After a car accident, a fall, or a blow to the head, you are not the same. You lose your train of thought, forget appointments, reread the same paragraph three times, and get exhausted by work that used to be routine. Bright lights and noise bring on headaches. Your CT scan was normal, and your long-term disability insurer says nothing objective explains your complaints.
Cognitive impairment is one of the hardest disabilities to prove because it is invisible. It is also one of the most provable, if you get the right testing.
Why insurers push back on brain injury and cognitive claims
- Normal imaging. Many brain injuries, especially concussions and mild traumatic brain injuries, do not show on a standard CT or MRI. Insurers treat a normal scan as proof of no injury.
- “Subjective” complaints. Memory, concentration, and fatigue problems are reported by the patient unless they are measured.
- Questions about effort. Insurers often look for signs of exaggeration in testing.
- Recasting the claim as mental health. Depression and anxiety often follow a brain injury. Insurers may try to treat the whole claim as psychiatric and apply a 24-month mental health limitation.
- You can still talk and drive. Insurers point to everyday functioning as proof you can do your job.
The evidence that matters
Neuropsychological testing. This is the centerpiece of most cognitive claims. A neuropsychologist gives a battery of standardized tests measuring memory, attention, processing speed, language, and executive function, and compares your results with what would be expected for someone of your age and education. It turns “I can’t concentrate” into measured deficits. Example: a 58-year-old accountant can no longer do complex financial analysis. Testing that documents slowed processing and impaired working memory explains why, in a way his own description cannot.
Validity testing. Good neuropsychological evaluations include tests that check whether the person gave full effort. Valid results answer the insurer’s exaggeration argument before it is made. Do your best on every test; that is how valid results are produced.
Medical records of the injury. Emergency room and hospital records, loss of consciousness or confusion at the time, imaging, and neurology records establish what happened and when.
Specialized imaging and other testing, when your doctors recommend it, can sometimes show changes a standard scan misses. Evaluations of balance, vision, and headaches document related problems.
Before-and-after evidence. Performance reviews from before the injury, compared with warnings, errors, or reduced duties afterward, are powerful. So are statements from supervisors, coworkers, and family describing specific changes: missed deadlines, repeated questions, mistakes you never used to make.
Limits to document
- memory: how often you forget instructions, appointments, or conversations,
- attention and concentration: how long you can focus before you lose track,
- processing speed and pace: how much longer tasks take than before,
- multitasking and decision-making,
- fatigue: how often you must rest after mental effort,
- headaches, light and noise sensitivity, dizziness, and how often they disrupt your day, and
- how many days a month you would likely miss.
Policy provisions to watch
- Own occupation. Cognitive problems often end professional careers first. A lawyer, engineer, nurse, or accountant may be unable to do her own occupation while still able to do simpler work. Know when your definition changes. More: Own occupation vs. any occupation.
- Mental health limitations. A brain injury is a physical injury. If the insurer tries to treat cognitive problems as a mental illness, look at how your policy defines mental illness and whether it excludes conditions with a physical cause. Make sure your records connect your cognitive symptoms to the injury, and that any depression or anxiety is documented as separate from, not the cause of, your cognitive deficits. More: The 24-month mental health limitation.
- Pre-existing condition clauses, if the injury happened soon after your coverage began.
When the insurer’s doctor disagrees
Insurers sometimes order their own neuropsychological evaluation or have a psychologist review your testing. If their conclusions differ, have your neuropsychologist respond: what the testing showed, why the results were valid, and why the insurer’s reviewer is wrong. Testing done months apart can also show whether problems are persisting. More: What to expect at an IME.
Other causes of cognitive impairment
The same approach applies to cognitive problems from stroke, brain tumors, multiple sclerosis, and other neurological conditions: measure the deficits, connect them to the medical cause, and show how they affect your job. More: Multiple sclerosis.
What to do now
- Ask your doctor about a referral for neuropsychological testing.
- Gather your performance reviews and any evidence of changes at work after the injury.
- Ask people who know your work to write down specific changes they noticed.
- Keep a daily log of memory lapses, headaches, and rest.
- If the injury happened at work, coordinate your workers’ compensation, Social Security, and LTD claims. More: LTD and workers’ compensation offsets.
Struggling to prove a brain injury or cognitive problems to your LTD insurer? Call 770-351-0801 or request a free case evaluation.
Related: Why your doctor must describe limitations · Depression, anxiety, and PTSD · Top 5 reasons LTD claims are denied