Traumatic brain injuries (TBIs) cause physical and cognitive symptoms that can disrupt every aspect of life, from performing simple tasks to being able to think clearly. These catastrophic injuries also have a very long recovery period and can lead to permanent disabilities, leaving victims unable to work, support their families or even live independently.
Whether you’ve sustained a TBI from a serious car accident, a workplace injury, or due to a defective product, disability benefits can provide a crucial financial lifeline to help you navigate the aftermath of getting hurt.
Unfortunately, the Social Security Administration is known for making the process of applying for these benefits notoriously complicated, partly because they want to discourage claims that aren’t valid. Statistically, most claimants who do meet the program’s qualifications will initially be rejected and have to deal with the long and frustrating appeals process.
While navigating these administrative hurdles is difficult, having the right guidance can significantly improve your chances of being approved for the disability benefits you deserve. This post goes over the SSA’s definition of TBI-related disability, the types of medical evidence you’ll need to substantiate your claim, and how an experienced Social Security Disability lawyer can provide support throughout every step of the application process.
Are Traumatic Brain Injuries Considered a Disability?
Traumatic brain injuries typically stem from major head trauma that causes damage to the actual brain rather than just a surface wound. TBIs are often called an “invisible” injury because they cause a wide range of disruptive symptoms that won’t be immediately obvious and aren’t straightforward to prove.
The complex nature of these symptoms, varying in severity from person to person, can make it harder to apply for disability benefits. However, traumatic brain injuries are widely recognized as debilitating, including by the Social Security Administration. While rehabilitation can help improve this condition over time, there’s no guarantee that victims with brain damage can recover fully. In many cases, individuals who suffer a TBI will never be able to work full-time again.
Some of the difficult, life-changing challenges traumatic brain injuries can cause include:
- Cognitive symptoms: The most common and significant consequences of a traumatic brain injury will involve problems with thinking, reasoning, and problem-solving, as well as short and long-term memory. These issues can make it very hard to remember important information, organize tasks, or handle general day-to-day responsibilities like keeping a job or managing the household.
- Behavioral symptoms: TBIs often damage brain areas that manage mood, judgment, and social skills, leading to emotional and behavioral changes. Victims are literally “no longer themselves” and can become irritable, aggressive, impulsive, exhibit poor judgment, and generally have difficulty maintaining relationships.
- Physical symptoms: Brain injuries are not just mental or emotional and can also result in physical limitations that affect the victim’s ability to work, drive a car or perform normal activities. For example, chronic headaches, balance issues that make walking hard without assistance, fatigue, difficulty sleeping, extreme sensitivity to noise, and even seizures.
How Tbi Victims Can Qualify for Social Security Disability Benefits
The wide range of long-term symptoms caused by traumatic brain injuries can make it difficult, if not impossible, for victims to return to work. Social Security disability benefits are available to help TBI victims cope with this financial burden. Still, there are very specific qualifications for eligibility, including medical and non-medical requirements.
Two programs financially support disabled individuals: Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). Being approved for SSDI will depend on paying enough withheld taxes into the Social Security system. At the same time, SSI is available to all low-income individuals, regardless of their work history. To qualify for either SSDI or SSI, your injuries also have to meet the Social Security Administration’s definition of “disabled,” which depends both on the severity of the symptoms and how long they’ll last.
Medical Requirements for Disability Benefits
To be eligible for disability benefits, the injury must be expected to last for at least 12 months or to result in the claimant’s death. Your symptoms must also significantly limit your ability to perform basic work-related activities, like walking, sitting, remembering instructions, or concentrating.
The Social Security Administration uses a medical guide called The Blue Book to evaluate whether medical conditions are serious enough to prevent “substantial gainful activity.” The Blue Book’s criteria for being considered disabled are listed under sections 11.18 and 12.02, which cover the physical, cognitive, and neurological impairments that result from brain damage.
Claimants must have at least one of the following symptoms for three months or more after getting hurt:
- Difficulties with memory, attention, concentrating on tasks, applying information or other cognitive skills
- Difficulty with motor functions, like balance, coordinating arms or legs, or fine motor skills, resulting in extreme physical limitations
- Difficulty speaking or understanding others
- Disruptive emotional or behavioral changes, like depression, anxiety, irritability, or aggression
- Neurological symptoms like seizures, migraines, and vision problems
If your TBI symptoms don’t meet the criteria outlined in the Blue Book, you can still qualify for disability benefits through the Residual Functional Capacity (RFC) assessment. This is a separate, more individualized process of evaluation that’s also considered essential for determining the claimant’s ability to return to work.
Traumatic brain injury victims would have to show that the combination of their physical, cognitive, and mental limitations is severe enough to result in disability, even if they don’t reach the necessary threshold for any of these individual categories. The Social Security Administration will consider your medical history, symptoms, age, education, and work experience to determine what type of work, if any, you might still be able to do despite being injured.
Non-Medical Requirements for Disability Benefits
In addition to meeting specific medical criteria, applicants for disability benefits also have to meet other eligibility requirements, depending on the type of SSA program.
