For those with traumatic brain injury, or TBI, long-term disability benefits are a crucial component in the recovery process. Traumatic brain injuries can result from:
The severity of the injury varies greatly depending on the individual and the circumstances.
TBIs are also referred to as a head injury or an intracranial injury. They all refer to the same type of injury. A mild TBI may cause temporary amnesia, headache, nausea and vomiting, ringing in the ears, or problems with speech.
A moderate to severe injury can result in any of the symptoms of a mild injury, but may also include convulsions or seizures, uneven pupil dilation, inability to wake up, or confusion. As the result of a serious injury, there may be brain bruising, tissue tears, bleeding or other physiological damage.
Epilepsy may result after a TBI. Your eligibility for long-term disability benefits will depend on the frequency and severity of seizures. The insurance company will want to know the type of seizure, its duration, and details about your recovery period. For example, after the seizure were you unconscious, extremely fatigued, confused, etc.
If you experience a stroke(s), you may qualify to receive long-term disability benefits, particularly if the stroke results in the following impairments.
Psychological disorder are another type of injury which may result from a TBI. Disability benefits will be limited to those disorder that occur as a result of your TBI. If you experience any of the following conditions, you may qualify for long-term disability insurance.
Neuropsychological testing may provide additional information about cognitive impairments.
The diagnosis of a traumatic brain injury is based on objective clinical information such as a physical exam, neurological testing, an MRI, CT scan, or X-rays. Whether these tests were performed immediately after the accident or at a later time, the information will be used to verify the extent of your injuries. A neuropsychological exam may also be performed if you are experiencing psychological or cognitive disabilities.
The nature of a TBI can make it difficult to determine a long-term prognosis. Also, the unpredictability of the recovery process may require you to be reassessed to determine the extent to which your disability has changed. This is especially true if your disability is neurological or psychological in nature.
The insurance company will consider a number of different factors to determine if your TBI qualifies you for long-term disability benefits. These factors include the following:
The insurance company will assign an adjuster to review your claim information. He or she will evaluate the extent of your TBI relative to your ability to work. An evaluation of your physical, mental, and sensory functioning may be assessed by the insurance company. Your physician will have to fill out an Attending Physician Statement (APS), also called a Residual Functional Capacity (RFC) form. The more documentation you have which includes objective, measurable disability information, the more credible your claim will appear to the insurance company.
As noted above, the unpredictable nature of a traumatic brain injury may require you to be reassessed over time. Your initial claim will determine your ability to return to work within the first two-years after your disability.
After 24 months, the insurance company may reevaluate your claim and your qualification for benefits may subsequently be slightly different. It’s common for insurance policies to change the way they define disability after 24 months. For example, instead of determining your ability to return to your previous work, they may consider your ability to perform any type of work.
At the CJ Henry Law Firm we understand how profoundly a TBI can affect your life. Contact us today to learn more about how to obtain TBI disability benefits.