Can I Qualify For Long Term Disability Due to A Traumatic Brain Injury (TBI)?
A traumatic brain injury (“TBI”) is a serious and life-changing injury caused by a sudden blow to the head that damages the brain. Suffering a TBI can lead to physical and/or cognitive difficulties requiring intense rehabilitative care. Even with intensive treatment, a traumatic brain injury may cause residual symptoms severe enough to cause a permanent or long term disability.
If you’ve suffered a TBI, you may find it impossible to continue working due to your condition. In that case, you may consider filing a long term disability insurance claim. It’s important to know beforehand what steps you should take to ensure your best chances of disability claim approval.
Here are the key tips you need to know before filing your traumatic brain injury long term disability insurance claim.
What Kinds of Disabilities Are Caused by a Traumatic Brain Injury (TBI)?
The after-effects of a traumatic brain injury (TBI) can last years or become permanent, even when treated properly. Understanding the specific ways your TBI impairs your ability to work will help you put together the strongest disability claim possible.
TBIs can cause disabling symptoms in two areas: physical and cognitive.
Disabling Physical Symptoms of TBIs
Disabling physical symptoms of a TBI may include:
Disabling Cognitive Symptoms of TBIs
Disabling cognitive symptoms of a TBI may include:
- Uncontrollable mood swings
- Impaired short/long-term memory
- Difficulty with focus, attention, or thinking
- Depression and anxiety
- Personality changes (often increased irrational anger and aggression)
- Lack of impulse control and poor decision-making skills
- Post-Traumatic Stress
Any of these symptoms, both cognitive and physical, can be disabling if severe or frequent enough. It is common for those who suffer from traumatic brain injuries (TBIs) to become disabled on a long term or permanent basis, depending on the severity of the injury.
How Do I Prove My TBI As a Disability?
As serious as traumatic brain injuries (TBIs) are, your insurance company will require proof of your diagnosis, disabling symptoms, and appropriate treatment before approving your long term disability claim. Never assume your insurance company will understand how your condition impairs your ability to work without supportive documentation.
Diagnostic Testing Results
The insurance company will review your records for diagnostic proof of your brain injury and ongoing symptoms. Typically, the insurance company will want to see the results of a CT scan and/or MRI of your brain. If you are suffering from residual cognitive and/or mental symptoms, the insurance company may also want to review the results of neuropsychological testing.
Medical Evidence is Key
The most important documentation to provide your insurance company when filing a long term disability claim is objective medical evidence.
Your insurance company will require more than just an MRI of your brain and a note from your doctor stating that you are disabled. Other medical evidence they may ask for can include:
- Hospital records from your TBI;
- Abnormal findings on diagnostic imaging (e.g., CT scan or MRI of the brain);
- Follow-up notes from your doctors;
- Proof of your medications/prescriptions;
- Records from any physical or cognitive rehabilitative therapy that you received.
Your insurance company will want your doctor’s opinion as to whether you are disabled. Unfortunately, a simple note stated that you are “disabled” is rarely sufficient. Instead, your insurance company will want a thorough assessment from your doctor that details the severity of your symptoms and their resulting work-related limitations.
If your doctor does not provide you with a thorough assessment, your insurance company may compel you to be examined by one of their “independent” medical examiners. Alternatively, your insurance company could have your file reviewed by an “independent” medical consultant. But these doctors are far from independent. They provide services for the insurance company and, therefore, operate under a serious conflict of interest. You will generally want to avoid being subjected to one of these doctors.
Provide Evidence of Your Disabling Symptoms
Your insurance company will consider the combined impact of your physical and cognitive/mental symptoms. It is important to make sure to report all of your symptoms to your treating doctor(s), both physical and cognitive, so they are well-documented.
Many people suffer from a combination of physical and cognitive/mental symptoms following a traumatic brain injury. Others may be disabled due to solely to cognitive/mental symptoms or physical symptoms.
Fortunately, insurance companies generally recognize the broad spectrum of symptoms that can result from a TBI. Thus, insurance companies tend to evaluate each claim on a case-by-case basis to consider the combined impact of symptoms. However, if a particular symptom is not well-documented, your insurance company is unlikely to consider it. Therefore, proper documentation of all symptoms, as well as their severity and frequency, is necessary for the insurance company to conduct a thorough review.
Proof of your symptoms and abnormal objective findings is essential. The insurance company will review your medical records for reliable documentation of your symptoms following your traumatic brain injury. The insurance company will also look to see whether there are sufficiently documented abnormal clinical findings to explain your symptoms.
Show That You Are Receiving “Appropriate” Treatment
Your insurance company will scrutinize the medical evidence to determine whether your treatment has been “appropriate.”
Depending on the terms of your policy, your insurance company may also scrutinize these records to determine whether your treatment has been “appropriate.” If your insurance company finds that your treatment has not been “appropriate,” it may deny your claim.
Of course, TBIs are extremely complicated injuries – the resulting symptoms vary drastically depending on the nature and severity of the TBI. Thus, determining whether a claimant is under “appropriate” care is no easy task.
Typically, “appropriate” care means that you are seeing with qualified specialists (e.g., a neurologist, rehabilitative medical professionals, etc.) and that you are compliant with your doctor’s treatment plan. For example, if your neurologist thinks that you may benefit from physical or cognitive behavioral therapy, but you never attended the program, your insurance company may deny your benefits for lack of appropriate care. Your insurance company may also claim that you are non-compliant.
Make sure to follow your doctor’s recommendations and show you are doing everything in your power to improve your condition.
Your Insurance Company Requires Ongoing Proof
Your insurance company will require proof even after your claim is approved.
Traumatic brain injury symptoms are known to change and persist over time. Sometimes the symptoms improve or resolve with rehabilitative care and treatment. Other times, the symptoms persist or worsen. Some individuals develop new symptoms entirely.
As a result, your insurance company will usually require proof of an ongoing disability – often for many years after approval. Updated medical records or forms from your doctors may suffice, so long as they are supportive. Therefore, it is usually best to remain in consistent treatment after approval. If you are unable to provide ongoing proof, then your insurance company may subject you to one of their “independent” doctors, or else terminate your benefits altogether.
Disability claims involving traumatic brain injuries (TBIs) are often complicated and complex. Filling out endless forms and painstakingly documenting your injury and symptoms properly to your insurance company can be exhausting and emotionally draining. An ERISA long term disability attorney can help you navigate the confusing process.
To maximize your chances of qualifying for benefits, work with New York disability attorneys who have a proven track record handling ERISA long term disability insurance claims.
To speak to a New York long term disability attorney about your claim, call Riemer Hess LLC, Attorneys at Law, to arrange a consultation: 212-297-0700.