Fighting the Insurance Company After a TBI

Fighting the Insurance Company After a TBI

Severe traumatic brain injuries are life-altering. The financial and emotional expenses resulting from a traumatic brain injury can be astronomical, requiring legal help to obtain fair compensation.

Traumatic brain injuries (TBI) occur after a forceful blow to the head, penetration of the skull, or forces of motion causing the brain to move within the skull. TBIs can cause uncomfortable symptoms, complications, and permanent changes within the brain.

Some patients who suffer a traumatic brain injury will experience a full and quick recovery. Others may take several months or years to recover, and some may never fully recover. 

Suppose you or someone you love is suffering from a TBI because of another person's actions. In that case, hire an experienced TBI attorney. You need legal representation if a full medical recovery will take a long time or will not happen.

Without a seasoned Philadelphia brain injury lawyer, you might never receive the compensation your injuries require.

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What Causes Traumatic Brain Injuries?

Fighting the Insurance Company After a TBI

A traumatic brain injury happens when the brain moves within the skull or an outside force penetrates the skull and causes an altered mental state or physical disabilities.

Examples of outside forces:

  • An impact such as falling and hitting your head
  • Penetration caused by gunshot wounds, knives, or other objects
  • The rapid movement caused when a vehicle suddenly comes to a stop or hits a large object

Accidents That Can Cause Traumatic Brain Injuries

Traumatic brain injuries result from a blow or other severe head injury.

Sometimes, they happen because another party didn't uphold their duty to keep you safe. If another party is liable, the injured party can file an insurance claim with or without a personal injury attorney's assistance.


Falls are the most frequent cause of traumatic brain injuries. Workers can fall from a ladder or scaffolding on the job. Shoppers can slip and fall at the grocery store or the mall. Renters can fall at home on flooring or stairs in need of repair.

Motor Vehicle Accidents

Another frequent cause of traumatic brain injury is motor vehicle accidents. Bicyclists, pedestrians, and motorcyclists are at a higher risk due to the lack of protective gear than those riding inside a vehicle.


Shaken baby syndrome causes traumatic brain injuries in infants. The extreme force of shaking on an underdeveloped brain causes brain damage quickly.

Other types of violence that can lead to a traumatic brain injury:

  • Gunshot wounds
  • Domestic violence
  • Child abuse

Traumatic brain injury patients whose injuries arose from acts of violence have the right to pursue criminal and civil cases against the offender.

Sport Accidents

Accidents during sports or recreational activities can cause a traumatic brain injury, especially in children. High-impact sports like football, baseball, hockey, and skateboarding are frequent causes of brain injuries.

Sometimes faulty equipment, sports fields or courts, facilities, or even people are responsible in the event of a sports-related TBI.

Defective Products

Products such as toys, machinery, and even cars and their parts are sometimes defective. If a defective product causes a traumatic brain injury, the manufacturers, distributors, suppliers, and retailers might be responsible.

Long-Term Outcomes

The long-term outcomes of a brain injury can be difficult for doctors to predict. Some patients should make a full recovery but do not. Conversely, other patients make an unexpected significant recovery.

There are many potential adverse long-term effects. Traumatic brain injuries can result in long-term mental and behavioral problems.

Evidence shows that severe TBIs and repeat TBIs can cause an increased risk of progressive brain diseases such as Alzheimer's disease, chronic traumatic encephalopathy, and Parkinson's disease.

Compensation for Traumatic Brain Injuries

Traumatic brain injuries are one of the most severe life-changing injuries a person can sustain. Many injured victims and their families file civil lawsuits seeking compensation for traumatic brain injury damages.

You or your loved one might have a claim worth pursuing if you or your attorney can prove:

  • Another party had a duty to you, such as to repair broken flooring, provide safety equipment at work, not abuse you, stop their vehicle at a red light, provide safe sports gear, or maintain the playing field.
  • That party did not uphold its duty to you
  • Their failure to do so led to your injuries
  • Your injuries led to your damages


Damages represent the losses or inconveniences an injured party suffers because of their injury. The type and amounts of the individual's damages will determine how much compensation they should receive.

There are damages with a predetermined value, such as:

  • Medical bills
  • Long-term care and rehabilitation bills
  • Life care costs
  • Medical devices
  • Medication
  • Lost wages
  • Property damage (for instance, in a car or slip and fall accident)

Medical bills, receipts, and income information will be necessary to prove these damages.

Subjective damages that lack a predetermined value include:

You need a lawyer who knows how to prove damages.

Sometimes, the injured party's attorney will call witnesses who can provide testimony. The attorneys for both the injured party and the liable party will interview them about the injured party's life before the injury and what it is like now.

Those with a traumatic brain injury can also keep a daily journal of how it affects them. Injured individuals should write about their physical pain, how they feel emotionally, and events and activities they are missing out on. The journal can serve as evidence.

What Is Your Case Worth?

To determine your financial damages, add up your medical bills, lost income, and any other expenses related to your injuries. Generally, attorneys advise their personal injury clients that their pain and suffering is worth one to two times their financial damages.

Additional factors that affect what your injury claim is worth:

  • The facts of a case
  • The extent of the traumatic brain injury
  • If a secondary injury occurred
  • The degree of hospitalization and medical treatment

Since a traumatic brain injury can be a long-term or permanent disability, those suffering from one deserve more compensation.

