Brain injuries can have a life-altering impact on your ability to perform daily functions, including work. If you or a loved one have experienced a brain injury, you may be considering your options for short or long term disability benefits. As devastating as a brain injury may be, insurance companies still often pose challenges when evaluating your claim for benefit approval. Understanding the intricacies of the disability claims process is crucial when seeking short and/or long term disability benefits.
Below we’ll provide essential insights into the challenges of securing disability benefits for brain injuries, what evidence is necessary to get your claim approved, and how an experienced ERISA attorney can effectively advocate for you in your pursuit of disability benefits.
What Brain Injury Conditions Cause Disability?
Brain injuries can cause varying degrees of disability depending on the severity and location of the injury. Some common brain injuries that may lead to disability include:
Traumatic Brain Injury (“TBI”): TBI results from an external force causing injury to the brain. This can occur due to falls, motor vehicle accidents, sports-related injuries, or other forms of trauma. TBI can cause a wide range of disabilities, including cognitive impairments, memory problems, motor deficits, communication difficulties, and emotional and behavioral changes.
Stroke: A stroke occurs when there is a blockage or rupture of blood vessels in the brain, leading to brain cell damage. Strokes can cause various disabilities, such as paralysis, difficulty speaking or understanding language (aphasia), impaired coordination, and cognitive impairments.
Anoxic Brain Injury: An anoxic brain injury occurs when the brain is deprived of oxygen for an extended period. This can happen due to drowning, suffocation, cardiac arrest, or other medical emergencies. Anoxic brain injury can lead to severe and permanent disabilities, affecting cognitive, motor, and sensory functions.
Hypoxic Brain Injury: Hypoxic brain injury is similar to anoxic brain injury but involves a partial lack of oxygen to the brain. It can also cause various disabilities depending on the extent and duration of oxygen deprivation.
Brain Tumors: Tumors in the brain can cause disabilities depending on their size and location. They can press against and damage surrounding brain tissue, leading to a range of neurological impairments.
Infections and Inflammation: Conditions like meningitis, encephalitis, and brain abscesses can cause brain damage and disabilities. These infections and inflammations may affect brain function and lead to cognitive, motor, and sensory impairments.
Neurodegenerative Diseases: Conditions like Alzheimer’s disease, Parkinson’s disease, and multiple sclerosis can cause progressive brain damage and result in various degrees of disability over time.
Physical Disability Due to Brain Injuries
Brain injuries can result in a wide range of physical symptoms that may lead to disability. These physical symptoms include:
Motor deficits: Brain injuries can lead to difficulties with movement and coordination. This can manifest as weakness, paralysis, spasticity (stiffness and involuntary muscle contractions), or ataxia (loss of coordination and balance).
Sensory impairments: Damage to specific areas of the brain can result in sensory deficits. This may include changes in vision, hearing loss, altered sense of touch, or disturbances in proprioception (awareness of body position).
Headaches and migraines: Many individuals with brain injuries experience persistent headaches or migraines, which can significantly impact daily functioning.
Dizziness and balance problems: Brain injuries can disrupt the brain’s balance centers, leading to feelings of dizziness, vertigo, and difficulty maintaining balance.
Seizures: Some brain injuries can cause an increased susceptibility to seizures, leading to recurrent convulsions and potential physical injuries during seizures.
Fatigue and sleep disturbances: Many individuals with brain injuries experience chronic fatigue and sleep disturbances, which can further affect your ability to engage in daily activities.
Speech and language difficulties: Depending on the location of the brain injury, a person may experience difficulties with speech production expressive aphasia) or understanding language (receptive aphasia).
Swallowing difficulties: Brain injuries can impair the coordination of the muscles involved in swallowing, leading to dysphagia, which can cause problems with eating and increase the risk of choking or aspiration.
Bowel and bladder dysfunction: Brain injuries may disrupt the control of bowel and bladder function, leading to incontinence or other digestive issues.
Impaired fine motor skills: Damage to specific brain areas can result in difficulties with fine motor tasks, such as writing, typing, or using tools and utensils.
Sensitivity to light and sound: Some individuals with brain injuries become hypersensitive to light and sound, leading to discomfort and challenges in noisy or bright environments.
Cognitive Impairment Due to Brain Injuries
Brain injuries may lead to various cognitive symptoms, which can impact your thinking, memory, processing speed, judgment, and other cognitive abilities. Some of the common cognitive symptoms of brain injuries that may cause disability include:
Memory problems: Difficulty with short-term or long-term memory is a common cognitive impairment following brain injuries. This can affect your ability to learn new information, remember recent events, or recall past experiences.
Attention and concentration issues: Brain injuries can lead to deficits in attention, making it challenging to focus on tasks, filter out distractions, or sustain attention for extended periods.
