Why Insurance Companies Undervalue Post-Concussion Syndrome Claims

The Insurer’s Strategy: How “Mild” TBI Claims Are Minimized

Insurance companies operate using a systematic playbook when handling claims involving traumatic brain injuries. These strategies are designed specifically to challenge the medical diagnosis, confuse the victim, and delay the claim process until the injured person is desperate enough to accept a lowball settlement offer.

Their primary goal is to maximize profits by questioning the severity and causation of the long-term symptoms associated with PCS. In fact, insurers systematically employ tactics to reduce brain injury claim payouts, including questioning diagnoses and misrepresenting medical evidence.

The Problem of the “Invisible Injury”

PCS is often referred to as an “invisible injury” because the damage doesn't always show up on standard diagnostic tests. Routine emergency room imaging, such as CT scans and basic MRIs, can appear normal in mild to moderate traumatic brain injury cases. Insurance companies exploit this finding as primary evidence that the injury is not serious or does not actually exist.

The injury associated with PCS often occurs at the microscopic level of the brain tissue or involves chemical imbalances, making it challenging to prove through routine objective tests. Adjusters intentionally use the lack of clear, structural damage on common scans to argue that the victim is either exaggerating their symptoms or that the symptoms must be psychological in nature.

Leveraging the Misleading "Mild TBI" Label

The label "Mild Traumatic Brain Injury" (mTBI) is perhaps the most heavily misused term by insurance companies. Clinically, the term "mild" relates only to the initial Glasgow Coma Scale (GCS) score recorded shortly after the accident. It doesn't reflect the potential severity of the long-term recovery process or the lasting impairment it may cause.

Insurance adjusters intentionally misrepresent this clinical designation, using the word "mild" to suggest the injury is minor or insignificant. They want the victim or the jury to believe that if the injury was "mild," the debilitating symptoms of PCS, which can persist for months or years, should not be compensable. Statistics show that approximately 15% of mTBI patients develop persistent PCS, proving that a "mild" diagnosis doesn't guarantee a benign outcome.

Attacking Subjective Symptoms and Patient Credibility

Many of the most debilitating symptoms of PCS fall into the category of subjective complaints, which insurance adjusters are trained to attack. Symptoms like chronic headaches, intense vertigo, crippling fatigue, and memory issues are difficult for doctors to measure with a simple blood test or standard scan.

Adjusters use this perceived lack of objective proof to suggest the claimant is exaggerating or fabricating their suffering. To further undermine the claim, insurance companies often engage in intrusive surveillance, including monitoring the victim's social media accounts.

Navigating Social Media During a PCS Claim

If you're pursuing a personal injury claim, you should assume that everything you post online is visible to the insurance company and defense lawyers. These parties frequently look for evidence that contradicts your claimed injuries or limitations, especially for invisible injuries like PCS.

We advise clients to set all social media profiles to the highest privacy settings immediately. You should also refrain from posting photos of intense physical activity, travel, or complex social interactions. Even positive or "normal" looking photos can be used aggressively to minimize your documented struggles with cognitive impairment or emotional distress, so exercising caution is paramount.

The Pre-Existing Condition Defense

A common tactic used by insurers is to request overly broad medical authorizations to scrutinize the claimant’s medical history. They search for any prior diagnosis that could potentially be linked to the current PCS symptoms, even if the prior condition was completely unrelated to the accident.

Insurance companies typically examine medical records spanning three to five years, but they often request records extending back seven to ten years or longer for complex injuries like traumatic brain injuries. They may look for any history of prior headaches, stress, anxiety, or psychological issues. They then argue that these pre-existing conditions, not the accident, are the true cause of the current post-concussion symptoms, to deny or significantly reduce the claim.

Countering the Defense with the Aggravation Doctrine

A skilled personal injury lawyer counters the pre-existing condition defense using the legal concept of the "Aggravation Doctrine." Florida law recognizes that even if you had a dormant medical condition, the negligent party is responsible if the accident aggravated or worsened that condition.

To prove aggravation, we must compare pre-accident medical reports with post-accident reports to show a material increase in symptoms, duration, or severity. The key is to prove that the accident caused a new problem or significantly worsened a pre-existing one, ensuring the insurance company remains liable for all damages arising from the traumatic event.

Using Delay and Lowball Offers to Force a Settlement

Insurance companies often use calculated delays and excessive documentation requests to create financial and psychological pressure on the victim. These delays prey on the victim’s financial vulnerability, especially if they’re unable to work due to cognitive or physical impairment resulting from the PCS.