- Social Security Disability Insurance: SSDI benefits are specifically for applicants that meet specific work history and earnings requirements, especially their contributions to Social Security through payroll taxes. The SSA uses a system called work credits to determine whether the applicant has paid enough into the program to qualify for disability benefits, depending on the applicant’s age when they became disabled and had to stop working. Generally, an applicant must have at least 40 credits, with at least 20 earned in the last decade. However, younger workers may be able to qualify with fewer credits.
- Supplemental Security Income: SSI is a needs-based program for disability applicants with limited income and resources, especially if they haven’t worked long enough for SSDI. The Social Security Administration sets specific annual income limits to adjust for inflation.
What to Expect When Apply for Disability Benefits After a Traumatic Brain Injury
Applying for Social Security benefits is a complicated, bureaucratic process that most people will find intimidating, especially while struggling with a traumatic brain injury. Most applicants trying to secure this much-needed financial support will face at least one denial, if not multiple, so persistence is essential. Having skilled legal representation from an attorney who understands the system can place you in the strongest possible position to prove your injuries’ extent.
Here’s what TBI victims can expect throughout every stage of the application:
Gathering Medical Documentation
Providing the Social Security Administration with a complete picture of how your TBI impacts your daily life and causes significant limitations is crucial.
That means detailed medical proof of your diagnosis, treatment, and ongoing medical care, including:
- Diagnostic tests, like CT scans or MRIs, show the extent of your brain injury.
- Documentation for medications, therapies, or surgeries you’ve undergone to manage your TBI
- Neuropsychological evaluations that assess cognitive impairments and memory issues
- Statements from doctors, therapists, and other healthcare professionals about the specific limitations caused by your injuries and how they impact your ability to work
Initial Application Review
Once your application and supporting documents have been submitted, they will be reviewed by Florida’s Disability Determination Services (DDS) agency. This process can take several months. You may be asked to provide additional information or undergo a consultative examination with a doctor chosen by the SSA. You will eventually receive a written decision either approving your benefits or explaining the grounds for denial.
Many applications are rejected at this stage due to not having enough substantiating medical evidence, whether by not demonstrating the severity of their traumatic brain injury symptoms or not being able to establish that they will last for at least a year.
However, a wide range of common technical errors can also harm your claim and potentially lead to a denial, such as not filling out paperwork correctly, not attending scheduled appointments, or not returning calls from DDS agents investigating your claim. In short, it’s important to be as proactive and responsive as possible throughout this process.
The good news is that if you do get denied after the initial review, you may appeal and continue strengthening your claim.
Filing an Appeal, if Necessary
Most successful disability benefit claims are initially denied but later approved through appeals, so it’s important not to get discouraged by this extremely common setback.
You can pursue to escalate your claim through four levels of appeal:
- Reconsideration: After receiving a rejection on your application, you have 60 days to request a reconsideration. This means your case will be reviewed again by a different DDS examiner, and you’ll also be able to submit more evidence.
- Administrative law judge hearing: If your claim for benefits gets denied again during reconsideration, you can request a hearing before an Administrative Law Judge (ALJ), a formal trial similar to civil court. This is an opportunity to present your case in person as well as strengthen your claim with witness testimony from friends, family, or medical professionals that can attest to the severity of your TBI symptoms. You can also have a lawyer by your side to help you make a persuasive case and increase your chances of a favorable outcome.
- Appeals council: If your claim gets denied again, you can request the Appeals Council to evaluate the decision. They can either approve your claim, deny it, or send it back for another ALJ hearing.
- Federal court review: If all else fails, disability claimants can file a lawsuit in federal district court. This is the most complicated and time-consuming form of appeal available. Still, it can be the right option depending on the individual circumstances of your case and your lawyer’s advice.
How a Disability Benefits Lawyer Can Help
Suffering a traumatic brain injury is a serious, potentially life-changing event with long-term consequences. These injuries’ physical, emotional, and financial toll can be overwhelming, especially since some individuals will never fully recover. Social Security’s disability benefits programs are designed to provide TBI victims with the support they need to cope with these challenges; however, getting approved is often a long and uncertain process.
An experienced lawyer with in-depth knowledge of the Social Security Administration’s application requirements can be crucial to present your case in the best possible light and help you secure benefits.
To improve your chances of a positive outcome, an attorney can:
- Handle all the complex paperwork involved throughout pursuing benefits, avoiding unnecessary delays due to technical mistakes with your application.
- Work closely with your medical team to gather the most effective documentation of your traumatic injuries and resulting symptoms.
- Help you prepare for your Consultative Examination with SSA’s doctors so that you know what to expect and can present your injuries accurately.
- Provide guidance during every step of the appeals process, help you understand your best options for strengthening the claim, and advocate for you during formal hearings.
In the aftermath of a traumatic brain injury that’s serious enough to prevent you from working, Social Security disability benefits can help ease the financial burden and provide some peace of mind. Having skilled legal representation is essential to help you understand every stage of the process, make informed decisions, and prepare a strong claim demonstrating the full extent of your symptoms from getting injured.