• Menu
  • Skip to right header navigation
  • Skip to main content
  • Skip to secondary navigation
  • Skip to primary sidebar
  • Skip to footer

Before Header

Has your disability claim been wrongfully denied or terminated? Call us today for help!  (888) 321-8131

  • Facebook
  • Instagram
  • LinkedIn
  • Twitter
  • YouTube

National Disability Law Firm | Ortiz Law Firm

We appeal wrongful long term disability insurance and Social Security Disability denials.

  • ABOUT US
    • Our Team
    • Our Results
    • Areas We Serve
    • Core Values
  • PRACTICE AREAS
    • Administrative Appeals
    • Lawsuits
    • Lump Sum Settlement Offers
  • RESOURCES
    • Top 10 Mistakes That Will Destroy Your Long Term Disability Claim
    • Lump Sum Disability Settlement Calculator
    • Physical RFC Form
    • Mental RFC Form
    • Ultimate Appeal Checklist
    • Long Term Disability Case Study
  • BLOG
    • Long Term Disability Denials and Appeals
    • Medical Eligibility for Long Term Disability Claims
    • Eligibility for Long Term Disability Claims
    • Your Chances of Getting Approved for Disability Benefits
    • Additional Parts Of A Claim That Do Not Happen in Every Case
  • Search
  • CONTACT
  • ABOUT US
    • Our Team
      • Nick Ortiz
      • Jessica Ortiz
      • Dawn Keller
      • Tory Nelson
      • Sarah Palag
    • Core Values
    • Our Results
      • Why Choose Ortiz Law Firm
      • What Our Clients Say
      • Testimonials
  • PRACTICE AREAS
    • Long Term Disability Claims
      • Administrative Appeals
      • Lawsuits
      • Lump-Sum Settlement Offers
      • Qualifying Conditions
      • Disability Insurance Companies
      • Qualifying Occupations
      • Case Summary Archives
      • FAQs
    • Social Security Disability Claims
      • Initial Application
      • Request for Reconsideration
      • Hearing Before an Administrative Law Judge
      • Qualifying Conditions
      • FAQs
    • Personal Injury Claims
      • Car Accident Claims in Pensacola, Florida
      • Bicycle Accident Claims in Pensacola, Florida
      • Motorcycle Accident Claims in Pensacola, Florida
      • Truck Accident Claims in Pensacola, Florida
      • Slip & Fall
      • Insurance Companies
      • FAQs
  • AREAS WE SERVE
  • RESOURCES
    • Top 10 Mistakes That Will Destroy Your LTD Claim
    • Top 10 Mistakes That Will Destroy Your SSD Claim
    • Lump Sum Disability Settlement Calculator
    • Physical Residual Functional Capacity Form
    • Mental Residual Functional Capacity Form
    • Ultimate LTD Appeal Checklist
    • LTD Case Study: Fibromyalgia
    • Top 10 Mistakes That Will Destroy Your FL Car Accident Claim
  • BLOG
    • Long Term Disability
      • Eligibility for Long Term Disability Claims
      • Medical Eligibility for Long Term Disability Claims
      • Your Chances of Getting Approved for Disability Benefits
      • Long Term Disability Denials and Appeals
      • Additional Parts Of A Claim That Do Not Happen in Every Case
    • Social Security Disability
    • Personal Injury
  • REFER A CASE
  • Search
  • CONTACT

Mobile Menu

Schedule A Free Consultation Now!

Find out how our law firm can help you win your case or you don’t pay a cent.

(888) 321-8131

  • Facebook
  • LinkedIn
  • Twitter
  • YouTube

Traumatic Brain Injury (TBI) and Long Term Disability Insurance Claims


Patients with a traumatic brain injury may be unable to work because of their disease and its related complications. Patients who find themselves unable to work because of their traumatic brain injury may qualify for long term disability (LTD) benefits. The insurance company will review their claim to see if they qualify under the conditions of that plan.

What is a Traumatic Brain Injury?

Traumatic brain injury (TBI), which is also called intracranial injury, is an acute injury to the brain caused by a traumatic event or external force such as a car accident, military incident, slip/trip/fall, or discharge from a firearm. The general term “head injury” is often used synonymously with traumatic brain injury. A TBI can vary in severity from mild temporary amnesia to a more serious permanent coma. Some TBIs may heal over time and some functionality may improve through therapy; however, other impairments may never improve — or may even worsen over time.

LTD Disability Benefits for TBI

Severe TBIs may qualify for long term disability (LTD) insurance benefits after taking into account the wide range of impairments that a TBI may cause. Cerebral trauma may cause numerous impairments that would limit work activity, including seizure disorders and strokes.

TBI symptoms can vary widely depending on the type and severity of the injury and the area of the brain affected by the trauma. Immediately after an injury, a patient may lose consciousness for a period of time from a few seconds to a few minutes. Debilitating symptoms of TBI may include severe headaches, nausea and vomiting, dizziness, fatigue, tired eyes, blurred vision, lightheadedness and lack of motor skills or motor control (use of the hands, arms, legs, and feet).

If your symptoms are so severe that you are no longer able to work, you may qualify for LTD benefits for cerebral trauma.

Epilepsy

To qualify for long term disability benefits due to epilepsy (including all seizure disorders), you must show that your seizures and the recovery periods after a seizure are so frequent and debilitating that you cannot continue full-time employment. Your doctor should describe a typical seizure, indicate how much of the description is based on personal observations versus others’ observations, and describe your recovery period after each seizure event (i.e., how much time you will need to recover from each seizure, how fatigued or drained you are after each seizure, etc.). For more information about LTD benefits for epilepsy, see our article on qualifying for long-term disability insurance benefits for epilepsy.

