Brain Injury IMEs in 2026

 June is Brain Injury Awareness Month – an annual prompt for the legal community to revisit how brain injury claims are evaluated.  

According to Brain Injury Canada, an estimated 165,000 Canadians sustain an acquired brain injury each year, and traumatic brain injury (TBI) remains a leading cause of long-term disability in adults under 40. Public Health Agency of Canada surveillance data continues to show concussion as one of the most common injury presentations to emergency departments nationally.

For counsel working on these files, the quality of the Independent Medical Examination (IME) often turns on something that happens before the assessment ever begins: the design of the referral question.

Why brain injury claims are uniquely difficult

Mild TBI (mTBI) accounts for roughly 80% of all traumatic brain injuries. In most cases, recovery follows the expected trajectory within three months. But in an estimated 10-20% of cases, symptoms persist - cognitive fog, fatigue, headache, mood change, sleep disruption, and sensitivity to light and noise. These persistent post-concussive presentations are where litigation tends to live.

Compounding the diagnostic challenge, brain injury rarely presents in isolation. Studies consistently show high rates of comorbidity with Post Traumatic Stress Disorder (PTSD), depression, chronic pain, and somatic symptom disorders. Vestibular and visual dysfunction frequently sit beneath the surface. Pre-existing learning differences, migraine history, or prior concussions can complicate causation. Without a precisely framed referral question - and the right specialty matched to it - reports can drift, miss key issues, or produce findings that are difficult to use.

The biggest lever counsel controls: the referral question

A vague referral question produces a vague report. A precise one produces a usable one. Five principles tend to separate the two:

1. Be specific about the issue in dispute. “Please assess cognitive function” invites a broad survey. “Please opine on whether the claimant's reported cognitive symptoms are attributable to the index event, and whether they affect capacity to perform the cognitive demands of [specific role]” focuses the assessment.
2. Separate diagnosis, causation, prognosis, and functional capacity. These are four different questions. Reports are strongest when each is answered explicitly, with its own clinical reasoning.
3. Ask about competing explanations. Counsel benefits from a report that addresses comorbidities, pre-existing conditions, concurrent conditions and confounders head-on - not one that quietly omits them.
4. Define the relevant time frame. Brain injury symptoms evolve. Ask the expert to opine on current status and probable trajectory, with reference to prognosis and when maximum medical recovery (MMR) should be reached.
5. Specify the standard. Are you asking about impairment, catastrophic impairment, capacity, or fitness for a specific occupation? Each has a different threshold and a different evidentiary requirement.
   
   

Selecting the right specialty (or combination)

Not every brain injury Independent Medical Examination (IME) requires the same assessor. For most files, the question is not “neurology or psychiatry?” but “what combination?”

• Neurology for diagnosis and neurological sequelae.
• Neuropsychology for objective cognitive testing, validity assessment, and functional cognitive impact.
• Physiatry for functional capacity, return-to-work planning, and overlapping musculoskeletal issues.
• Psychiatry where mood, PTSD, or somatic symptom comorbidity is significant.

When complex files call for coordinated multi-specialty assessments, the right specialty combination is typically identified at the referral stage - most requests arrive with the specialty already in mind. Where scoping support is needed, our physician-led intake process can help structure the approach before scheduling begins. (See also our blog on Orthopaedic vs. Physiatry IMEs for related context on specialty selection.)

What strengthens every brain injury referral

Three inputs consistently strengthen the resulting report: complete pre and post incident clinical notes and records (including imaging, Emergency Department notes, specialist consultations and family physician follow-up); collateral information from employers where available; and course of treatment documentation - what was tried, for how long, and with what response. Reports built on incomplete records are easier to challenge and harder to rely on.

Designed for clarity, not conflict

A well-designed brain injury Independent Medical Examination (IME) is not about winning a position. It is about giving the decision-maker - judge, arbitrator, adjuster, or tribunal - a clinically defensible answer to a precisely framed question. That is the standard our national assessor network is built around.

Learn more about how the Medylex Independent Medical Examination (IME) process works, explore our national coverage areas, or contact our team to scope a brain injury referral.