What is Post-Concussion Syndrome?
Most concussions and mild traumatic brain injuries resolve spontaneously in a matter of days or weeks. Post-concussion syndrome, or PCS, is a medical condition characterized by persistent concussion symptoms that last for months or years. Common symptoms include headache, dizziness, imbalance, fatigue, sleep disruption, impaired cognition, and light and sound sensitivity. People may also develop depression, anxiety, and other psychological disorders that can overlap with the original concussion symptoms.
There are some known risk factors for development of post-concussion syndrome, including unconsciousness or amnesia immediately following the injury, multiple prior concussions, pre-existing psychiatric conditions (such as anxiety and depression), and younger age.
Post-concussion syndrome symptoms can be severe, and in some cases make a return to work impossible. Long term disability benefits may be available if you are unable to work due to symptoms of PCS, but unfortunately many LTD claims for concussion symptoms are denied.
What are long term disability benefits?
Long term disability, or LTD, is an insurance product that is meant to replace a portion of your income while you are unable to work due to illness or injury. Many employers provide their employees with this coverage through a group plan. Professionals and other self employed workers will often obtain their own LTD coverage through an individual policy.
Making An LTD Claim For Post-Concussion Syndrome
Applying for long term disability benefits usually requires providing various forms completed by you, your employer, and your doctor. The insurer will likely also require your doctor’s clinical notes and records, and those of any specialist you have seen as well as well. In most cases your level of function is more important than your diagnosis. In fact, post-concussion syndrome claims are often highly scrutinized by insurers, and many legitimate claims are denied.
Why Are LTD Claims Denied?
Disability insurers are in the business of collecting premiums and paying claims. But they do not approve all claims submitted. Insurers require proof of disability, and some medical conditions are harder than others to establish, especially if the insurer insists upon objective medical evidence.
Post-concussion syndrome falls into a category of medical conditions sometimes referred to as “invisible illnesses”. For most concussions, there is no objective evidence to support disability. Symptoms such as headache, dizziness, imbalance, fatigue, etcetera are subjective by their nature. This does not mean they are not disabling, it just means they are harder to prove.
Increasing The Chances of Your LTD Claim Being Approved
There are some things you can do to increase the chance of your disability claim being approved.
First, be sure to obtain treatment and report your symptoms to both your family physician and other healthcare providers. LTD insurers will look closely at these medical records. If the symptoms reported to the insurer are similar to those documented by your treatment providers, these symptoms are more likely to be accepted as legitimate.
Credibility is another important consideration. Be truthful and candid when speaking with the insurer. You should also be aware insurers monitor online activity. Be careful what you post to Facebook, Instagram, and other social media. What may seem innocuous to you may be perceived differently by the insurer. Sometimes insurers will conduct surveillance. It the private investigator documents several hours of sustained activity, but you report rarely leaving the house, this will raise red flags.
What To Do If Your Long Term Disability Claim is Denied
There are generally two or three options when an LTD claim is denied: appeal, lawsuit, and for unionized employees there may be an option to proceed with the union grievance process as set out in the collective bargaining agreement. All three options have their advantages and disadvantages.
The main advantage of an appeal is it can be fast. The biggest disadvantage is very few appeals are successful. This is because appeals do not go to an independent decision maker; rather, it is the same company looking at the same information that it has already rejected. The only time long term disability lawyers would ever recommend an appeal is if there is new compelling evidence that was not included in the original application. In the case of post-concussion syndrome, this could be a detailed report from a neurologist or neuropsychologist, or other similar evidence.
Lawsuits do not mean you are going to court. But they do take longer than appeals. Lawsuits, however, have a much higher success rate. Another advantage of a taking legal action is the settlement usually results in a single lump sum payment for both past and future benefits, meaning you no longer have to deal with the insurance company. Often you can save on income tax as well when you settle out of court. Experienced long term disability lawyers have success rates of more than 95%
For unionized employees, the union may assist with an appeal or arbitration. But often the union does not have the resources nor the expertise to do so. Sometimes unionized employees do not have the option of retaining a long term disability lawyer.
Which route to take is an important decision that should not be taken lightly. Consider obtaining free legal advice from a long term disability lawyer first.
Post-Concussion Syndrome can be a disabling condition. If you unable to work because of symptoms of PCS, long term disability benefits may pay a portion of your income while you focus on your recovery. If your LTD claim is denied for any reason, contact a long term disability lawyer for fast, free, legal advice.
About The Author
Michael Jordan is a long term disability lawyer with more than 17 years experience litigating all types of insurance claims. He is a founding partner of the Bay Street firm Jordan Honickman Barristers, and is one of just 25 lawyers in all of Canada ranked by Lexpert as a “Leading Legal Practitioner” in long term disability law. Michael represents clients across all of Ontario, with satellite offices in Ottawa and London.
Direct Cell: 416-460-6823