Do You Have A Case?

Can I Get Long-Term Disability For A Traumatic Brain Injury (TBI)?

Yes, you may be eligible to receive long-term disability benefits for a traumatic Brain Injury (TBI). A TBI is a serious, and often life-changing injury. Generally, it is caused by a sudden blow, or series of blows, to the head, leading to brain damage. Depending on the severity of your TBI, you may have to live with physical and/or cognitive difficulties. To overcome these difficulties, you may need intense rehabilitative care. Some traumatic brain injuries are so severe, that rehab is necessary for the maintenance of what capabilities remain. Additionally, some traumatic brain injuries may cause residual effects severe enough to permanently disable someone.

If you have suffered from a TBI, you may find it difficult or even impossible to return to work in your condition. If that is the case, you should consider filing for long-term disability. It is important to speak with your attorney and your doctor before filing for disability insurance so that you can have a strong case from the start.

Causes of TBI

A traumatic brain injury occurs after you sustain a sudden blow to the head. The damage sustained will generally lead to bruising, swelling, and even internal bleeding. Common causes of TBIs include automobile accidents, falls, sports injuries, assaults, and other injuries. Roughly 1.5 million people in the US suffer from a traumatic brain injury each year. According to the CDC, over 200,000 people were hospitalized in 2019 for TBI-related injuries.

Additionally, traumatic brain injuries are common among military personnel. One of the most common causes of TBIs in soldiers is explosive devices, such as IEDs.

Individuals involved in sports often report concussions and other traumatic brain injuries. 15% of all US high school students self-reported a sports or recreation-related concussion in 2019, according to the CDC.

Disabling Symptoms of a Traumatic Brain Injury

Often, the effects of one’s TBI will last long after the injury occurs. For some, the effects can last years or even their whole lives. Even with proper treatment, care, and rehabilitation, some symptoms may never go away. This is why long-term disability coverage for your traumatic brain injury can be critical. Generally, symptoms of traumatic brain injuries are categorized as either physical or cognitive.

Disabling Physical TBI Symptoms

Common physical symptoms that may be disabling include:

• Headaches
• Dizziness
• Nausea
• Fatigue
• Ringing in ears (Tinnitus)
• Seizures and convulsions, or the development of epilepsy
• Loss of balance
• Light/noise sensitivity
• Muscle Weakness
• Poor sleep patterns
• Blurred vision

Disabling Cognitive Symptoms of TBIs

Disabling cognitive symptoms of sustaining a TBI may include:

• Mood Swings
• Impaired memory (short- or long-term)
• Poor attention span
• Difficulty with focus
• Difficulty with critical or abstract thinking
• Depression
• Anxiety
• Changes in Personality
• Poor impulse control
• PTSD

Any of the above symptoms, both physical and cognitive, can be disabling if they occur frequently or severely enough. It is common for people who suffer from a TBI to become permanently disabled because of the trauma, or the accompanying symptoms.

Mild vs Severe Traumatic Brain Injury

Traumatic brain injuries are often classified from mild to severe. Mild TBIs, such as minor concussions, often occur when an individual suffers a blow that confuses or causes loss of consciousness for up to 30 minutes. Although “mild,” these injuries can still come with serious cognitive impairments. These impairments can include memory loss, headaches, dizziness, and fatigue. About 80% of all brain injuries are “mild” cases. Depending on the severity of your cognitive impairment, a mild case of TBI can still qualify for disability insurance.

“Severe” cases of TBI are generally classified as those where the individual loses consciousness for longer than 30 minutes. Cognitive impairments may include changes in speech or language use, poor critical or abstract thinking skills, and loss of motor function. Symptoms can last months or even years after the initial injury occurs. Additional long-term symptoms can also include shorter attention spans, sleep abnormalities, chronic headaches, poor memory, and even depression.

How Do I Prove My Traumatic Brain Injury As A Disability?

While your traumatic brain injury can be severe, your insurance company will still require you to prove it as a disability. You will need to show proof of diagnosis, as well as proof that your symptoms are disabling you. Additionally, you will need to show that you are receiving “appropriate” treatment for your symptoms. It is rare for insurance companies to approve disability claims without supportive documentation of all 3.

Diagnostic Testing for TBI

Proper testing and documentation of your injury are key to building your disability insurance case. The first place to start is usually a scan that can support your TBI claim. CT scans and/or MRIs can show proof of your injury. Additionally, a neuropsychological test may be necessary to prove that you are suffering from cognitive or mental symptoms of your injury.

Objective Medical Evidence of Your Injury

Having objective medical evidence of your injury and symptoms is key to creating a strong case. While a head scan can prove a head injury, you’ll need more than just that to prove that you are disabled by the injury. Having different forms of objective medical evidence can help provide a framework of your disability for the insurance company. These may include:

• Hospital records related to your injury
• Diagnostic imaging (brain scans)
• Prescription records
• Physical or cognitive rehabilitation therapy records

The insurance company will also want your doctor’s opinion on your condition. Your doctor will need to provide a thorough assessment of your condition. This assessment should detail the level of severity of your symptoms. It should also detail how your symptoms could limit you from work-related activity.

Receiving “Appropriate Treatment” for Your Traumatic Brain Injury

Insurance companies will review your case with much scrutiny to avoid paying out. One way they try to get away with this is by determining whether your treatment is appropriate for your symptoms or injuries. However, because TBIs are often complicated, and can vary by person, it can be hard to determine what appropriate treatment looks like. Generally, treatment for TBIs includes treating physical injuries, along with any additional symptoms. Physical, cognitive, and mental rehabilitation care may also be necessary.

Seeing qualified specialists for your care may also be a good way of showing that you are receiving appropriate care. These specialists may include neurologists, rehabilitation specialists, physical therapists, and more. They may also check that you are compliant with any prescribed treatment plans. Be sure to follow the recommendations of your doctors and other healthcare professionals.

How Do I Provide Ongoing Proof of my Traumatic Brain Injury Disability?

Once your claim is approved, your insurance company may require ongoing proof of your disability. Continue seeking treatment for your TBI and the symptoms you experience. Additionally, be sure to save records from your doctors about your condition. These will help you show evidence of your ongoing condition. If you cannot provide proof of ongoing care and symptoms, insurance companies may require you to go to one of their doctors for review. Or, they may choose to terminate your benefits.

Symptoms of a Traumatic Brain Injury may change and develop over time. If you are experiencing new or worsening symptoms, please discuss those with your doctors. Be sure that they note any changes in your symptoms in your medical records. These updates can be important in providing an Attending Physician Statement if your insurance company requires one.

Can an Attorney Help Me Get Long-Term Disability for TBI?

If you are looking to file a long term disability claim for your Traumatic Brain Injury, you should seek out an experienced attorney. At D’Agostino & Associates, we help people living with disabling conditions such as TBIs file long-term disability claims. We help you through the process step by step to help you build a strong case. Our law team is here for you.

At D’Agostino & Associates, our team of lawyers can help you sort through all the details, understand what you are entitled to, and fight to get what you deserve. D’Agostino & Associates P.C. has offices in New York and New Jersey. Contact us, or call us at 1-888-245-2924 to schedule a free consultation with our attorneys.