Central Nervous System Vascular Accident

If you have had a stroke (or multiple strokes), you may qualify for LTD due to said central nervous system vascular accident(s). You are most likely to qualify for benefits when you continue to experience the following types of impairments after the stroke(s):

  • Trouble with language skills resulting in ineffective speech or communication, or
  • Significant and persistent disruption of the use of your arms or legs that interferes with your ability to walk and/or ability to use your fingers, hands, and arms.

For more information, see our article on qualifying for LTD benefits for stroke.

Organic Mental Disorders

To qualify for long term disability insurance benefits due to organic mental disorders (cognitive or emotional changes resulting from brain damage), you should be able to prove the following types of impairments:

  • A change in your cognitive abilities;
  • Disorientation;
  • Personality changes; or
  • Mood changes that limit your daily activities, social functioning, or the ability to concentrate.

You can also demonstrate these types of impairments where, for example, your IQ is 15 points less than before your accident, or if your IQ is within the severely impaired range on neuropsychological testing.

Diagnosis of a TBI

Diagnosis of a traumatic brain injury is based on clinical evidence and lesion occurrences. Neurological examination is usually performed to verify whether the pupils are contracting normally in response to light. In emergency situations, such as immediately after an accident, a radiological test known as computed tomography is widely used to provide a fast and accurate diagnosis. Other objective medical procedures, including MRIs, CT scans, and X-Rays, can be performed at a later time to verify the extent and location of injuries. In addition, a neuropsychological examination can be performed to assess the lasting cognitive impairments and to assist in planning rehabilitation.

The Long Term Disability Insurance Company’s Review of Your Claim

In evaluating a claim for LTD benefits, the adjuster assigned to your claim will evaluate the impact of your TBI on your ability to perform work activities. The insurance company may assess your physical, mental, and sensory limitations using an Attending Physician Statement (APS) – also called a residual functional capacity (RFC) form – that it will ask your physician to fill out. This APS form should note the limitations that you have as a result of your TBI that affect your ability to work. The processing of disability claims is focused heavily on a claimant’s measurable limitations and objective findings showing impaired functional ability.

For those who have suffered a TBI, there is often a distinct change in mental and/or physical functions that can prevent them from returning to a previous job. Under most policies, the standard is whether the claimant can return to his or her prior work for the first two years after the disability. However, it is important to note that most policies change the definition of disability after 24 months to evaluate whether the claimant can return to virtually any job.

When filing for long term disability insurance benefits on the basis of a traumatic brain injury diagnosis, it is imperative that you present all appropriate medical evidence, including detailed reports of functional restrictions imposed by the symptoms of your condition over time.

TBIs are different than many other illnesses or diseases in that it can be difficult to make a long term prognosis about an individual’s recovery and job abilities. Insurance companies are acutely aware of the high variability associated with TBIs. With TBIs, an individual who sustains profound neurological impairment will be constantly reassessed to determine whether the claimant’s neurological or mental impairments continue to be severe and debilitating.

Your Traumatic Brain Injury Disability Case

If you can no longer work because of traumatic brain injury and you have a long term disability insurance policy, you should qualify for LTD benefits. It is important to be aware that the extent of your impairment will be determined based largely on the type, duration, frequency, and debilitating effect of symptoms of your TBI rather than a diagnosis alone. As stated above, your doctor should be sure to indicate where the doctor’s treatment and observations corroborate the negative effects and exertional limitations described in your claim.

If you are not currently represented by a long term disability attorney, you should seriously consider hiring an attorney to represent you in the appeal process. Mr. Ortiz is an experienced long term disability lawyer and he offers free consultations to claimants when a TBI long term disability claim has been denied, unreasonably delayed, or terminated. Call (888) 321-8131 to discuss your rights.

Facebook0Tweet0Pin0LinkedIn0Print0Email0

Primary Sidebar

View All Long Term Disability Insurance Resources


David B.

Nick fought for me and did everything he said he would. His people are top-notch and professional. They are great Lawyers and Sarah Palag was great to deal with.

View All Reviews and Testimonials

Learn More About Long Term Disability

  • Areas We Serve
  • Frequently Asked Questions
  • Denials and Appeals
  • Your Chances of Getting Approved
  • Medical Eligibility
  • Additional Parts That Do Not Happen in Every Case
  • Medical Conditions That May Qualify
  • Long Term Disability Insurance Carriers
  • Occupations That May Qualify
  • LTD Federal Court Case Summaries
https://www.youtube.com/watch?v=3EHrRKBKsok

Complete This CONFIDENTIAL Form for a FREE Disability Insurance Case Evaluation

  • This field is for validation purposes and should be left unchanged.

Footer

Our Team

  • Nick Ortiz
  • Jessica Ortiz
  • Dawn Keller
  • Sarah Palag
  • Tory Nelson

Our Law Office

ORTIZ LAW FIRM
(888) 321-8131

823 E. Jackson St.
Pensacola, FL 32501
Monday - Thursday: 9:00 AM - 5:00 PM Friday: 9:00 AM - 2:00 PM

Saturday - Sunday: Closed

Practice Areas

  • Long Term Disability Claims
  • Social Security Disability Claims
  • Personal Injury Claims
  • Facebook
  • LinkedIn
  • Twitter
  • YouTube
  • Free Long Term Disability Resources
  • Long Term Disability Frequently Asked Questions
  • Medical Conditions That May Qualify for Long Term Disability
  • LTD Insurance Carriers
  • Occupations That May Qualify for LTD
  • LTD Blog
  • LTD Federal Court Case Summaries
  • Contact
  • Disclaimer

Site Footer

©2020 Ortiz Law Firm, All Rights Reserved. Reproduced with Permission | Privacy Policy

Share this ArticleLike this article? Email it to a friend!

Email sent!