TBI and Disability Insurance: A Claimant’s Guide
Over the past several years, public awareness of traumatic brain injuries (TBI) has dramatically increased. While this awareness is leading to earlier diagnoses and proactive treatment, TBI is still a widely misunderstood condition.
If you or a loved one can no longer maintain full-time employment due to a traumatic brain injury, it may be time to explore a long-term disability (LTD) claim. Here, the attorneys at Bryant Legal Group discuss TBI and the disability claim process.
What Is a Traumatic Brain Injury?
The brain is your body’s control center. It produces your thoughts, actions, feelings, and physical responses. It is made up of a complex network of nerves, tissues, and glands.
Traumatic brain injury occurs when your brain is violently subjected to forces like acceleration and deceleration, damaging these structures. The most common TBI causes include falls and motor vehicle accidents.
During a traumatic brain injury, the brain’s sensitive tissues and nerves are stretched, torn, and bruised. Swelling and fluid buildup can cause further damage. While there are many types of TBI, some are more common than others.
- Concussion: Typically considered a mild TBI, the brain hits the ridged inside of the skull.
- Coup-contrecoup: When your brain bounces back and forth in the skull, causing bruising and damage to brain and nerve tissues.
- Diffuse axonal injury (DAI): Forces twist, tear, and stretch the axons (nerve fibers that send electrical impulses), causing permanent damage. It can be difficult to identify and diagnose a DAI.
- Penetrating: Something penetrates both the skull and brain tissues.
Injuries involving lack of oxygen to the brain or demyelination from a disease like multiple sclerosis are not TBIs.
While most traumatic brain injuries are not fatal, many survivors struggle with their symptoms — and even a seemingly minor concussion can change your life forever.
For example, up to 30% of people suffer from post-concussion syndrome after a mild TBI. This can cause severe headaches, sensitivity to light and sound, and disturbed sleep. Other common TBI symptoms include:
- Attention and concentration problems
- Blurred or double vision
- Depression and anxiety
- Problems with decision-making and executive function
- Ringing in your ears (tinnitus)
- Speech and language difficulties
- Mood and personality changes
RELATED ARTICLE: When Should I Speak With a Disability Insurance Lawyer?
Should I Apply for LTD Benefits After a TBI?
Before you apply for long-term disability or other disability-related benefits, you should talk to your doctors and an experienced attorney. Filing for disability isn’t a simple process, and you’ll want to make sure you understand your LTD policy’s terms and conditions (and the strength of your evidence) before you initiate a claim.
Your doctor can help you understand your prognosis and likelihood of a full recovery. Based on your symptoms, they can also help you understand whether you’ll be able to safely return to work. For example, your doctor may suggest that you take frequent breaks or avoid unprotected heights after a TBI.
Once you understand your physical and cognitive abilities, a disability lawyer can help you evaluate your LTD claim. This will include an analysis of your disability plan’s language and procedures. Most policies include strict waiting periods, filing deadlines, and definitions of disability.
RELATED ARTICLE: Building a Comprehensive Application for Disability Benefits
4 Reasons Disability Insurance Companies Dispute Brain Injury Claims
Traumatic brain injuries are nuanced and complicated. Unfortunately, most insurance adjusters don’t have the time or inclination to dig deep into your medical records and consult with experts. That’s why it’s not uncommon for them to make mistakes and deny valid TBI disability claims.
Depending on your circumstances and medical history, the adjuster may deny your TBI disability claim for any of the following reasons.
1. Your Brain Injury Doesn’t Appear on an Imaging Study
When doctors suspect someone has a TBI, they almost always order an MRI, CT scan, or another imaging study. However, a surprising number of these studies do not show evidence of a brain injury — even when the person suffered trauma and has TBI-related symptoms. Unfortunately, an imaging study that is within “normal limits” can lead to a denied LTD claim.
At Bryant Legal Group, we understand that some CT and MRI machines aren’t sophisticated enough to identify subtle micro-trauma. That’s why we work with experts (including radiologists and neuropsychologists) who can help us properly evaluate our clients’ evidence.
2. Your Recovery Is Slower than Anticipated or Plateaus
A TBI recovery can take a lifetime, but many adjusters get impatient. As your condition stabilizes, the insurance company may assume that your “stable” diagnosis means that you’ve recovered and are capable of working. However, we know that stability isn’t the same thing as recovery — it just means that your symptoms have plateaued.
In these cases, you may need help from an experienced lawyer and doctors to refine and clarify your prognosis and capabilities. This is especially true if the insurance adjuster suspects that you’re malingering or exaggerating your symptoms for financial gain.
3. The Adjuster Thinks You Can Do Simple Work
Some LTD policies define disability as an inability to perform any occupation. That means you’ll have to show that you’re not only unable to do your past work, but any other type of full-time, gainful employment. Sometimes, insurance adjusters will argue that you can do simple, routine, or unskilled work after a TBI, such as sorting small parts into bins or greeting customers at a grocery store.
In response, you’ll need to highlight the full array of your physical and mental symptoms, which may include profound fatigue, dizzy spells, and motor dysfunction. Your lawyer may also consult with a vocational expert or consultant who can carefully evaluate your abilities and skills.
4. There’s Missing Evidence
After a TBI, you’ll see a lot of doctors, therapists, and other healthcare providers. Each of these people can offer unique insight into your TBI claim. However, when you’re trying to balance your recovery and an LTD claim, it’s easy to forget to list every doctor or provide copies of your complete medical record.
To ensure that your disability claim is fully developed, it’s best to consult with an experienced disability insurance lawyer. They can help you review the insurance company’s file, identify gaps in your information, and supplement those documents.
Bryant Legal Group: We Help TBI Survivors Regain Control
If you’re struggling after a traumatic brain injury, you probably have a lot of questions and concerns about your future. At Bryant Legal Group, we think you deserve practical advice and compassionate service. Our lawyers have more than 100 years of collective experience and focus their practices solely on disability and insurance law.
To learn more about our client-centered, sophisticated approach, please contact us today for a free consultation. You can reach Bryant Legal Group by completing this brief online form or by calling 312-561-3010.
TBI-related emergency department visits, hospitalizations, and deaths (EDHDs). (2019, March 29). Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/traumaticbraininjury/data/tbi-edhd.html
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.