Executive function deficits: Executive functions are higher-level cognitive processes responsible for planning, organizing, decision-making, and problem-solving. Brain injuries can disrupt these abilities, leading to difficulties in managing time, setting goals, and initiating tasks.
Language impairments: Depending on the location of your brain injury, you may experience difficulties with speaking (expressive language) or understanding language (receptive language).
Processing speed reduction: Brain injuries can slow down cognitive processing speed, making it harder to think, respond, or process information quickly.
Impaired reasoning and judgment: Brain injuries may affect your ability to make sound decisions, assess risks, and understand consequences, leading to poor judgment in various situations.
Visuospatial difficulties: You may have trouble with visuospatial skills, making it challenging to perceive and interpret visual information, such as maps or spatial relationships.
Disorientation and confusion: Brain injuries can lead to disorientation and confusion, making it challenging to navigate familiar environments or follow routines.
Difficulty with multitasking: Brain injuries may hinder your ability to multitask and handle multiple cognitive demands simultaneously.
Emotional and behavioral changes: Brain injuries can lead to emotional lability, mood swings, impulsivity, and alterations in personality, which can contribute to disability and impact social and interpersonal functioning.
How Do Insurance Companies Evaluate Brain Injury Disability Claims?
Insurance companies evaluate brain injury disability claims through a comprehensive process that involves reviewing medical evidence, functional assessments, and other relevant information in order to determine if you meet the definition of disability outlined in your insurance policy. Despite the gravity of a brain injury, getting approved for short or long term disability insurance benefits by your insurance company can be challenging due to various factors.
Your insurance company will require substantial evidence supporting the extent of your condition. Brain injuries can result in a wide range of cognitive, physical, and emotional symptoms, and not all of these symptoms may be easily measurable or objectively observed. Insurance companies typically prefer objective evidence to support disability claims, but you may experience symptoms such as cognitive impairments or headaches that are difficult to quantify with traditional medical tests or imaging. Unlike physical disabilities that may be more apparent, the effects of brain injuries are not always externally visible. This may lead to skepticism from your insurance company and questioning of your limitations.
Evaluating brain injury claims requires a thorough understanding of neurology and the complex interplay of cognitive, physical, and emotional impairments. Your insurance company may rely on their own medical consultants to review the evidence, leading to potential disputes over the extent of your disability. Additionally, some brain injury symptoms may not manifest immediately after the injury, and there could be a delay before the full extent of your disability becomes apparent. Your insurance company may question whether the injury occurred during the coverage period or attempt to argue that other factors caused your disability.
Brain injuries can lead to lasting or even permanent disability, but your insurance company may be hesitant to provide long term benefits due to their own profit considerations. They may seek to terminate benefits after a certain period or continually and frequently reassess your disability status. For example, it is common for disability insurance policies to limit benefits for mental illness disabilities to two years. Brain injuries can cause emotional and behavioral changes secondary to the injury, such as depression, anxiety, or irritability. If you’ve experienced a mental health condition such as depression or anxiety due to your brain injury, your insurance company may allege that your mental illness is unrelated to your brain injury and the true cause of your disability. This way they can restrict paying benefits to a limited time period.
To improve your chances of getting approved for short or long term disability insurance benefits, it is recommended you consult an ERISA attorney specializing in disability claims. An experienced attorney can help navigate the complexities of the claims process and advocate on behalf of your best interests.
What Evidence Can I Submit for My Brain Injury Disability Claim?
Well-organized and comprehensive evidence of your symptoms and their impact on your ability to work can strengthen your brain injury disability claim, therefore increasing your chances of benefit approval. Consulting with an experienced disability attorney can also be beneficial in preparing the necessary evidence and navigating the claims process effectively.
Here we’ll discuss the specific types of evidence that can substantiate your brain injury short or long term disability claim.
Medical Evidence for Brain Injury Disability
Medical Records: Provide all relevant medical records related to your brain injury. This includes hospitalization records, emergency room reports, doctor’s notes, specialist consultations, and any other medical documentation detailing your initial injury, treatment received, and ongoing care.
Neuroimaging Results: Include the results of neuroimaging tests such as MRI Magnetic Resonance Imaging) or CT (Computed Tomography) scans. These tests can help visualize brain abnormalities or structural damage resulting from your injury.
Specialist Reports: Include reports from your treating specialists, such as neurologists, neurosurgeons, physiatrists, or other relevant experts who have assessed and treated your brain injury. These reports can attest to the legitimacy, severity, and frequency of your symptoms.
