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Do You Qualify for TBI Disability Benefits?
18December 18

Do You Qualify for TBI Disability Benefits?

Traumatic brain injuries (TBIs) can be devastating, especially if can’t get specialized TBI disability benefits to cover your medical bills and basic living expenses.

TBIs result when someone’s brain is seriously damaged due to a head injury. Common causes include gunshot wounds, trips and falls, and car accidents. The results may range from minor amnesia to complete loss of function and permanent coma. Some people improve with treatment; some don’t.

The symptoms of TBIs can vary widely, and not all benefits providers are sympathetic to all the possibilities. So you may be asking yourself, What if I can’t get the help I need? We’re here to help. To learn more about TBIs and your benefits options in New Jersey and New York, contact Uscher, Quiat, Uscher & Russo, P.C. today.

TBI Disability, New York, New Jersey

How Doctors Diagnose TBIs

In addition to obvious clinical evidence, doctors diagnose TBIs by performing neurological (brain-related) examinations. You can expect a doctor to shine a light in your eyes to see if your pupils contract normally, and to perform numerous tests. One will be a neuropsychological examination that determines if you’ve suffered permanent damage. X-rays, CT scans, and MRIs may follow.

Symptoms to Watch For

Brain injuries can be unpredictable. In one patient, an accident may produce minor, short-term problems. In another, the same accident can result in strokes and other issues with long-term consequences. Symptoms your doctor will take most seriously include the following:

  • Severe headaches
  • Dizziness
  • Blurred vision
  • Lightheadedness
  • Fatigue
  • Nausea/Vomiting
  • Loss of motor skills or motor control
  • Cognitive deficits
  • Coma

The last few may render you completely unable to work for the foreseeable future.

How Will the Insurance Company Evaluate Your Claim?

The insurance company may want to do their own neurological evaluation before awarding you Long Term Disability (LTD) benefits. At the very least, you’ll be judged according to an Attending Physician Statement (APS) or Residual Functional Capacity (RFC) form, which your physician should fill out. This gauges your capacity to work on a five-point scale, from sedentary to heavy work. It also takes into account your mental capabilities.

Claims processors base their determinations on objective clinical findings and measured limitations. Most policies will pay out if you can prove you can’t return to work within two years due to a TBI. Be sure to give the insurer all your medical records, forms, any applicable evidence, and descriptions of your functional restrictions. Expect to be repeatedly reassessed over a long period just in case you’re improving.

Limitations for Specific Physical and Cognitive Disorders

To get LTD for seizure disorders like epilepsy, you have to show that your seizures are both debilitating and common enough to prevent you from working. You’ll need your doctor’s confirmation and their description of a typical seizure, including recovery time. Similarly, one or more strokes may qualify you on the basis of “central nervous system vascular accident,” but only if they affect your ability to speak or communicate, or keep you from walking and/or using your arms, hands, or fingers.

Organic mental disorders that cause permanent disorientation, changes in personality, unexpected mood changes, or cognitive disabilities (especially a significant drop in IQ) can qualify you for LTD only if sufficiently proven.

Getting Long Term Disability Benefits

Disability insurers do their best to save money, so expect push-back when trying to obtain LTD benefits. You’re most likely to qualify for them if your TBI is so severe you obviously can’t work any longer. Some insurers pay off if you can no longer work in your chosen profession; others fall back to “any profession.”

State Options. In New Jersey, the Division of Disability Services (DDS) handles TBI claims and administers the TBI Fund. This fund provides community assistance as well as support services to people with TBIs. The intent is to foster independence and also maximize quality-of-life in ways insurance and other sources can’t.

New York offers special provisions for veterans. For non-veterans, there’s a Traumatic Brain Injury Waiver Program to help people with TBIs continue to live in the community. The TBI Housing Subsidy helps them pay for housing if they actively receive other services through the Waiver program.

Social Security. Finally, as an American citizen, you may be eligible for Social Security disability benefits. Be sure to have your own doctor fill out the APS/RFC form when you apply.

Learn More About Your TBI Disability Case

If you’ve suffered a TBI in New Jersey or the New York City area and can no longer work, you’ll need experienced legal help to navigate the bureaucratic benefits maze. Contact Uscher, Quiat, Uscher & Russo, P.C. today.

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