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Don’t Let Your TBI Claim Get Denied: Common Reasons Why It Happens

Don’t Let Your TBI Claim Get Denied: Common Reasons Why It Happens

Is your TBI claim denied? Surely, it can be a frustrating and disheartening experience. Suffering from a traumatic brain injury (TBI) caused by someone else’s negligence can be traumatic and life-altering. Being denied proper compensation is even more difficult to handle.

Insurance companies often try to deny or minimize TBI claims, making it essential to know the common reasons why your TBI claims get denied. Knowing these reasons can help you avoid mistakes and strengthen your case for a successful claim.

 Was your TBI claim denied?

In this article, we will discuss some of the most common reasons why TBI claims get denied and provide tips on how to avoid these issues. 

Lack of Medical Evidence

To prove that you suffered a TBI, you need to provide evidence. This includes medical records, imaging scans, and testimony from medical experts. If you don’t have enough evidence to support your claim, it may be denied.

The common medical tests that can help support a TBI claim:

  1. CT scan: A computed tomography (CT) scan uses X-rays to produce detailed images of the brain and can help detect bleeding, swelling, or other abnormalities in the brain.
  1. MRI: Magnetic resonance imaging (MRI) uses a magnetic field and radio waves to create detailed images of the brain, which can help identify any abnormalities or changes in the brain’s structure.
  1. EEG: An electroencephalogram (EEG) is a non-invasive diagnostic tool that involves recording the electrical activity of the brain by placing electrodes on the scalp to monitor brain waves. This test is to identify and diagnose brain-related issues such as seizures, sleep disorders, and executive function impairments.
  1. Neuropsychological testing: Neuropsychological testing is a type of evaluation that assesses cognitive and behavioral changes that may result from a TBI. These tests provide valuable information about the extent and severity of brain damage, as well as any specific cognitive deficits that may be present. 
  1. Neurological exams: A neurological evaluation can assess the level of consciousness and cognitive function, detect any abnormalities or changes in the nervous system, and present medical evidence from these tests can bolster a TBI claim and improve the likelihood of a favorable outcome.

Failure To Seek Timely Medical Attention

One of the most important factors in a successful TBI claim is seeking prompt and appropriate medical treatment after a head injury. Failing to seek medical attention can significantly impact your chances of proving that you suffered a TBI.

Insurance companies often rely on medical records and expert testimony to evaluate the severity and legitimacy of a TBI claim. If there is no documented medical evidence of your injury, it becomes challenging to establish the link between the accident and the resulting TBI.

Seeking medical treatment immediately after a head injury not only ensures your well-being but also provides crucial documentation and evidence to support your claim. It is essential to consult a healthcare professional who specializes in brain injuries to receive a proper diagnosis, undergo necessary tests, and receive appropriate treatment.

By promptly seeking medical attention, you enhance your chances of obtaining the necessary evidence to prove your TBI claim and increase the likelihood of a successful outcome.

tbi claim denied

Injuries That Are Not Considered Serious

One common challenge in TBI claims is the delayed onset of symptoms. In some cases, the symptoms of a TBI may not manifest immediately after the injury but can surface days or even weeks later. Insurance companies often exploit this time gap to argue that the injury may not be related to the accident, and consequently, they may deny your claim.

It is crucial to be aware of this possibility and seek medical attention promptly if you experience any delayed symptoms after an accident or trauma. By obtaining a medical evaluation and connecting the delayed symptoms, you can strengthen your claim and counter the insurance company’s denial.

Working closely with medical professionals and gathering supporting documentation can help establish the causal relationship between the accident and the delayed symptoms, increasing the likelihood of a successful TBI claim.

Remember, it is crucial to document and report any changes in your health, even if they appear after a significant time lag, to protect your rights and ensure proper compensation.

Inconsistent Statements From The Claimant

Providing accurate and complete information is essential when filing a TBI claim. Insurance companies will carefully scrutinize every detail of your claim, and any inconsistencies or inaccuracies in your statements could result in a denial. Therefore, it’s crucial to be honest and consistent throughout the claims process.

Inconsistencies in your statements can be used against you to undermine the credibility of your claim. Provide all the relevant information and not leave anything out. Failing to disclose any relevant information, such as a pre-existing condition, loss of consciousness, or vision changes could also lead to your TBI claim being denied.

