Traumatic Brain Injury and Disability Benefits

The importance of the brain’s health to a person’s ability to function cannot be overstated. The brain controls everything in the body, and when a traumatic brain injury (TBI) occurs, the victims are likely to experience some form of disability, at least in the short-term. When these injuries lead to permanent impairments, the sufferers often turn to disability insurance benefits to replace some of the income lost now that work is no longer possible. Depending on a person’s situation, he/she may be able to pursue disability benefits through a private insurance policy or the federal Social Security Disability Insurance (SSDI) program. In either case, the key element of gaining approval is proving the brain injury exists, and that it prevents the person from working. However, determining whether a person will ever be able to return to work and live a normal life following a TBI is not always easy to ascertain in the beginning, and the Social Security Administration (SSA) accounts for this issue by applying special rules to the evaluation process. Because the prognosis for recovery from a TBI is very case specific, understanding how the SSA evaluates these disability cases can help those seeking disability benefits know what their options may be.

Types of TBI Injuries

A TBI occurs when the brain swells, is bruised, or experiences internal bleeding, which can be the result of falls, car accidents, sports injuries and bombs (for those in the military). The bodily systems that could possibly be affected by a TBI range from balance issues, inability to concentrate, loss of the use of extremities, and mood changes. The severity of a TBI is linked to if and how long a person loses consciousness. Loss of consciousness for less than 30 minutes is considered mild; though, even this level of loss can still cause memory loss, headaches and dizziness. A severe TBI is characterized by a loss of consciousness for more than 30 minutes, and can cause significant physical and cognitive impairments for years after.

Is It Severe?

Starting in October 2016, TBI was officially added to the SSA’s Listing of Impairments, which means that anyone diagnosed with this condition and experiencing severe impairments expected to last at least one year should be approved for benefits. Note that only severe cases of TBI will receive this treatment, and less severe cases will have to go through the residual functional capacity analysis that examines a person’s ability to perform past work or to learn and perform less demanding duties in a different job. In order to be considered a severe TBI case by the SSA, a person must present medical evidence documenting the following impairments:

• the inability to control movement in at least two extremities (arms and legs) for at least three consecutive months following the injury, which directly causes issues with the ability to stand up, maintain balance when standing or walking, or use one’s arms; or
• have a seriously limited ability to perform or sustain work due to physical impairments for at least three months following the injury, and have serious limitations related to thinking, finishing tasks, controlling behavior and/or interacting with others.

Staggered Evaluation Process

Because forming a long-term prognosis for a TBI is difficult in many cases, the SSA accounts for this variability by allowing claimants to seek benefits earlier and to be reassessed for evidence of impairments more than once. Specifically, TBI claimants can be approved for benefits as soon as three months post-injury, while most claimants must have a disabling condition for at least 12 months to qualify. Further, if there is insufficient evidence of impairment, the SSA will reevaluate the claimant when new information is available, giving TBI claimants additional opportunities to win approval within the first year of disability.

Contact a Disability Insurance Attorney

The onset of any disabling condition is hard to accept and manage. The financial impact that comes with this event only adds to the burden a person has to carry. A disability insurance attorney can help lift some that burden by getting you the benefits you need so you can focus on your health. Farrell Disability Law understands how the law and regulations work, and can help get you approved even if the SSA has already denied your claim. If you live in Jacksonville, Orange Park, Neptune Beach or the surrounding area, contact the office for a free consultation.

Resources:

ssa.gov/pubs/EN-05-10029.pdf

ssa.gov/disability/professionals/bluebook/11.00-Neurological-Adult.htm#11_18