Concussions and Traumatic Brain Injury After a Crash

Published July 8, 2015 · Injury Law Basics

You were rear-ended on I-675, the airbag did not even deploy, and the emergency room sent you home with a diagnosis of "neck strain." Two weeks later you cannot concentrate at work, you are sleeping badly, you snap at your kids, and a headache sits behind your eyes most afternoons. Nobody has used the words "brain injury," and the insurance adjuster certainly has not. This post is about why that pattern is so common, and what to do about it.

A concussion is a brain injury

A concussion is a mild traumatic brain injury. The word "mild" describes the initial medical classification, not how it feels or how long it lasts. It happens when the brain moves inside the skull hard enough to disturb the way brain cells function. The brain floats in fluid; when the head stops suddenly or whips forward and back, the brain can strike the inside of the skull or stretch and twist on its stem.

Two things about that mechanism matter for crash victims:

• You do not have to hit your head. The whiplash motion of a rear-end or side-impact collision can concuss a person whose head never touches the headrest, the window, or the steering wheel.
• You do not have to be knocked out. Most concussions involve no loss of consciousness at all. A moment of feeling dazed, "seeing stars," or not remembering the seconds right after the impact is enough to signal that the brain was injured.

Because there is no bruise, no cast, and usually nothing abnormal on a CT scan (which looks for bleeding and fractures, not for the functional injury of a concussion), the injury is invisible to everyone but the person living with it.

Why the ER often misses it

Emergency rooms are built to find what can kill you in the next few hours. After a crash, that means checking for internal bleeding, broken bones, and spinal injury. A patient who answers questions, walks, and has a normal CT is often discharged with instructions about neck pain and told to follow up with a family doctor.

Concussion symptoms, by contrast, frequently show up or get worse over the following days. Common ones include:

• Headaches that do not respond well to over-the-counter medication
• A foggy, slowed-down feeling; trouble concentrating or finding words
• Memory problems, especially short-term
• Sleeping much more or much less than usual
• Irritability, anxiety, mood swings, or crying easily
• Sensitivity to light and noise
• Dizziness, balance problems, nausea
• Ringing in the ears or blurry vision

Many people assume these are stress, lack of sleep, or "just getting older." Family members often notice the personality change before the injured person does. If any of this sounds familiar, get evaluated, and say the word "concussion" to the doctor. For most people the symptoms resolve in weeks. For a meaningful minority they persist for months or longer, affecting work, relationships, and daily life. Those are the cases where the stakes are highest.

Why these claims get undervalued

Insurance adjusters evaluate claims from paper. A fractured wrist comes with an X-ray, a surgical report, and a bill. A concussion often comes with an ER note that says "neck strain," a gap of a few weeks, and then a family-doctor visit where the patient mentions headaches. The adjuster's file says: minor impact, no head strike, no loss of consciousness, normal CT, delayed complaints. The offer reflects that story, not your reality.

The same adjusters, and later defense lawyers, will look for anything that suggests you are functioning normally: a work schedule, a vacation, a photo of you at a family cookout. That is one reason we tell every client to be careful about what they post online, as discussed in our post on social media and your injury claim.

How we prove an invisible injury

A brain-injury claim is won with documentation and witnesses, built over time. Here is what that looks like in our office.

Prompt and consistent treatment. The single most important step is to be evaluated early and to follow through. A primary-care doctor can diagnose a concussion and refer you to a neurologist or a concussion clinic. Every visit creates a dated record of your symptoms in a medical professional's words. Gaps in treatment are read by insurers as proof that nothing was wrong. We wrote about this general principle years ago in why you should see a doctor even if you "feel fine."

Neuropsychological testing. A neuropsychologist administers a battery of standardized tests of memory, attention, processing speed, and executive function. The results are objective numbers, compared against what a person of your age and education would be expected to score. They turn "I feel foggy" into measurable deficits, and they are the kind of evidence a jury can hold onto.

Before-and-after witnesses. Your spouse, a co-worker, a supervisor, a coach, a close friend: people who knew you before the crash and can describe specifically what changed. These witnesses are often the most persuasive evidence in a brain-injury case because they have no stake in the outcome and they talk about concrete things: the missed deadlines, the forgotten appointments, the short temper that was never there before.

Work records. Performance reviews, attendance, reduced hours, and a change in duties document the economic side of the injury. For a self-employed person, tax returns and client records serve the same purpose.

A symptom journal. We ask clients to keep a brief daily note of headaches, sleep, and cognitive difficulties. It helps your doctors treat you, and it keeps your account consistent over a case that may take a year or more.

Motorcyclists and the helmet question

Riders face brain injury at far higher rates than people inside a car, and the insurance defense in a motorcycle crash case often turns quickly to whether the rider wore a helmet. Ohio does not require adult riders to wear one. A helmet reduces the risk of a severe brain injury, but it does not prevent concussions, and a driver who turned left in front of a motorcycle is responsible for the harm that followed. Do not let anyone convince you that an unhelmeted rider has no claim.

What this means for you

If you were in a collision and you are not thinking, sleeping, or feeling the way you did before, treat that as an injury, because it is one. Tell your doctor, get a referral, and keep going to appointments. Do not accept an early settlement offer for a "soft-tissue" claim while you are still symptomatic; a release signed in month two closes the door on a brain injury that is still being diagnosed in month six. If the crash was a rear-end collision, fault is usually clear, and the only real fight is over what the injury is worth. That fight is won or lost on documentation, which starts now.