Although Traumatic Brain (“TBI”) impairments are quite common, disability insurers are reluctant to pay for cognitive impairments that are alleged to be “subjective” and “self-reported. TBI can result in speech, ambulatory, muscular control, aphasia, and auditory symptoms that prevent insureds from returning to work. Still, insurers are reluctant to accept proof of claim when it’s placed directly in front of them.
Traditionally, Unum has a history of rejecting TBI claims as a permanent disability and will “risk manage” claims aggressively. Of late, Reliance Standard just won’t quit either, continuing to deny, overturn and pay, deny, overturn and pay. Meanwhile, insureds are desperately remaining in continuous patterns of treatment for residual effects and lingering symptoms, but insurance companies just don’t get it.
Part of the problem with medically supporting TBI claims is that the etiology of residual symptoms is not clearly identifiable via MRI or CAT scan imaging. Although mild damage to the brain can cause serious symptoms in the future, there is no diagnostic objective evidence to prove severity of ongoing medical issues.
There are cases, in particular, where the actual brain injury becomes less identifiable by MRI, but aphasia symptoms remain, again preventing insureds from returning to work. Strokes (“CVAs”) often the result of brain injuries can also cause aphasia symptoms that are quite severe.
Adding to the problems are stymied physicians not knowing how to support medical disability, cognitive dysfunction and physical effects of TBI. Even when insureds are referred to other appropriate rehabilitation resources, such as speech therapists, occupational physical therapists, or cognitive re-training therapists, insurers often refuse payment alleging insureds eventually regain 100% functional capacity to return to work.
Medically, we know this is not true for everyone. In fact, most TBI victims often spend years of rehabilitation attempting to regain minimal functional capacity. In addition, cognitive dysfunction at any level is generally treated by a psychologist with therapy directed toward dealing with the after-effects of brain injury. Insurers, however, view “therapy” as mental and nervous and attempt to limit benefits to 24 months when they can.
While it may seem as though TBI victims won’t receive disability benefits, there are ways to make sure that all symptoms are reported, many of which have their own ICD-10 codes. Referrals to any type of rehabilitative therapy should be documented with comments from treating physicians stating they “buy-in” or support the current treatment regimens , for let’s say speech or hearing therapy.
Insurance companies have pre-determined target impairments that are difficult to prove for total disability, including TBI. Although TBIs are legitimate payable claims, convincing insurers to pay benefits is often a struggle that many insureds simply give-up on.
