.

"They expect her to be able to function at lot higher level than [what's] even possible," she said, adding the most her daughter has been able to work is four hours, one day a week, helping out in the back of a shop.

Work difficult for brain injury patients 

Dr. Jose Tellez-Zenteno, a neurology teacher at the University of Saskatchewan's College of Medicine, said it's well-documented that sufferers of serious head trauma can develop anxiety, depression and other psychiatric troubles after an accident, making it all the more difficult to maintain work. 

"Many of these patients develop memory problems, poor performance," he said. 

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The recovery period for brain injury patients depends on the severity of the injury, Tellez-Zenteno said, but the more serious injuries — like Sarah's — can take five years, if not longer, to recover from.

Factoring in the occurrence of seizures, which affects up to 20 per cent of head injury patients, Tellez-Zenteno said that some forms of neurological impairment can be a lifelong condition.

SGI responds

Tyler McMurchy, a spokesman for SGI, said the insurer cannot discuss the specifics of a claimant's file, citing privacy concerns.

However, in an email statement, SGI says that more complex injuries can take longer to evaluate.

She was smart. She was intelligent. She had tons of friends. Now she's alone.- Tamara Courtney

"In some cases, including brain injuries, we are required to wait until the injury has reached its maximum recovery. Until that time, SGI would be unable to do a proper assessment."

The statement also says the insurer determines whether a claimant qualifies for an income replacement benefit through a series of medical assessments, with a primary practitioner responsible for reporting their diagnosis post-accident — something Courtney said happened.

'I want her to be able to succeed'

Without financial help for Sarah's day-to-day living, Courtney said the family will foot the bill for her rent and cellphone.

She said her daughter continues to see a psychologist, neurologist, ophthalmologist and vocational trainer regularly.

As for herself, Courtney said the whole ordeal has taken its toll. 

"I'm exhausted. I can barely sleep. Just a complete mess," she said, choking back tears. 

"The worst part of it is if she didn't have us helping her — an 18 year old who's expected to be an adult with a traumatic brain injury — who would do it for her?"

Courtney said the family is considering hiring a lawyer and taking the issue to mediation with SGI.