Navigating insurance claims for brain injury victims
- Posted by Taylor Ernst on
- May 12, 2023
Severe brain injuries don’t just impact the victim; their entire family suffers. Family members may be thrust into the role of caregiver, or if the injured person was the family breadwinner and is now unable to work, the family is left in financial straits.
Navigating the traumatic brain injury insurance claims process is challenging, especially for a victim who may be unable to advocate for themselves. Many people do not receive everything they’re entitled to because they either try to represent themselves or hire an inexperienced attorney.
Our San Luis Obispo brain injury lawyers are among the best in the state, and we can help you file and appeal insurance claims or file a suit for damages against the party that caused your brain injury.
Types of brain injuries
Brain injuries can happen in one of three ways:
- Blunt force head trauma
- Penetrative head and brain trauma
- Hypoxia, or oxygen deprivation damages brain tissue
Brain damage may also occur due to a degenerative disease or suddenly after an aneurysm or stroke.
Insurance coverage for options for brain injuries
Insurance policies differ in coverage for brain injuries, so it’s important to read yours closely to see its benefits and limitations. You’ll likely be affected by the following elements of your policy:
- Lifetime coverage limit, which a brain injury victim may reach fairly quickly
- Subrogation clauses, which provide someone else the right to act on behalf of the policyholder concerning legal actions regarding the insurance contract
- Therapy benefits, stating the number of visits allowed per year (many brain injury victims require occupational or physical therapy)
- In-home care benefits, including the amount allowed each year for a hired caregiver or home health nurse
- Durable medical equipment, stipulating which types are covered and under which conditions
Some people with brain injuries may be eligible for California Medicaid, especially if they cannot work due to the injury, lose their employer-sponsored coverage, and now meet income eligibility for Medicaid. Medicaid covers more than just the doctor’s appointments; it also pays for most or all the cost of in-home health care or residence in a nursing home.
Navigating the claims process
Filing traumatic brain injury insurance claims is the same filing process for any other type of injury. Providing the right supporting documentation for your claim is essential to ensuring that all your required services and care are covered. This includes:
- All medical records, including initial diagnosis and follow-up appointments that monitor the victim’s improvement
- The treating physician’s estimate of the victim’s maximum medical progress (will the recovery have permanent limitations?)
- All medical bills to calculate the cost of treatment
- A log of how the injury has affected the victim’s quality of life, mental and physical abilities, and ability to work or go to school
Insurance companies usually pay only for treatment deemed “medically necessary.” Your loved one’s doctor can help you provide proof that their recommended procedures or care are medically necessary and therefore should be covered.
Challenges in the claims process
Brain injury victims face several hurdles in getting the right insurance coverage for their injuries. The first is having the injury covered, period. How the victim received the injury determines which insurance policy covers them. Workers comp may cover a workplace injury, while a TBI sustained in a car accident may be covered by an auto insurance policy (the victim’s or the other driver’s).
Proving how badly someone is injured is another difficulty. Insurance companies are notorious for minimizing claims or even denying them outright. Claimants need to prove that they should be covered and prove the degree of their injury to receive proper coverage.
If the victim is injured by another party and that person or entity challenges the claim, the situation becomes more complicated. Often in these cases, a brain injury lawsuit is the best recourse for a brain injury victim. Brain injury victims harmed by another party’s negligence or reckless actions have the right to file a personal injury lawsuit for damages. A San Luis Obispo brain injury lawyer can explain your legal options and litigate your case.
Resources for brain injury victims and their families
San Luis Obispo brain injury victims can receive help and support through one or more of these organizations for brain injury victims:
Do you need help pursuing traumatic brain injury insurance claims?
We can help! The San Luis Obispo brain injury attorneys at Ernst Law Group work with California families like yours who have been devastated by the brain injury of a loved one. Contact us today at (805) 541-0300 for a free initial consultation.
Brain Injury Awareness Month: March 2022
- Posted by Taylor Ernst on
- March 29, 2022
Since March is Brain Injury Awareness Month, it is a great time to educate yourself on what brain injuries are, how they can happen, and how you can help injured victims.
Types of Brain Injuries
There are two types of brain injuries that are not hereditary, congenital, or related to birth. These two types are Acquired Brain Injuries (ABIs) and Traumatic Brain Injuries (TBIs).
