Traumatic Brain Injury Claims: Proving an Injury Scans Can Miss

A traumatic brain injury claim is won or lost on documentation. A concussion often doesn't show up on a CT scan, and symptoms can surface days later. If you hit your head, or your head snapped back and forth, get evaluated and keep a record of every change you notice.

What counts as a traumatic brain injury?

The CDC defines a traumatic brain injury as "an injury that affects how the brain works." A concussion is a mild TBI. It can come from a bump, blow or jolt to the head. It can also come from a hit to the body that snaps the head and brain back and forth.

That second part matters in car crashes. You don't need to strike the steering wheel or window. A hard rear-end impact can be enough for the brain to "bounce around or twist in the skull," in the CDC's words.

Moderate and severe TBIs come from the same forces or from a penetrating injury, such as a gunshot. The CDC says moderate or severe TBI "may lead to long-term or life-long health problems."

How common are TBI hospitalizations and deaths?

The CDC counted 68,663 TBI-related deaths in 2023, about 190 a day. Its most recent hospitalization figure is about 214,110 TBI-related hospitalizations in 2020, or more than 586 a day, according to CDC TBI data.

People 75 and older account for about 32% of those hospitalizations and 28% of the deaths. Males are nearly 2 times more likely than females to be hospitalized with a TBI and 3 times more likely to die from one.

Falls cause nearly half of TBI-related hospitalizations. The CDC lists motor vehicle crashes and assaults among the other common causes.

Why can symptoms show up days later?

The CDC says some concussion symptoms "may not appear for hours or days after the injury," according to its signs and symptoms page. That's why an ER discharge on the day of a crash doesn't settle whether you have a brain injury.

The CDC groups mild TBI symptoms into 4 categories:

• Physical. Headaches, dizziness, nausea, fatigue, vision problems, sensitivity to light or noise.
• Thinking. Trouble concentrating, memory problems, feeling slowed down.
• Emotional. Irritability, anxiety, sadness, being more emotional than usual.
• Sleep. Sleeping much more or less than usual, or trouble falling asleep.

Most people with a mild TBI feel better within a couple of weeks, the CDC says. Go to an emergency room right away for a worsening headache, repeated vomiting, slurred speech, unequal pupils, weakness or numbness, or loss of consciousness.

Why a normal CT scan doesn't end the question

Standard imaging is built to find structural damage, not every concussion. The National Institute of Neurological Disorders and Stroke says CT can show a skull fracture and bruising, bleeding or swelling. It adds that MRI "can pick up more subtle brain changes that a CT scan may miss."

NINDS also says current validated imaging and blood tests "can't always detect damage from mild, concussive injuries." Insurance adjusters still point to a normal CT as proof that nothing happened. Your answer is the rest of the medical record.

Blood tests now help doctors decide who needs a CT. On April 1, 2024, the FDA cleared Abbott's i-STAT TBI whole-blood test. It measures 2 proteins, GFAP and UCH-L1, up to 24 hours after injury, according to the U.S. Army, which announced the clearance.

How do you document a brain injury for a claim?

Build a record that shows the injury from several directions. NINDS describes a neurological exam covering motor and sensory skills, hearing, speech, coordination, balance, mental status and mood.

• Neuropsychological testing. These tests measure memory, concentration, information processing, executive functioning, reaction time and problem solving.
• Consistent reporting. Tell every provider about every symptom, including ones that seem unrelated, such as irritability or light sensitivity.
• A symptom log. Note dates, headaches, missed work and tasks you can no longer do. Entries written at the time carry more weight than memories months later.
• People who knew you before. A spouse, coworker or supervisor can describe changes you may not notice yourself.
• Work records. Performance reviews, missed deadlines and reduced hours before and after the crash.

Gaps between visits give an insurer room to argue your problems came from something else. Our guide to mistakes that hurt your settlement covers how that argument works.

What does a TBI cost over a lifetime?

The costs can run for decades. The CDC reports that 5 years after a moderate to severe TBI, 57% are moderately or severely disabled. In addition, 55% are out of work even though they had jobs when injured, and 33% rely on others for everyday activities.

The same CDC page says life expectancy is 9 years shorter even after inpatient rehabilitation. It also reports that 12% of people live in nursing homes or other institutions 5 years out.

Mild injuries are not cheap in total. A CDC-authored study in Medical Care used a large private insurance and Medicaid claims database. It put the 2016 health care cost of nonfatal TBI at $40.6 billion. First-year costs for low-severity TBIs were substantially higher than for middle and high severity.

What is a life care plan?

A life care plan projects the medical care, therapy, equipment and home help a person will need for life. It turns a future you can't see yet into line items a jury or adjuster can price.

In an injury case, the plan is usually written by a life care planner hired as an expert. The Certified Life Care Planner (CLCP) credential comes from the International Commission on Health Care Certification. It describes itself as the only accredited certifying agency in the field.

Life care plans are common in moderate and severe TBI cases. They are less common after a concussion that resolves in weeks, where the claim centers on medical bills, lost wages and pain and suffering.

What should you do next?

• See a doctor within days if you have any symptom on the CDC list, even if the ER cleared you.
• Ask your doctor whether a referral to a neurologist or neuropsychologist makes sense.
• Start a dated symptom log today and ask one person close to you to write down what they notice.
• Don't give a recorded statement to the other driver's insurer while your symptoms are still changing. See our guide to dealing with insurance adjusters.
• Check your filing deadline in our statute of limitations guide. A brain injury claim can take longer to value than the deadline allows.

When you talk to a lawyer, ask how many brain injury cases they have handled and which experts they use. Also ask who pays for neuropsychological testing up front.