As an L&I attorney representing injured workers, I see all kinds of work injuries and specific problems that arise. That includes L&I claims for head injury and L&I claim issues for traumatic brain injuries (TBI). Workers compensation clients suffering from head injury or brain injury can be very difficult to work with. But often, they are also the ones that need my help the most.
What is a traumatic brain injury?
The CDC defines TBI as “a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury“. The CDC reports that everyone is at risk for TBI. However, children and the elderly are particularly vulnerable. TBI is considered a serious public health concern resulting in death and disability for thousands yearly. Not all bumps, blows, or jolts to the head result in a TBI. However, if a TBI does occur it can vary in severity from mild to severe.
Mild TBI cases, often referred to as a simple concussion, usually resolve fairly quickly. More severe cases may involve extended periods of unconsciousness or amnesia following the injury. According to the CDC, TBI symptoms may affect a person’s ability to think, ability to remember, and their physical well-being. Furthermore, it can also affect one’s emotions, mood and sleep. Some symptoms may appear quickly. Others may take days or even months to appear.
L&I claim for head injuries or brain injury
An L&I claim for TBI or head injury can be a very challenging case. In fact, as an L&I attorney, these cases are probably the most challenging ones I handle. This is due to a variety of things:
(1) The symptoms are largely subjective – There isn’t much objective medical evidence available to support the extent of the injury.
(2) Head injuries are often accompanied by physical injuries impacting other parts of the body. Those other injuries often take priority, and the head injury is overlooked.
(3) Significant efforts are being made to research and understand head injuries, especially related to professional athletes. However, in L&I claims and workers’ compensation setting there seem to be significant medical delays in TBI diagnosis and treatment.
(4) Fourth, it seems to me that there is an institutional resistance within the L&I claim administration system to accepting and authorizing necessary and proper treatment for TBI.
(5) Finally, due to the nature of the injury itself, clients who have suffered TBI are often difficult to work with.
Subjectivity in L&I claims for head or brain injury
In the L&I workers’ compensation system, if the work injury claimant makes statements or complaints to a medical provider, then those statements are considered subjective. On the other hand, objective findings of disability are those that a medical provider can see, feel or measure. It is widely acknowledged that mental health conditions such as depression and anxiety lack objectivity. Most other injuries in the L&I claim system require objective evidence to substantiate the extent of disability. Head injuries and TBI are complicated because it is a physical injury, but the extent can’t be seen, felt, or measured.
Usually, a TBI diagnosis is based on the worker’s description of how the injury occurred and their subjective symptom complaints. Common symptom complaints that I see all the time include difficulty thinking clearly, headaches, blurred vision, irritability, and sadness. Other symptoms include excessive sleeping, difficulty sleeping, noise sensitivity, concentration problems, problems remembering, lack of energy, nervousness, anxiety, and dizziness. Doctors simply cannot objectively verify these symptom complaints. Especially when the onset may be days or months following the injury.
Lack of Priority for L&I claims for TBI
TBI generally occurs from a blow to the head, or a jolt or a bump. Consequently, it is not uncommon for other physical injuries to occur in addition to the head injury. For example, someone may have fallen from a ladder breaking their arm and hitting their head. In most cases, the initial medical treatment is so focused on the arm injury that the head injury is ignored or overlooked. If the worker was working alone, they may not recall whether they lost consciousness. In fact, they may have significant difficulty recalling the details of the injury entirely.
According to the CDC, TBI symptoms are challenging to sort out. It is not uncommon for symptoms to be overlooked by the person injured, their family, friends, and even doctors. I have seen many severe TBI diagnosis made long after the original work injury. In my experience, this creates difficulty for getting the condition accepted under the claim.
L&I claim for head injury often result in medical delays
From my experience as an L&I attorney, it seems that many of the providers within the Department’s Medical Provider Network (MPN) overlook the importance of making an early and accurate TBI diagnosis. There seems to be a lack of urgency in making appropriate referrals for TBI diagnosis and treatment.
For example, I have seen cases where a blow to the head has been reported as the primary injury and wasn’t referred for MRI for more than a year. I’ve also seen work injury victims discharged from medical care and released to return to work without restriction, based on resolution of their other physical injuries, despite having numerous ongoing symptoms consistent with TBI. Unsurprisingly, the lack of attentive medical care leaves work injury claimants, who are already struggling with the symptoms of their TBI, feeling scared, hopeless, and angry.
Institutional Resistance within the Department of Labor and Industries (L&I)
From my perspective, L&I claim administrators tend to view the conditions causally related to an injury very narrowly. Generally, the administrator accepts the initial diagnosis on the accident report. It can be very difficult to add another condition to the claim later.
In some head injury and TBI cases, the initial diagnosis may include “concussion”. However, it is not uncommon for the head injury not to be reported at all on the initial paperwork. If the person suffering a work injury develops symptoms, or if the TBI diagnoses appears sometime later, then adding the condition to the L&I claim is often met with administrative resistance.
L&I attorney dealing with TBI work injury clients
As I’ve already noted, there are many symptoms for TBI. Side effects such as difficulty thinking clearly, irritability, sadness, and concentration problems, can be very challenging. Other issues such as problems remembering, nervousness, and anxiety, don’t make things easier. Add these kinds of symptoms to the normal stress of a workplace injury including financial instability and recovery uncertainty – clients who have suffered a TBI are often challenging to represent.
In my experience, they have good days and bad days. They aren’t always good at recalling past conversations, keeping appointments, or following through with requests. But I am always reminded that these are the people that need me the most. And I never discount this fact. On the positive side, our office has vast experience representing injured workers who have suffered a TBI. Because we understand the symptoms and their impact on our clients, we always do our best to help those clients understand the current status, difficulties, and needs of their claim.
L&I attorney and TBI workers compensation claims – additional resources
Remember, just because TBI claims are difficult does not mean they are impossible. The good news is that TBI is a condition that’s undergoing significant research by the medical community, professional athletic organizations, and the CDC. Every year it seems that new developments are made, to better understand the diagnosis and treatment. In fact, the CDC has several resources available related to TBI. One of those resources is the “Acute Concussion Evaluation” or ACE forms available for medical providers. The CDC also has a program called “HEADS UP” designed to help parents, sports and school coaches, as well as health care providers minimize and respond to the risk of TBI.
If you suspect that you, a friend, or family member sustained a TBI in a workplace injury, I would encourage you to review the helpful Brain Injury Basics information on the CDC website. If a TBI is complicating your workers’ compensation claim, don’t delay in consulting with an experienced L&I attorney who can help you understand your rights and determine if you need representation. You must ensure you receive appropriate benefits in such a challenging claim and difficult times.