Post-Concussion Syndrome and Disability Insurance: A Claimant’s Guide
Most people who suffer a mild traumatic brain injury or concussion heal quickly, often within a month. However, not everyone is so lucky. Approximately 30% of people with concussions develop post-concussion syndrome (PCS), which can last a lifetime.
If you live with PCS and can no longer work, you may be eligible for short-term or long-term disability benefits. In this blog, the experienced disability insurance lawyers at Bryant Legal Group discuss the essentials of a post-concussion syndrome claim.
What Is Post-Concussion Syndrome?
Post-concussion syndrome occurs when your mild TBI symptoms, like headache, ringing in the ears, blurred vision, and fatigue, continue for more than two months. While we don’t know what causes PCS, certain populations, including women, older individuals, and those with a history of mental health issues, are more likely to develop the condition.
Post-concussion syndrome can dramatically change your life, causing:
- Migraine and tension headaches
- Fatigue or insomnia
- Depression, anxiety, and irritability
- Memory and concentration problems
- Dizzy spells
- Ringing in the ears (tinnitus)
- Blurred vision
- Sensitivity to light and sound
Sometimes, post-concussion lasts for several months. Other times, symptoms persist for a lifetime.
Can I Get Disability Insurance Benefits for Post-Concussion Syndrome?
Some people with post-concussion syndrome continue to work. Others cannot manage their jobs amid their overwhelming headaches, dizziness, and other symptoms.
If it becomes impossible to work, you may be eligible for either short-term or long-term disability benefits. Unlike Social Security disability benefits, disability insurance policies are sold and paid by insurance companies. Many professionals either have employer-sponsored or privately purchased disability plans.
Disability insurance plans will pay a portion of your lost income if you meet their definition of disability. There are two common disability definitions in short-term and long-term disability policies:
- Own occupation: You are disabled if you cannot perform your actual job or profession.
- Any occupation: You will receive benefits if your post-concussion syndrome and other conditions prevent you from doing any type of full-time work.
If you need help understanding your disability plan’s definitions, refer to your Summary Plan Description or consult a knowledgeable disability insurance lawyer.
Insurance companies frequently deny long-term and short-term disability claims involving post-concussion syndrome. Insurance adjusters prefer objective, fact-based data, like an MRI study or bloodwork, to symptom-based diagnoses. PCS is often a diagnosis of exclusion — your doctors will rule out other conditions instead of ordering a single test that can confirm your post-concussion syndrome.
To fight back, you’ll need help from a law firm that understands the science behind PCS and the complex laws the control disability insurance claims. At Bryant Legal Group, we’ve helped people throughout Chicago and Illinois with their head injury claims. Our ERISA lawyers have recovered hundreds of millions in benefits for our clients, and we can help you evaluate your claim’s strength and your legal options.
Look Out for “Self-Reported Condition” Limitations
Many LTD policies limit benefits for “self-reported conditions,” where there isn’t an objective test that clearly diagnoses your condition. The insurance company may try to terminate your benefits for post-concussion syndrome after two years, citing these limitations. If the insurance company tries this tactic, it’s best to consult a disability insurance lawyer right away. Sometimes, insurance adjusters improperly apply “self-reported condition” limitations.
Filing for LTD Benefits? Your Plan’s Definition of “Disability” May Change
If your post-concussion syndrome does not resolve within a year, you may have to file for long-term disability benefits. Many people with mild brain injuries are surprised when the insurance company denies their LTD claims, especially because their short-term disability claims were quickly approved.
Some of these denials are due to a change in your plan’s definition of disability. Many short-term disability plans use an “own occupation” definition, which is easier to meet. However, most long-term disability plans, especially employer-sponsored ones, apply the tougher “any occupation” standard.
People with PCS do receive long-term disability benefits under “any occupation” plans. However, success often requires extensive evidence, detailed legal analysis, and guidance from expert witnesses. A disability lawyer can help you navigate these hurdles, clarify your evidence, and connect you with the right vocational and medical experts.
Bryant Legal Group: Compassionate Legal Representation for People Living With TBIs
At Bryant Legal Group, we’ve built a reputation for our practical, compassionate, and client-focused approach. We help individuals with traumatic brain injuries and post-concussion syndrome get the short-term and long-term disability benefits they deserve.
Rather than struggle alone, contact our office for a free, no-risk consultation. Our team has recovered millions in compensation for our clients, and we can help you understand your options.
What is PCS? (n.d.). Concussion Legacy Foundation. Retrieved from https://concussionfoundation.org/PCS-resources/what-is-PCS
The content provided here is for informational purposes only and should not be construed as legal advice on any subject.