Acquired Brain Injury
An Acquired Brain Injury (ABI) occurs as a result of internal causes, not from external trauma. Some causes of ABIs include but are not limited to:
- Brain tumors
- Near drowning
- Heart attacks
Traumatic Brain Injury
A Traumatic Brain Injury (TBI) can happen as a result of sudden external assault to the head that damages the brain’s structure and/or functioning. TBIs can be closed-brain injuries or penetrating brain injuries depending on whether the trauma caused a break in the skull or not.
An example of a cause of a penetrating brain injury is a gunshot wound to the head where the bullet enters the brain.
Closed-brain TBIs can be caused by sports accidents, car crashes, or falls, although any trauma to the head can cause internal damage and closed-brain injuries.
Symptoms of TBIs can include:
- Slurred or slowed speech
Some milder brain injuries can heal over time, while some more severe brain injuries cause permanent disability and deficits in cognitive, motor, sensory, and communicative functioning.
Some Professions Carry a Higher Risk of TBI, but Anyone Could Be Affected
Brain Injury Awareness Month is an excellent time to evaluate your risk of sustaining a traumatic brain injury.
Some professions carry a higher risk of TBI. If you are an athlete, construction worker, or work in law enforcement or the military, you have a higher risk of TBI. Adhering to safety regulations in the workplace is imperative to lowering that risk.
While some people have a higher risk of TBI than others, anyone can be affected. Accidents happen and TBIs can never be 100% preventable, but there are steps you can take to lower your risk of brain injury.
- Read the instructions and heed the warnings on your medications. Some medications may have side effects such as dizziness or drowsiness that can increase your risk of falling, while some may warn against operating heavy machinery while taking them.
- Don’t drive under the influence, and always make sure all car passengers are wearing their seatbelts. Also, be sure to check that your airbags are working properly when you get your car serviced.
- Always wear a helmet when participating in sports with a high risk of falls and head injuries, such as horseback riding, skateboarding, biking, skiing, football, and hockey.
- If you have issues with stability or risk of falling, consider using a walker or a cane. Nearly 50% of all brain injuries are related to falls.
Brain Injuries in Women
Brain injuries are often more fatal among women than men. There’s a high incidence of assault-related TBIs due to the prevalence of violence against women.
Women are more likely to sustain assault-related TBIs in the workplace in the fields of education, social services, and healthcare.
Intimate partner violence is also a major cause of assault-related TBIs in women. If you are experiencing intimate partner violence, or believe there is a risk of violence in your home, reach out to your local domestic violence agency for immediate assistance and safety planning.
One common recommendation made during the safety planning process is to try to remove yourself from conflict in rooms such as the kitchen or bathroom. These rooms are more likely to contain hard surfaces and sharp corners that increase the risk of TBI.
If you are experiencing intimate partner violence, please call the National Domestic Violence Hotline at 1-800-799-7233 (SAFE).
How to Observe Brain Injury Awareness Month All the Time, Not Just in March
For more information, check out these videos covering a range of topics such as information on rehabilitation for TBIs, personality changes as a result of TBIs, ways to make your daily life better after a TBI, how to help TBI victims financially, and more resources for victims and their caregivers.
The Ernst Law Group’s California resource center for brain injuries is also a great place to educate yourself.
If you are a parent or caregiver of a young person with a traumatic brain injury, this free guide can give you valuable tips and resources to help support the TBI survivor in your life.
Brain injuries can permanently affect your life in significant ways, but you can still have a happy and meaningful life after sustaining a TBI.
Get involved in a support group – you are not alone and there are resources to help you.
Help advocate for the injured.
Legal action can help injured victims of brain injuries. Ernst Law Group’s Los Angeles and San Luis Obispo Brain Injury Lawyers can help by advocating for you or your loved ones who have been affected by brain injuries.
If your brain injury was caused by another’s negligent, intentional, or reckless behavior, they should be held accountable, and you deserve justice and can seek compensation to pay for damages.
Under California law, the injured party can still recover some damages in the form of compensation even if they are partially at fault for the accident. While compensation may not always help a victim heal their brain injury, it can help their quality of life to be as close as possible to what it was pre-injury.