Being transparent and forthcoming with your attorney can help avoid any inaccuracies or inconsistencies in your claim.

Improper Filing of A Claim

Filing a TBI claim can be a complicated process, and there are often strict deadlines for filing a claim. If you fail to file your claim within the required time frame, your TBI claim may be denied. It is why you must understand the statute of limitations for TBI claims in your state and to ensure that you file your claim in a timely manner. In California, the statute of limitations is two years from the date of injury.

In addition, improper filing of a claim can also result in a denial. This can happen if you fail to provide all of the necessary information or if you make errors on your claim form. Working with an experienced TBI attorney can help you navigate the claims process and ensure that your claim is filed correctly and within the required time frame.

Pre-existing Conditions Before TBI From Accident

Pre-existing conditions can complicate a TBI claim from an accident. Insurance companies may argue that the physical symptoms of the TBI are due to a pre-existing condition rather than the accident.

For example, if the claimant had a history of migraines or post-traumatic stress disorder before the accident, the insurance company may argue that these conditions caused the TBI symptoms and not the accident.

However, having a pre-existing condition doesn’t necessarily mean that you can’t file a TBI claim. If the accident worsened your pre-existing condition or caused a new injury, you may still be able to recover compensation for the damages that resulted from the accident.

Working with an experienced TBI attorney can help you navigate the complexities of your case and ensure that your rights are protected. The attorney can help you gather medical records and other evidence to prove the extent of your injuries and establish the link between the accident and the TBI.

Disability and Mental Health Conditions

To ensure the success of your TBI claim, provide thorough documentation of any disability and mental health factors related to the injury. Insurance companies may argue that your disability is not related to the accident or that your mental health was not affected, leading to a claim denial or reduced compensation.

Obtaining a diagnosis from a medical professional, following their recommended treatment plan, and keeping records of medical appointments and therapy sessions can strengthen your claim. TBI can also cause mental health issues, such as depression and anxiety, which can significantly impact your quality of life and ability to work.

Seeking treatment and keeping records of mental health services received can support your claim. If your TBI claim is denied due to mental health factors, working with an experienced attorney can help you appeal the decision and present additional evidence. 

What Should You Avoid Getting Your TBI Claims Denied?

If you’re filing an insurance claim for a traumatic brain injury (TBI), understand what to avoid in order to prevent claim denials. Successfully navigating the claims process can be complex, so being aware of potential pitfalls is crucial. Here are the key factors to consider and actions to avoid to increase your chances of a successful TBI insurance claim.

Obtain and review the Insurance Policy

Read through your insurance policy. Avoid relying on verbal discussions and ensure you receive the reason for denial in writing to prevent insurance companies from changing their explanation after receiving additional documentation.

Establish A Baseline of Brain Function

Undergoing neuropsychological testing soon after a head injury can help demonstrate continued progress and detect problems that were not initially apparent. This information is a must for understanding the patient’s needs and resources. It can help recover and counter insurance companies’ claims of cognitive impairments.

Moreover, it can differentiate pre-existing physical and mental disorders from the residual symptoms of a TBI, making your appeal stronger in case of compensation denial.

Use The Right Terminologies

Understand the definitions in your insurance policy to ensure that you receive the compensation you need. Terminology is vital for any type of claim. Using a different one might greatly affect the result of your claim application.

Consult With An Personal Injury Attorney

Consulting with a personal injury attorney knowledgeable about the appeal process is recommended. Independent case managers or attorneys who specialize in life-care planning for patients with disabilities or lifetime injuries can offer valuable assistance, and in some cases, their fees can be paid by deferred funds from settlements or worker’s compensation funds.

Get the Help You Need!

Looking for legal assistance after a brain injury can be overwhelming, but you don’t have to face it alone. The California Brain Injury Help Center offers a variety of resources to help you get the help you need. 

Our team can connect you with experienced personal injury lawyers, medical specialists, and case managers who can provide you with the support you need to get the medical care you need and the fair compensation you deserve.

Contact us today for a free, no-obligation consultation. We speak both English and Spanish and are available to take your call 24/7. Let us help you get the justice you deserve.

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