Traumatic Brain Injuries: High-Value Claims

A person with a traumatic brain injury may not enjoy family and friends, attend events, or participate in activities that once brought them enjoyment.

Personal injury cases involving long-term disabilities and ongoing medical care must address some unique factors to determine compensation.

  • Type of disability: Will you need continuing medical care and equipment? Will you require help with mobility and daily living activities, such as brushing teeth or combing hair? Lifetime daily assistance for individuals with a traumatic brain injury can quickly add up to millions of dollars.
  • Future lost income: Typically, lawyers hire expert accountants to analyze the potential income the injured individual should have earned during their lifetime if they did not have a head injury. The accountant considers the individual's skills and education, how many more years of employment the individual might have had, projected income increases, and the rate expected of inflation.
  • Evident disfigurement: Compensation for emotional distress increases when permanent and noticeable scarring or disfigurement occurs.
  • Age of the victim: Younger traumatic brain injury victims usually receive more compensation as their permanent losses will affect more of their lives. Whereas with an older individual, the injury may not affect as much of their life.
  • Pain and suffering: Those with permanent injuries due to others' negligence are entitled to much higher compensation for pain, suffering, and emotional distress than the typical injury claimant. Additionally, those who endure multiple painful medical procedures or witness others die in an accident should receive more compensation.

Fighting the Insurance Company After a TBI

Typically, TBI injury claims require extensive medical care and rehabilitation, making claims worth even more than other personal injuries.

Even though the insurance company should protect your interests and pay you fairly for your claim, they will always prioritize their bottom line first. If they can get away with paying you less than what your claim is worth, they certainly will. As such, they often devalue or even deny claims.

Insurance companies may deny or devalue traumatic brain injury (TBI) claims. A lawyer can take appropriate steps to protect your rights and seek fair compensation.

Here are some common tactics your lawyer can overcome:

  • Minimizing the Severity of the Injury: Insurance adjusters may downplay the severity of the TBI to reduce the amount they have to pay out.
  • Disputing the Cause of the Injury: The insurance company might argue that the TBI was not a direct result from the accident or incident but was a pre-existing condition or resulted from another cause.
  • Questioning Medical Treatment: Insurers may question or challenge the necessity and extent of medical treatment, including diagnostic tests, therapy, or rehabilitation.
  • Using Pre-Existing Conditions as a Defense: If you have a history of head injuries or medical conditions related to the brain, the insurance company may misattribute your current TBI to these pre-existing conditions.
  • Requesting Unnecessary Documentation: Insurers may request extensive documentation or medical records to delay the claims process or create additional hurdles for you.
  • Offering Lowball Settlements: Insurance adjusters may present initial settlement offers that are far below the actual value of your claim, hoping that you'll accept a lower amount.
  • Seeking Independent Medical Examinations (IMEs): The insurance company may request that you undergo an IME by a doctor of their choosing. These exams may be used to dispute or downplay the severity of your TBI.
  • Using Surveillance or Social Media Monitoring: Insurers may conduct surveillance or monitor your social media activity to look for evidence that contradicts your injury claims.
  • Delaying the Claims Process: Insurance companies may intentionally prolong the claims process, hoping you'll become frustrated or desperate and accept a lower settlement.
  • Pressuring for a Quick Settlement: The insurer may try to rush you into accepting a settlement before you have a complete understanding of the extent of your injuries and the long-term impact on your life.
  • Downplaying Cognitive or Emotional Effects: A TBI can have significant cognitive and emotional effects. The insurer might minimize or dismiss these aspects of your injury.

Insurance companies are profit-driven businesses that want to minimize payouts. If you're dealing with a TBI claim, consult an experienced TBI attorney who handles such cases. They can navigate the claims process, protect your rights, and advocate for fair compensation.

Traumatic brain injuries are medically and legally complicated. Brain injuries need immediate medical attention, expert medical care, and legal skills and knowledge.

An attorney will handle numerous legal matters surrounding your injury, including:

  • Preserving evidence
  • Protecting your legal claim
  • Insurance issues
  • Filing Your TBI claim
  • Obtaining financial compensation for an injury

The representation of an attorney can significantly boost your claim's value.

If you or a loved one have a traumatic brain injury that another party caused, speak to a lawyer as soon as you can. You need to know that you are fairly compensated for such a severe injury, especially if you or your loved one will endure long-term effects.

The lifetime financial burden for one person surviving a severe TBI can be around $4 million. The good news is that meeting with a lawyer to discuss your case doesn't cost a dime. Most personal injury attorneys work on a contingency fee basis. You do not owe them anything until they secure compensation on your behalf. 

What if the Insurance Company Accepts Responsibility?

Even if the insurance company for the party who caused the injury offers to accept full responsibility for your injuries, contact an attorney. You will not know if you are receiving fair compensation for your claim if you don't.

Gabriel Levin Author Image

Gabriel Levin - Attorney

Gabriel Levin is a highly experienced and credible attorney with over 10 years of practice in Pennsylvania. Known for his tenacity, he has represented clients in a wide range of civil matters, trying hundreds of cases. He prepares each case as if it will go to trial, ensuring meticulous attention to detail.

Unlike many firms that delegate tasks, Levin personally handles every aspect of a case and maintains open communication with clients throughout. He has secured millions in compensation, making him a reliable choice for those seeking legal representation.

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