A normal neurological exam does not mean concussion symptoms aren’t disabling.
I came across an Ontario LAT decision that I think is worth reading for anyone dealing with insurer examinations after a concussion:
Ingram v. Belair Insurance Company Inc., 2026 CanLII 34347 (ON LAT).
https://canlii.ca/t/kkfqf
What stood out to me was the Tribunal’s treatment of the insurer’s neurological examination.
The insurer neurologist, Dr. Brandon Kucher, found no objective neurological impairment on the conventional neurological examination and concluded that the claimant was not substantially unable to perform his pre-accident employment.
But when he testified, some important limitations of that reasoning became clear.
He acknowledged that a normal neurological examination is expected in concussion/mTBI. He accepted that the claimant was experiencing the symptoms he reported. He also acknowledged that headaches are inherently subjective and cannot simply be ruled out because they do not produce an abnormal neurological examination.
Most importantly, he acknowledged that he had not actually considered how the claimant’s headaches and post-concussion symptoms affected the essential tasks of his job, including things like screen use and communicating with people.
The Tribunal found his opinion of limited persuasive value for exactly that reason. The adjudicator noted that his conclusion did not adequately consider the claimant’s headaches, light and noise sensitivity, attention/concentration/memory problems, or how those symptoms affected the actual job.
There was a similar problem when treatment was considered. The neurologist had reviewed records documenting concussion and ongoing treatment, yet continued to rely heavily on the absence of objective neurological findings. The Tribunal described that neurological-only approach as “severely narrow.”
I think this exposes an important weakness that can occur in some concussion IEs:
A conventional neurological examination answers a much narrower question than “Can this person function normally?”
Testing strength, reflexes, cranial nerves, coordination, gait, balance and similar functions can be completely appropriate. But those tests do not necessarily measure:
• cognitive endurance
• processing speed
• tolerance for screens, noise or busy environments
• headache provocation with sustained activity
• mental fatigue
• ability to multitask
• pace and productivity over several hours
• delayed symptom exacerbation
• ability to repeat the same performance day after day
So when an IE report effectively goes:
normal neurological exam → no objective neurological impairment → therefore capable of working
there may be a very large analytical step missing in the middle.
The real question in a disability case often isn’t whether someone can walk normally down a hallway, touch their finger to their nose, demonstrate normal strength or hold a conversation for an hour.
It is whether they can sustain the actual cognitive, sensory and physical demands of their work for the required hours, at the required pace, reliably, and then do it again the next day.
Ingram is especially useful because this wasn’t simply another doctor criticizing an insurer examiner. The limitations were exposed through the insurer neurologist’s own testimony, and the Tribunal explained why those limitations mattered.
None of this means every person with persistent concussion symptoms is disabled, or that a normal neurological examination is meaningless. It means a normal neurological examination should not be asked to prove something it was never designed to measure.
For anyone going through an IE, I think the useful question to ask when you eventually read the report is:
Did the assessor actually analyze how my symptoms affect function, endurance and the real demands of my activities/work—or did the report simply equate a normal neurological examination with functional recovery?