Post-Concussive Syndrome and Long Term Disability Insurance Claims

What is Post-Concussive Syndrome?

A concussion is a head injury that causes a temporary loss of normal brain functions. Many people recover from a head injury with few or no persistent symptoms. Other experience symptoms for weeks, months, or even years after the original date of injury. This collection of associated symptoms is referred to as post-concussive syndrome.

While some people experience symptoms of post-concussive syndrome immediately following the initial injury, others may be surprised by symptoms after they thought that their concussion had healed. Symptoms of post-concussive syndrome generally get worse with increased stress and exertion. Not all patients experience all signs of the disorder. Symptoms can include:

  • Headaches
  • Dizziness and loss of coordination
  • Visual disturbances
  • Nausea
  • Sleep issues
  • Irritability, anxiety, and depression
  • Confusion
  • Difficulty thinking, remembering, or understanding instructions
  • Difficulty communicating through speech or writing
  • Changes in the senses

Post-concussive syndrome always follows a head injury or trauma. The head injury may be mild or more moderate in severity. People who have had multiple head injuries or have had a more severe head injury are more likely to develop post-concussive syndrome. Athletes of contact sports such as football or soccer are more likely to develop the condition than non-athletes. Other risk factors for developing the condition include a history of headaches and issues with cognitive function or fatigue following the initial diagnosis. Younger patients and women are more likely to develop post-concussive syndrome than other groups.

Diagnosing Post-Concussive Syndrome

Because post-concussive disorder does not have many visible symptoms and symptoms are generally vague, it can be challenging to get a diagnosis. There are no definitive diagnostic tests for the disorder. Instead, doctors look at patient symptoms and history of injury to determine if the patient may be experiencing post-concussive syndrome.

Doctors may order diagnostic testing to rule out other conditions and to ensure that the patient is not suffering from dangerous swelling of the brain following the injury that may require more drastic interventions. CT scans or MRIs can show possible swelling that may cause the described symptoms. If brain swelling is severe enough, emergency surgical intervention may be necessary. Neuropsychological testing can show difficulty thinking in patients affected by those symptoms. In rare cases, blood tests may be ordered to rule out other causes of symptoms such as anemia or infection.

Treating Post-Concussive Syndrome

Generally, post-concussive syndrome improves with rest and stress reduction. Patients that experience symptoms that do not get better with time or that significantly impact their lives may benefit from medication. Medication can treat headaches and mood disorders stemming from the condition. Talk therapy can also help with related mood disorders.

Patients with severe swelling of the brain may need surgery to prevent the swelling from reaching potentially fatal levels. Alternative treatments such as massage, acupuncture, and gentle exercises such as yoga or tai chi can complement traditional medical therapies for post-concussive syndrome.

In all cases of post-concussive syndrome, patients must avoid any activity that could cause another concussion while experiencing symptoms of post-concussive syndrome. If a person suffers from another concussion while still healing from the first, the additional trauma to the brain can prove to be fatal in a rare condition called second-impact syndrome. Repeated concussions can also cause symptoms of post-concussive syndrome to increase in severity.

Disability Evaluation of Post-Concussive Syndrome

People with post-concussive syndrome may be unable to work because of their disease and its related complications. People who cannot work because of their post-concussive syndrome may be eligible to apply for Long Term Disability (LTD) benefits. The insurance company will review their claim to see if they qualify under the conditions of that plan.

Definition of Disability

Most LTD plans consider a person disabled if they have a medical condition that causes them to 1) be unable to perform their work duties for the first two years of the policy and 2) be unable to complete the work duties of almost any occupation for the years following the initial 2-year period. It is crucial to understand how your specific plan defines disability.

Evaluating Disability for Claimants with Post-Concussive Syndrome

To qualify for disability benefits, the condition must prevent the person from working. If the claimant recovers after a few weeks or even a few months, they may benefit from short-term disability benefits provided through the workplace or individual coverage. 

But some people experience more severe symptoms that last for more extended periods. These patients may suffer from permanent headaches, changes in cognition, or mood disorders. They will need a Residual Functional Capacity (RFC) assessment that indicates how their symptoms affect and limit their life activities. For example, a person who has difficulty learning new tasks or understanding information may not be able to work in a high-skills career such as a doctor or an accountant or may not be able to learn a new job that may accommodate their other physical symptoms. People who have persistent problems with balance or dizziness would be unable to work with dangerous machinery or on ladders.

What the Insurance Company Needs From You and Your Medical Providers

The insurance company needs to know about any doctor that has treated you for your post-concussive syndrome so that they can get your medical records. These records include office notes, clinical exams, diagnostic tests, and lab results. Records of hospitalizations and neuropsychological testing, both in-office and diagnostic test results, are particularly important. It is essential to include the records from the original injury or injuries as well as all treatment records. If the insurance company cannot get those records directly from your doctors, you will have to get them yourself and send them to the insurance company.

You will need to provide proof of your diagnosis and your ongoing symptoms, as well as proof of how you are affected by your symptoms. Providing detailed documentation is key to a successful claim. Residual Functional Capacity (RFC) assessments determine how you are affected by the condition and what you can do despite your limitations. It is used to determine what jobs you may still be qualified to perform. Make sure that you are as honest as possible with your doctors so that they can complete an accurate RFC for you.

Working With an Experienced Disability Attorney

You do not have to fight the insurance companies alone. An experienced disability attorney will guide you through the process and give you the best chance of getting the benefits you deserve. Even if you have already applied and you have been denied, you are not out of luck. The experienced disability attorneys at the Ortiz law firm can help you through the process, from appeals to potential litigation.

While the process can be daunting, your expert disability attorney will be able to guide you through the process. They do not get paid until you win your case. You can seek help without worrying about upfront costs or unexpected bills. Our law experts will focus on your case so you can focus on your illness.

The Ortiz law firm has successfully represented people in disability cases across the United States. If you would like to talk to one of our experienced disability lawyers about your cognitive impairment and how it affects your life, call us at (850)308-7833.