Documenting Concussion and TBI Symptoms After a Crash: What to Write Down and When

Published August 8, 2023 · Injury Law Basics

The emergency room did a CT scan, it came back clean, and you were sent home with instructions to rest. Three weeks later you are still getting headaches every afternoon, you lost your train of thought twice in a meeting, and your spouse says you snap at the kids over nothing. You may be wondering whether this is "real" or whether you are imagining it.

It is real, and the way you document it over the next few weeks will shape how seriously anyone else takes it. Concussions and other mild traumatic brain injuries are among the most underestimated injuries in car and truck crash cases. Insurers count on that.

Why brain injuries are so easy to discount

A concussion is a brain injury caused by a blow to the head or by the head whipping back and forth, which is exactly what happens to occupants in a rear-end or side-impact collision even when the head never strikes anything. The injury is to how the brain functions, not usually to its visible structure. That is why a CT scan, which is designed to find bleeding and fractures, is so often normal.

Symptoms also tend to change over time. Some appear immediately; others become noticeable only days or weeks later, when a person goes back to work or tries to read, drive in traffic, or keep up with a conversation. Common complaints include:

• headaches, dizziness, nausea, and sensitivity to light or noise;
• mental fog, slowed thinking, and trouble concentrating or remembering;
• irritability, anxiety, depression, or mood swings; and
• sleeping much more or much less than usual.

Every one of these is invisible on an X-ray, and every one is something an adjuster can describe as "subjective." When the record is thin, the insurer's position is simple: no objective findings, no serious injury. I have written before about how insurers use minimal vehicle damage to argue minimal injury, and brain-injury claims draw the same argument.

The symptom journal: what to write down

The single most useful thing you can do, starting today, is keep a dated symptom journal. Our guide chapter on preserving documents and records describes the journal as the best evidence of the human side of an injury. For a brain injury, it is often the only evidence of what happens between doctor visits.

Keep each entry short and factual. Note:

1. The date. Every entry, every time.
2. Headaches: when they started, how long they lasted, how bad (on a 0-10 scale), and what you took for them.
3. Thinking problems: forgotten appointments, losing your place in a task, rereading the same page, getting lost on a familiar route, struggling to find a word.
4. Mood: episodes of irritability or tearfulness, and what set them off.
5. Sleep: when you went to bed, how often you woke, and how rested you felt.
6. Sensory problems: light, noise, screens, crowded stores.
7. What you could not do: left work early, skipped a family event, asked someone else to drive.

Do not embellish and do not write for an audience. A journal that reads like a legal brief is less believable than one that says "Couldn't finish the grocery list, had to call Mike from the store." Your lawyer will decide later whether and how it is used.

Tell your doctor, every time

A journal is only half the record. The other half is what your treating providers write down, and they can write down only what you tell them.

People with brain injuries are especially likely to underreport. They forget symptoms by the time they reach the exam room, they do not want to seem like complainers, or they do not connect the irritability or sleep problems to the crash. Bring your journal, or a short written list, to every appointment and hand it to the doctor. Ask that the symptoms be noted in the chart.

If symptoms continue for more than a few weeks, ask whether a referral to a neurologist, a concussion clinic, or a neuropsychologist is appropriate. Neuropsychological testing measures memory, attention and processing speed against expected norms and can turn "I can't think straight" into documented, measurable deficits. Our chapter on focusing on treatment first explains why consistent care and following through on referrals matter so much; gaps in treatment are the first thing an insurer looks for.

Witnesses from your everyday life

Some of the best evidence in a brain-injury case comes from people who knew you before. A spouse who notices you now repeat questions, a coworker who has had to cover mistakes, a friend who sees that you no longer follow a ball game: these people can describe the change in a way no medical record can.

Ask them to jot down specific examples with approximate dates while the memories are fresh. If the case goes forward, these observations can become written statements or testimony. If you lost time from work or had your duties changed, keep the emails and ask your supervisor for a letter.

Why documentation affects the value of the case

Ohio law treats a brain injury like any other injury: you are entitled to compensation for medical expenses, lost income, and the noneconomic harms of pain, suffering and loss of enjoyment of life. Under R.C. 2315.18(B)(2), noneconomic damages in most injury cases are capped at the greater of $250,000 or three times economic loss, up to $350,000 per plaintiff. But R.C. 2315.18(B)(3) removes the cap entirely for a permanent physical functional injury that prevents a person from independently caring for self and performing life-sustaining activities, or for a permanent and substantial deformity or loss of use of a bodily organ system.

Most concussions heal. Some do not, and a brain injury that leaves someone unable to work, manage money or live alone may fit that exception. Whether it does depends on a medical record that tracks the injury from the first week. We explain how the caps and their exceptions work in What Your Case Is Worth, and we covered the medical background of these injuries in our earlier post on concussions and traumatic brain injury after a crash.

What this means for you

If you hit your head, or were jolted hard in a crash, and something still feels wrong:

• Start a dated symptom journal today, and keep it going until your doctors say you have recovered or reached your maximum improvement.
• Tell every provider about every symptom, including mood and sleep.
• Ask about specialist referrals and testing if symptoms last more than a few weeks.
• Ask family and coworkers to note specific changes they see.
• Do not accept a quick settlement while your symptoms are still evolving. A release signed in month two cannot be undone in month eight.