Fighting the Insurance Company After a Traumatic Brain Injury (TBI)

February 2, 2024 | Jarrett Blakeley
Fighting the Insurance Company After a Traumatic Brain Injury (TBI)

Dealing with an insurance company after suffering a traumatic brain injury (TBI) is almost impossible without an attorney. That is why you need to count on an attorney’s advice and assistance to receive a fair settlement. The team of experienced traumatic brain injury lawyers can help you in several ways that may otherwise take up too much of your precious recovery time or prevent you from succeeding and getting the settlement you deserve and need.

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Building Your Case

Unhappy young couple discussing legal issues with a lawyer, expressing frustration over a bad contract.

Gather copies of medical records, bills, and statements from doctors and therapists to assemble the evidence that supports your claim. Seek opinions from specialists, if necessary. The more documentation you collect, the more difficult it becomes for insurance companies to deny or lowball your payout requests.

The insurance company’s insurance adjuster will closely examine your records to assess the severity of your injuries, so, again, make sure you provide copies of records from all the healthcare professionals, hospitals, and rehabilitation facilities that have treated you for your head trauma and any resulting complications.

Types of Supporting Documentation for Your Claim

Supporting documentation should include:

  • Emergency room reports, notes from physicians and nurses, and discharge summaries from hospital stays.
  • Diagnoses, test results (such as CT scans, MRIs, and X-rays), and treatment plans from specialists like neurologists, neurosurgeons, and occupational therapists.
  • Prescription records for any medications related to your brain injury and recovery.
  • Calendars or statements indicating the dates of treatment.
  • Descriptions of symptoms, experienced pain levels, loss of brain function, or quality of life. 
  • The prognosis for recovery, as provided by your doctors.

Ensure there are no gaps in your treatment that the insurance company can question. The more comprehensive you are in collecting the evidence, the easier it will be to file and argue your claim.

Out-of-Pocket Expenses and Reimbursement Costs

Keep track of all the expenses you've had to pay out of pocket because of your TBI. Costs may include hospital bills, surgeries, emergency transportation, and diagnostic tests.

You may also have paid costs for rehabilitation services like physical therapy, occupational treatment, and speech therapy. Additionally, any expenses related to equipment such as wheelchairs, hospital beds, mobility devices, or home modifications for accessibility should be documented and recorded.

Don't forget to include any lost income due to time off work during your recovery period and treatment. If you've needed in-home care or assistance from a caregiver, make sure to record those costs as well.

Remember that it's the insurance company's responsibility to reimburse you for these injury-related expenses. Keeping records of all your expenditures will ensure that you receive the compensation that you deserve.

Hiring an Attorney to Document Your Claim

As noted, it’s tough to stay on top of documentation while you're healing from a brain injury. However, it's definitely worth the effort as comprehensive records serve as your evidence and can be critical in securing a reasonable settlement against the insurance company.

An attorney’s help is necessary to ensure success in compiling the information and getting the compensation you need to progress medically and financially.

To improve your chances of success, your attorney will:

  1. Make sure you have all the supporting documents you need to comply with an insurance company’s request or a personal injury lawsuit.
  2. Negotiate with the insurance companies in your case to make sure their offers for a reasonable settlement meet your request for damages.
    They will submit a written appeal within the required time frame (180 days) if the insurance company denied your claim unjustly. They will politely but assertively explain why the insurer’s denial was unfair and provide supporting evidence.
  3. Restate details about your injury and care needs and request a review of all records and an explanation of the insurance company’s decision.
  4. Consider asking for an examination by a doctor specializing in brain injuries. Physicians and medical specialists can accurately assess your condition and offer an opinion to counter the doctor employed by the insurance company. Their report and testimony can play a major role and be a breakthrough in an appeal.

Why Consult an Attorney, Especially If the Insurance Company Denied Your Claim?

It's well worth consulting with an attorney, especially after a denial of a claim. An attorney possesses knowledge about the appeals process and laws concerning insurance practices. An attorney can help strengthen your case, putting pressure on an insurance company to offer a more equitable settlement.

Typically, most TBI accident attorneys work on a contingency basis, so you don't have to pay fees upfront. You don’t have to worry about paying them until your case reaches a resolution and you receive a settlement.

Why You Must Stay Resolute

Stay committed to resolving your claim, even if you need to go through arbitration or mediation or have to file a lawsuit in court. Because your health and financial security are at stake, you need to stay on course.

