On Demand

Proving the TBI Claim: An ERISA Long Term Disability Insurance Perspective (Audio Only)


Created on March 16, 2020




From professional and student-athletes to war veterans, the devastating impact of Traumatic Brain Injury ("TBI")  has been increasingly in the news. Rightly so, as the CDC advises that between 2006 and 2014 "the number of TBI-related emergency department visits, hospitalizations, and deaths increased by 53%."  The most severe traumatic brain injuries can disable people from walking, talking, caring for themselves, and functioning in the most basic activities of daily life, but even a mild traumatic brain injury can lead to permanent disability. Mild TBI can lead to long-standing or permanent impairments in areas such as cognitive function, emotional control, vision, vestibular regulation, and a host of other neurologic and pain-related symptoms. The task for the practitioner is to listen to the client carefully, understand the nature of TBI's, and know where to turn to document the client's symptoms and impairments.

In this program, the plaintiff's side insurance attorney Sara Kaplan-Khodorovsky gives a crash course on how to prove the traumatic brain injury disability insurance case. While this course will focus on Long Term Disability insurance claims, the skills and methods discussed will be useful to attorneys facing matters in personal injury litigation, guardianship proceedings, and the education law IEP (Individualized Education Program) contexts. Attorneys in these areas all face what LTD claimants frequently hear from insurance carriers: that a brain injury is only "mild," that the claimant "should have recovered by now," or that he or she "looks just fine."  After discussing the basics of the LTD insurance case, this program will discuss the relevant evidence needed to prove the extent of the TBI, how to overcome insurance company tactics such as the common "malingering," allegation, and what facts to emphasize to the insurance carrier, and ultimately the Court, to give a TBI LTD client the best chance of success.

Learning Objectives:

 I  Briefly review the basics of Long Term Disability claims to provide a framework for the rest of the course

II. Grasp the causes and categories of brain injuries, with an emphasis on Mild Traumatic Brain Injuries, and how each present

III. Identify the key insurance policy provisions and legal issues inherent in Long Term Disability claims and how they pertain to Traumatic Brain Injury cases

IV. Discuss the evidence that can be used to support a brain injury case (such as triage assessments, neuropsychological testing, and MRI) and how to use that evidence in the Long Term Disability context

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