Treatment for brain injuries can be expensive and cost thousands or even millions of dollars for the remainder of the victim’s life. The Ernst Law Group has recovered millions of dollars for their clients in personal injury and wrongful death lawsuits.
Ernst Law Group’s California traumatic brain injury lawyers believe that victims of TBIs deserve the highest quality of life possible all the time–not just during brain injury awareness month.
The Ernst Law Group has a proven track record and reputation for aggressive and experienced legal representation for victims of personal injury. Ernst Law Group takes cases on a contingency basis and there are no fees unless we win your case. There are no up-front fees, and your first consultation is always free.
If you have a brain injury, even if it is a mild concussion, that may have been caused by someone else’s negligence, call 1-805-541-0300 to schedule a complimentary case consultation. You may also email us at [email protected].
What You Need to Know About Fatal Amusement Park Injuries in California
- Posted by Taylor Ernst on
- July 3, 2018
There are seemingly two camps when it comes to amusement park rides in California: Those who ride them for the thrill, and those who don’t, finding them too risky. No matter which side of the fence you find yourself on when it comes to water slides, spinning rides, roller coasters and other adrenaline-fueled rides, the truth is that they can be dangerous. In the most severe cases, the aftermath requires the assistance of a wrongful death lawyer in San Luis Obispo.
Are Amusement Park Accidents in California Common?
Tens of thousands of people are injured on amusement park rides every year. Injuries range from minor ones that require no medical attention to accidents that prove fatal. About half of all people injured on these rides are children, with those between 10 and 14-years-old sustaining the most injuries of any age group. Children, due to their size, make up three-quarters of victims who have been thrown or have fallen from a ride.
The Most Common Amusement Park Ride Injuries
Almost any injury can be sustained on an amusement park ride that malfunctions, but some are more common than others. These include:
- Back, neck and head injuries
- Traumatic brain injury
- Torn ligaments
- Broken bones
- Fatal injuries
What Causes Amusement Park Ride Accidents?
According to the federal Consumer Product Safety Commission (CPSC), there are several common causes for amusement park ride accidents. These include mechanical failure, improper operation, passenger misuse and the nature of the ride.
When an accident is caused by mechanical failure or improper operation, the person who designed the ride, the park or the person operating it may be held accountable. When a death is the result of an amusement park accident, a wrongful death lawsuit may be pursued.
How a San Luis Obispo Wrongful Death Attorney Can Help
There are different avenues that may be pursued when someone is injured as the result of an amusement park accident. A person may pursue a personal injury claim if negligence led to the accident. For example, the operator may have failed to provide instructions to riders or the park may have neglected to post signs.
Another person may be able to file a product liability claim. This would happen if the ride malfunctioned during operation. In the case of fatality, the victim’s family could possibly pursue a wrongful death claim.
If you or a loved one have been injured on an amusement park ride and are interested in seeking compensation, reach out to our office. A wrongful death lawyer in San Luis Obispo from Ernst Law Group can assist your family in seeking the compensation you deserve. Call our office today to schedule a free case evaluation and learn more about your rights.
How Your Body Is Affected by a Car Crash
- Posted by Taylor Ernst on
- August 14, 2016
There you are, driving down the 101, rockin’ out with your windows down. Just like every day, traffic in front of you has slowed to a crawl, so you slow down, too. Unfortunately, the driver behind you is on their phone and not paying attention. They hit their brakes, but it’s too late. Suddenly, they slam into the rear of your car, causing airbags to deploy and your head and neck to snap forward.
This is an event that happens many times a day throughout the state of California. Car crashes range
from fender benders to T-bone accidents to even flipped vehicles. But even the most minor accident can leave you with more than just bumps and bruises. Here’s how car accidents affect your body, and what kind of injuries you need to look out for.
The Simple Physics of It All
The way your body is affected by a car crash comes down to one simple fact: Your body is soft, and cars are hard. Cars are designed to withstand impact. The metal bodies and crumple zones ensure it doesn’t simply come apart during a wreck. Your body, however, is made of soft flesh and breakable bones. In fact, you would have to become something of a monster in order to withstand the impact of a car crash.