Whether you’re negotiating a claim or have to file a personal injury lawsuit, you’ll have a much better chance of receiving fair compensation if you stay dedicated to the process.

Retaining a Brain Injury Attorney: How to Make a Decision

Facing an insurance company alone following a brain injury is a definite challenge. Insurance companies employ teams of lawyers and doctors who work diligently to deny claims and limit their liability.

To have a fighting chance at receiving the compensation and coverage you require involves securing legal help.

Lawyer shaking hands with client to accept offer for legal representation in court case.

If you're looking for a lawyer who can help with brain injury cases, it's important to find someone who focuses on these types of claims. You'll want to choose an attorney with a proven track record of success in handling TBIs.

TBI lawyers have the knowledge to properly assess the value of your damages, anticipate arguments from insurance companies, and build a strong case on your behalf.

One of the advantages of working with a lawyer is that they can handle all the paperwork and negotiations for you. Dealing with insurance companies can be overwhelming, especially if you're dealing with difficulties or complications in your medical case.

 A skilled attorney will communicate on your behalf, file appeals, if required, and advocate for your rights so that you can focus on your recovery. They can also determine if the insurance provider has violated any regulations or acted in bad faith.

Filing a Personal Injury Lawsuit

While negotiating a settlement is usually the goal, your lawyer may have to file a personal injury lawsuit so you can realize a more equitable settlement.

If negotiations fail, an experienced lawyer will gather evidence, obtain expert testimonies when needed, and compile the records needed to present a compelling court case. Lawsuits are complex processes, so you need an attorney with experience taking insurance companies to trial.

Before hiring an attorney to handle your TBI case, inquire about their experience, qualifications, fees, and availability. All these factors are important to consider if you want to succeed with your claim.

The Attorney’s Role in TBI Cases: A More In-depth Look

Your attorney can benefit you in many ways during your recovery and rehabilitation while waiting for a settlement. Let’s see how they can support the claim process.

Constructing Your Case Against the Insurance Company

Using copies of medical bills, receipts, and statements, your attorney will show the costs you have incurred from your injury. They can also use a doctor’s written statement and diagnosis to help you cover future medical expenses.

Photos and videos of the accident scene, as well as witness statements from people present at the time of the accident, can serve as useful evidence.

Reviewing Your Policy

You and your attorney can take time to thoroughly review your policy to understand its coverage, limits, and exclusions. An attorney can identify the sections that specifically support your claim.

Creating a Timeline

Your attorney may construct a timeline of the events related to your accident or diagnosis. This timeline may include dates of doctor’s visits, correspondence with the insurance company, and records of bills received and paid. A timeline can help define the sequence of events and highlight your efforts to seek treatment and benefits.

Submitting a Formal Demand Letter

Your lawyer may compose a demand letter addressed to the insurance company. The letter will clearly state your demand for the benefits you believe are rightfully owed according to your policy.

Your attorney will ensure proof of delivery and set a deadline for a response - usually 30 days.

Taking Your Case to Court

If your lawyer can’t get the insurance company to meet your terms, they will take the case to court and assertively work at gathering all the required evidence, including expert testimonies. They will advocate for your rights if you’re not getting the compensation you need to ensure your recovery or ongoing medical care.

Understanding Common Defense Strategies Used by Insurance Companies

Insurance companies are profit-oriented businesses. To achieve their goals, they may employ certain tactics to avoid paying out claims, especially high-cost ones such as those related to TBIs.

Therefore, prepare for the following maneuvers - all the more reason to seek legal counsel.
1. Disputing evidence. Insurance companies meticulously scrutinize your records, searching for any inconsistencies or preexisting conditions that they can use to cast doubt on whether your current issues are truly a result of the accident. To counter this type of defense, make sure that all your medical records have been reviewed by your doctors for accuracy. Additionally, be ready to provide documentation demonstrating how your symptoms, if applicable, emerged after the incident.

2. Protracting the process. Insurance companies know that prolonging a claim can put pressure on claimants and make them more willing to settle for less than they deserve. They may intentionally delay proceedings for months or even longer using bureaucratic red tape and repetitive requests for additional paperwork.

However, never give up in these situations. Continue consulting doctors and therapists, maintain records of all correspondence related to the case, and stay diligent with respect to meeting legal deadlines to keep pushing the case.

3. Offering lower settlement amounts. Another tactic insurance companies may employ is making lowball settlement offers that do not adequately reflect the value of your claim. It's critical not to accept offers without consideration and consultation with legal professionals who can assess whether an offer truly aligns with what you deserve.