Functional Capacity Evaluation (“FCE”) Report: If available, provide the results of an FCE conducted by a physical or occupational therapist. This evaluation assesses your physical abilities and helps determine your level of function, often focusing on work-related tasks (standing, walking, sitting, fine motor skills, etc.). The report provides objective evidence of your physical restrictions and limitations to further substantiate your claim.
Neuropsychological Evaluation: Submit the results of any neuropsychological evaluations, which are specialized tests administered by neuropsychologists to assess your cognitive function, memory, attention, executive function, and other cognitive abilities affected by your brain injury. The evaluation report provides valuable and objective data on how your injury has affected your cognitive functioning.
Physician’s Statement: Obtain a comprehensive statement from your treating physician outlining the diagnosis, prognosis, and the impact of your brain injury on your ability to work and perform daily activities. It is recommended to request a specialist such as a neurologist to furnish this statement.
Rehabilitation and Therapy Records: Include records of any rehabilitation or therapy received, such as physical therapy, occupational therapy, speech therapy, or cognitive rehabilitation. These records demonstrate ongoing efforts to improve function and manage the effects of your brain injury.
Medication Records: Provide a list of medications prescribed by your treating providers for managing your brain injury and related symptoms, along with any side effects experienced. Keep in mind that sometimes, the side effects of medications can themselves be disabling.
Vocational Evidence for Brain Injury Disability
Vocational evidence can be used to demonstrate the key material demands of your occupation to your insurance company and explain the impact of your brain injury on your ability to work. Here are key types of vocational evidence that you can submit to support your claim:
Official Job Description: An official job description from your employer can show your insurance company the requirements of your job role. The job description should outline the physical and cognitive functions needed to perform your occupation.
Vocational Expert Opinion: A vocational expert can evaluate your transferable skills, limitations, and employability in light of your brain injury-related impairments. The vocational assessment can analyze the material duties of your occupation, both physical and cognitive, and determine if your brain injury disables you from performing those tasks.
Letters from Employers or Colleagues: You may consider requesting your employer or co-workers to provide a statement supporting your brain injury disability claim. These statements can further explain the physical and cognitive responsibilities you perform in your role, as well as describe any decline in your job performance they have witnessed due to your brain injury.
How Can The Maddox Firm Prove My Brain Injury Disability Claim?
If you are in the process of filing, appealing, or litigating a short or long-term disability claim due to a brain injury, The Maddox Firm is here to assist you. Our experienced team understands the complexities involved in brain injury-related disability claims and is well-versed in the criteria insurance companies consider when evaluating these claims.
Here’s how The Maddox Firm can support your brain injury short or long-term disability claim:
The Maddox Firm Examines Your Insurance Policy: Disability insurance policies contain vital information regarding the approval of short or long term disability benefits. Our firm will diligently analyze your disability insurance policy to gain a clear understanding of your insurance company’s specific criteria, including the definition of disability, elimination period, and benefit amount. We will also identify and address any potential challenges that may arise during the claim process, such as pre-existing condition clauses or mental illness limitations.
The Maddox Firm Collects, Organizes, and Reviews Your Evidence: The Maddox Firm will take charge of obtaining your medical records, ensuring they provide a comprehensive and accurate depiction of your condition. We will also coordinate with your employer, if necessary, to gather any required documentation. Our team will meticulously scrutinize the evidence to identify any weaknesses or red flags that may need to be addressed to strengthen your claim.
The Maddox Firm Obtains Additional Evidence to Support Your Claim: We will collaborate closely with your treating healthcare providers to obtain supplemental statements supporting your claim. Insurance companies often request an Attending Physician Statement (“APS”), and we will facilitate effective communication with your physician to ensure the APS accurately outlines the limitations and restrictions caused by your brain injury. Additionally, we can recommend further testing, such as a Functional Capacity Evaluation or Neuropsychological Evaluation, to bolster your claim. We can also refer you to trusted vocational experts for a comprehensive vocational assessment to make sure your insurance company understands the scope of your occupational demands.
The Maddox Firm Represents You in Appeals and Litigation: In the unfortunate event that your short or long term disability claim for brain injury is denied or terminated, The Maddox Firm will stand by your side throughout the appeals process and, if needed, in litigation. Our dedicated team will prepare a robust appeal that addresses the reasons for denial and presents new evidence supporting your claim. In litigation, we are prepared to file a lawsuit against your insurance company and provide representation in court.
Whether you are looking for assistance in navigating the claims process, appealing a claim denial, or litigating a final adverse decision, The Maddox Firm can help with your brain injury short or long term disability claim. The expert team at The Maddox Firm will examine your insurance policy, correspondence from your insurance company, medical records, and any other relevant documentation in order to give you personalized guidance on how we can help you win your brain injury short or long term disability claim.
Contact us to help you file your claim, appeal, or litigation the right way.