Once the victim is emotionally and financially drained, the insurer will often issue a quick, lowball settlement offer. These offers are frequently made before the full, long-term impact and costs of the Post-Concussion Syndrome are accurately known. Since most traumatic brain injury claims are settled rather than taken to trial, the low settlement offer provides quicker compensation but often drastically underpays the true lifetime value of the case.

Building an Objective and Compelling Post-Concussion Syndrome Claim

Successfully countering the insurer's playbook requires shifting the narrative away from subjective complaints and toward objective medical validation and functional impairment. This means adopting a proactive, evidence-based strategy that utilizes specific medical testing and thorough documentation to prove the extent and severity of the brain injury. An effective legal strategy involves transforming invisible symptoms into concrete, legally recognizable damages.

Comprehensive Medical Documentation and Symptom Journaling

Establishing a clear timeline of causation is necessary, which is why continuous and consistent medical care must begin immediately following the injury. Any gaps in treatment will be exploited by the insurance company to suggest that the symptoms resolved or that the injury wasn't serious enough to warrant continuous care.

The injured person must maintain a detailed daily symptom journal, documenting the frequency and duration of symptoms like headaches, vertigo, and cognitive fog. More importantly, this journal should focus on the specific impact these symptoms have on daily living, such as the inability to perform job duties, drive, or maintain relationships. Detailed symptom diaries provide objective evidence of subjective symptoms by documenting patterns that courts and medical professionals accept, much like diagnostic test results.

Utilizing Advanced and Objective Diagnostic Evidence

Since standard CT and MRI scans often fail to show physical damage in PCS cases, leveraging advanced diagnostic testing is paramount to building an objective claim. These specialized tests provide tangible proof of changes in brain function or structure that an insurance company can't easily dismiss.

One important tool is the formal Neuropsychological Evaluation, which provides concrete data regarding cognitive function, memory, processing speed, and executive abilities. This testing objectively measures functional impairment, demonstrating exactly how the brain injury has affected the victim’s ability to think and perform complex tasks.

Specialized imaging techniques, such as SPECT brain perfusion imaging, can also be instrumental in these cases. SPECT scans can detect abnormalities in mild or moderate traumatic brain injury patients, even when standard CT scan results are negative. This provides objective evidence of altered blood flow or metabolism within the brain.

The Power of Expert Testimony: Neurologists and Neuropsychologists

The credibility of a PCS claim often hinges on the testimony provided by qualified medical experts. An experienced personal injury attorney will secure testimony from specialists, usually neurologists or neuropsychologists, who have a deep understanding of traumatic brain injuries.

These specialists officially diagnose Post-Concussion Syndrome and provide a professional, long-term prognosis that outlines the expected duration and severity of the claimant’s symptoms. Their testimony is essential for explaining to a jury or judge how the victim's invisible symptoms are entirely consistent with recognized medical science on PCS.

Crucially, these expert witnesses address the victim’s future damages, detailing anticipated ongoing medical care, future therapy needs, and the impact on the victim's ability to earn a living over their lifetime. Without this specialized testimony, the insurance company will simply dismiss the claim as speculative.

Calculating the Full Scope of Damages in a PCS Claim

Valuing a Post-Concussion Syndrome claim correctly requires calculating the full scope of damages the victim is entitled to, moving far beyond simple initial medical bills. These damages are typically separated into economic and non-economic losses. The average first-year cost of a traumatic brain injury is approximately $151,000, illustrating the immediate need for substantial compensation.

Economic Damages cover quantifiable financial losses, including past and future medical costs related to PCS treatment, lost wages from time missed at work, and diminished future earning capacity. Lifetime costs for traumatic brain injuries can range dramatically, and even seemingly mild injuries carry significant financial burdens over time.

Non-Economic Damages account for intangible losses, such as physical pain and suffering, mental anguish, and the loss of enjoyment of life caused by debilitating PCS symptoms like constant irritability and anxiety. Successfully argued TBI cases often result in substantial compensation for non-economic damages, demonstrating that the injury's value extends far beyond hospital bills.

Speak To An Injury Lawyer About Your Head Injury Claim

Post-Concussion Syndrome is a severe injury that significantly alters the life of the person suffering from it. Insurance companies systematically undervalue these claims, exploiting the "mild TBI" label and the invisible nature of symptoms to protect their profits. Fighting back successfully requires gathering sophisticated legal and objective medical evidence to prove the full, long-term scope of the functional damage.

If you or a loved one is battling an insurance company over a PCS diagnosis following an accident in Florida, you need powerful representation that understands brain injury litigation. Our expertise allows us to secure advanced diagnostic testing and expert testimony, fighting tirelessly to ensure Florida personal injury victims receive the maximum compensation they deserve.

Call Weinstein Legal Team now at 888.626.1108 for a free case review with a lawyer, or click here to schedule your case review today.