Nearly half of all wrecks involve at least two cars. In one of the most severe kinds of crashes, a head-on collision, hitting a car traveling 40 miles per hour while you are also traveling 40 miles per hour is similar to hitting a wall at 80 miles per hour. Luckily, this is the least likely kind of accident. Rear end accidents and fender benders are the most likely, though often they are the least severe. Even in these accidents, your body takes a beating.
Going Down the Body
Let’s go down the length of the body and look at the impact on each section:
- The head: Due to the laws of inertia, your body will continue to move forward, even when the vehicle lurches to a stop. Your head will likely snap forward, and can hit the dashboard, steering wheel or airbag. When this happens, your brain can slam into the inside of your skull, and the bones in your face may get broken. The brain injury may lead to a concussion or even swelling and death.
- The neck: As your head snaps forward, your neck reacts to the motion. It could cause whiplash, leading to dizziness and sometimes chronic pain. If the impact is severe enough, your neck could end up being broken.
- The abdomen: Your internal organs will also be carried forward by inertia. Your lungs and heart may slam into your ribcage, causing internal bleeding and bruising. This is especially true if your heart moves too violently and tears the aorta. Your ribs and arms may end up bruised or broken as well.
- The lower body: Depending on the nature of the accident, your legs may be slammed into the dashboard or steering wheel. Passengers who put their feet on the dashboard could end up being crushed by an airbag, which deploys at 200 miles per hour.
Car accidents are always a serious incident, no matter how minor they may seem. If you’ve been involved in a car crash, contact our San Luis Obispo car accident lawyers today for a free consultation and to learn more about your legal options.
Can a Brain Injury Cause a Change in Personality?
- Posted by Taylor Ernst on
- October 29, 2015
After a loved one suffers a brain injury, it’s not uncommon for friends and family to notice what seems like a personality change. This change can range from a mild or occasional bursts of aggression to long term, serious mood changes. In some cases they come and go, leaving the brain injury patient feeling as if they have two different people inside of them—or as if they have no control over themselves.
This apparent change in personality is one of the most disconcerting and painful aspects of a brain injury. But in most cases it is not a true personality change. Instead it is the net effect of stress, confusion and brain damage, which comes across as sudden changes in behavior. The person living with the brain injury may feel as if they are still the same on the inside, but their behavior is different outside.
These types of changes happen for five reasons:
- Damage to key areas that regulate emotional function. Different brain injuries cause damage to different brain areas, and some specific areas control or contribute to emotional function. If the frontal or temporal lobes, amygdala, or hippocampus are damaged, it may cause emotional volatility, increased aggression, agitation, sudden verbal outbursts, verbal or physical attacks, and loss of impulse control. This is the cause of the most dramatic changes in personality, which may come and go without warning.
- Stress and physical pain. Everyone, with or without a brain injury, is more likely to get frustrated, agitated or aggressive when they experience stress or pain. And there are few things more stressful than the sense of loss and day to day impairment that comes with serious brain injuries. Additionally, stress itself is one of the triggers for the personality changes listed above.
- Loss of executive functions. Some brain injuries, especially those to the front of the brain, damage what are known as “executive functions”: a person’s ability to sort information, make decisions, make plans, and control themselves. This can leave people feeling like they have no control in their life, which can lead to anger. More dangerously, impairment of executive functions can lead a person to ignore safety rules, take reckless risks, or ignore social conventions—because they can no longer see the reason behind these rules.
- Memory loss and confusion. Many traumatic brain injuries are accompanied by some form of memory loss. While most retrograde amnesia goes away with time, brain injury patients may continue to have memory “blackouts” during stressful times. Many will also experience confusion on a day to day basis. Both of these lead to increased frustration.
- Depression, anxiety and new habits. Like anyone else living with a life-changing injury, brain injury patients are prone to depression or anxiety. Serious depression itself is a change in personality. To complicate matters, brain injury can contribute to addiction/substance abuse issues, as drugs or alcohol may seem like a way to temporarily relieve the pain. These substances themselves then further contribute to an apparent change in personality.
If you or a loved one are living with a brain injury, remember that you may be entitled to compensation. This compensation can help pay for treatments that help you minimize or manage effects on your personality. To find out if you have a case for compensation, call the Ernst Law Group and get a free consultation today.