Claim Rejections

When rejecting a claim, insurance companies sometimes offer settlements that only cover expenses. They hope you'll accept the offer just to be done with it. It is important not to give in. Take the time to calculate all the costs for treatments and care and lost income to determine a settlement. If their offer seems unfair, you’ll need to take further steps to move toward a settlement.

Insurance companies frequently cite medical necessity when they reject or approve to pay for treatment. However, many times, the rejections are based on flawed policies - policies not shared by hospitals or doctors.

For example, a U.S. Department of Health and Human Services report found that 13 percent of Medicare Advantage care denials should have been covered under the rules of Medicare.

Read the Fine Print

Insurance companies may take advantage of the wording in policies that allows them a lot of leeway in determining what is covered and what isn't covered in a claim. For example, some policies might exclude injuries resulting from certain activities without defining what they consider hazardous.

5 Ways to Strengthen Your Case

Here's what you can do to strengthen your case to avoid complications.

  1. As mentioned, collect all documents, such as records, letters, medical reports, and eyewitness accounts that support your claim. Organize them in order and in files to present a timeline of events and activities.
  2. Obtain statements from doctors, therapists, and witnesses who can validate the seriousness of your injuries. The more evidence you have, the harder it will be for the insurance company to deny your claim.
  3. Use the services of an attorney who focuses their practice on injury and insurance law litigation when taking an insurance company to court. Explain your situation. Provide copies of all evidence so that they fully understand your case. Look for a lawyer who's willing to represent you on a contingency basis – meaning they only get paid if you win.
  4. Prepare for challenges from the insurance company. They may delve into your activities and previous medical history and argue that your injuries existed prior to or were unrelated to the accident. However, with facts and the proper medical evidence on hand, you can effectively counter their arguments.
  5. Stay calm and composed, and stick to the truth.

Brain Injury Insurance Claim FAQs

Dealing with insurance companies after suffering a brain injury can feel overwhelming. That’s why it’s important to understand your rights and know the answers to your questions.

Should you report your TBI to your insurance company?

Yes, it's important to report any injuries that can potentially lead to an insurance claim. If you fail to report the incident promptly, there's a chance that the insurance company will deny your coverage. Ensure you're prepared to provide all the details about the accident and your injuries.

How is a TBI defined?

Definitively, a TBI is a traumatically induced injury or physiological disruption of cerebral functioning that results from an external force. A patient may have received a penetrating head injury or a non-penetrating injury, such as a jolt or blow to the head.

What is the proper way to file a claim?

You should work with a lawyer and detail the incidents of the accident. Include medical reports/bills and a police report. Your medical reports and documentation should list your symptoms, diagnosis, and treatment. Your attorney will file the claim for you to ensure compliance with the court.

Most states enforce a statute of limitations of two years (sometimes three years) to file a TBI personal injury claim. If you wait until after this deadline, you will be unable to file a claim for compensation.

What evidence best supports a TBI claim?

Any documentation that supports the incident that led to your TBI - medical records that show the diagnosis and treatment for a TBI close to the time of the incident; records that track your symptoms and therapy; testimonies of accident scene witnesses; a police report; and records of academic issue, behavioral changes, or difficulties at work.

Can an event without loss of consciousness qualify as TBI?

Yes, a TBI diagnosis does not require loss of consciousness. Explosions/blasts, vehicle collisions, and wounds that jolt the brain can qualify for TBI compensation.

How are TBIs generally classified?

While some TBIs are considered primary, others are considered secondary. A primary TBI is immediate, while a secondary TBI occurs over the course of time, be it hours, days, or weeks after an accident.

Contact a TBI Injury Lawyer Today

You can get the legal assistance you need when recovering from a TBI. Contact a Fort Lauderdale personal injury lawyer today for the justice and compensation you need.

Jarrett Blakeley

Firm founder Jarrett Blakeley fights to get maximum compensation for all of Blakeley Law Firm’s clients. He has been practicing law since 2006 and takes great pride in representing the rights of injured individuals against the insurance companies and the law firms that represent them. He has successfully represented thousands of clients and recovered tens of millions of dollars on their behalf. Mr. Blakeley strives to give all of his clients personal attention and maximum effort and seeks to instill a firm culture that prioritizes customer service and compassion for the injured over all else. Fighting for the injured is Jarrett Blakeley’s greatest passion and he looks forward to fighting for the injured for the rest of his career.

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