Fighting the Insurance Company After a TBI

Why You Need a Personal Injury Lawyer to Help Fight the Insurance Company After a TBI

We don't often think about the brain and the hundreds of thousands, if not millions, of different ways we use it every day. But break down each part of your day into its component parts and you begin to see just how much your brain does for us.

Even making your morning coffee becomes a multi-faceted, complex operation your brain runs each and every day. Even more fundamental than that, your brain directs your body to do numerous things that we never even think about: it makes sure that you breathe, it tells your heart to beat, and it directs your body to digest the food that you eat.

So what happens when you or someone you love suffers a traumatic brain injury (TBI), affecting your brain's ability to function? The time after a brain injury is incredibly difficult, and you and your loved ones have your hands full. Brain injuries are serious injuries that require immediate medical attention to ensure that you fully recover. Of course, that leads to medical expenses.

Many of us purchase health insurance to protect us in just these situations when we're at our lowest, and we count on insurance companies to be there for us when we need them.

But what do you do when the insurance company leaves you holding the bill as you and your family navigate the aftermath of a brain injury? That is where an experienced personal injury lawyer comes in. A personal injury lawyer can help ensure you get the insurance coverage you deserve, indeed paid for, to protect you and your family.

Your first step to getting fair compensation when fighting the insurance company after a TBI is to contact an attorney. The traumatic brain injury lawyers at Munley Law have experience supporting TBI victims and would be happy to discuss your situation with you free of charge to give you personalized advice. You can reach us using the chat feature, filling out the form on this website, or by calling for a free consultation.

However, below we've tried to give some information that may help as you gear up for a fight with your insurance company.

What Is a Brain Injury?

First, it's important to understand what a brain injury is. Of course, any brain injury, indeed any head injury leading to brain damage, is traumatic for victims. But a head injury or a traumatic brain injury often has specific medical definitions.

At the core, a brain injury results from damage that causes the destruction or deterioration of brain cells.  There are two different types, traumatic brain injuries and acquired brain injuries.

• Traumatic brain injuries result from an external force that causes the brain to move inside or damage the skull.
• Acquired brain injuries occur at a cellular level and are most often associated with pressure on the brain, such as a tumor or stroke.

These injuries have numerous causes. You may automatically think of a car accident. And, most commonly, car, truck, motorcycle, or bicycle accidents are the culprit. Any accident that results in a collision can cause the head to move forward and backward at high speed. This thrusts the brain against the skull wall, resulting in a brain injury.

But a car accident is not the only cause of traumatic brain injury. Slip and falls, physical violence, and even certain sports can lead to brain injuries.

What Are the Symptoms of a Traumatic Brain Injury?

Common symptoms of brain injuries vary depending on the type and severity of the injury sustained, and sometimes do not appear immediately.

Mild injuries typically result in temporary side effects that include headaches, confusion, memory problems, and nausea. Symptoms of moderate injuries last longer and can be more pronounced. A TBI victim that suffers a severe brain injury can experience cognitive, behavioral, and physical disabilities.

Regardless of the degree, brain injury victims usually experience symptoms that fall into four main categories:  cognitive, perceptual, physical, and behavioral/emotional.

Common TBI symptoms of a brain injury include:

• Difficulty processing information
• Difficulty expressing thoughts
• Difficulty understanding others
• Shortened attention span
• Inability to understand abstract concepts
• Impaired decision-making ability
• Memory loss

Perceptual symptoms:

• Change in vision, hearing, or sense of touch
• Spatial disorientation
• Inability to appreciate time
• Disorders of smell and taste
• Balance issues
• Heightened sensitivity to pain

Some physical symptoms of traumatic brain injury include:

• Persistent headaches
• Extreme mental fatigue
• Extreme physical fatigue
• Seizures
• Sensitivity to light
• Sleep disorders, which can appear as either difficulty falling or staying asleep, or difficulty waking up.
• Sudden and unexplained slurred speech
• Loss of consciousness or fainting

Behavioral and emotional symptoms:

• Irritability and impatience
• Reduced tolerance for stress
• Sluggishness
• Flattened or heightened emotions and reactions
• Denial of disability
• Increased aggression
• personality changes

Will I Recover From a TBI? What Does That Process Look Like?

Unfortunately, the road to returning to your normal “life” following a traumatic brain injury is difficult to predict, and it might not be linear.

Most people who experience a concussion or mild traumatic brain injury regain all of their brain function within three months of the incident and will notice fewer episodes of memory loss along the way.

With a moderate traumatic brain injury, most people will eventually recover the majority of their brain function, and memory loss decreases over time. However, it's not unusual for someone with this level of injury to need imaging studies, and additional medical treatment in order to regain function, such as neurosurgery, occupational therapy, or physical therapy.

In the immediate aftermath of a moderate or severe injury, it's very possible that the injured party may, for some period of time, not show signs of awareness. Their eyes may remain closed as well. As the swelling and bleeding in the brain begin to ebb, they may slowly begin to show more signs of awareness, such as following commands and entering more normal sleep-wake cycles.

We explain all of this to make clear that, be it a mild traumatic brain injury or severe, the road to recovering from any head trauma is certainly long, and not without challenges. Accident victims must dedicate themselves fully to completing it in order to regain “normal” function in the brain.

This means medical costs. But it is important that you keep your appointments with the doctor, attend all therapy sessions, both cognitive and physical, and follow the course of treatment prescribed by your doctor. For that reason, it's important that your insurance company pays you what they must under your policy, so you and your loved ones can focus on recovery.

If they aren't, you should get a lawyer involved immediately.

My Insurance Company Won't Pay, What Can I Do?

When you purchase insurance, you are covered by an insurance policy issued by your insurance company. This policy is a contract, and it obligates the insurance company to pay for certain listed expenses.

When you purchase health insurance, this typically means your insurance company will cover your medical bills.

While we'd like to think that we could work with our insurance companies without involving lawyers, insurance disputes are more common than you might think. When your insurance company fails to properly pay a claim covered by your policy, or meet its duty to you as its policyholder, there are several ways you can proceed, and an experienced attorney can help.

Do I Have To Sue?

The short answer may surprise you: we hope not!

Insurance companies make mistakes, and sometimes experienced attorneys can convince an insurance company to change its mind by writing something called a demand letter. At Munley Law, we are well-versed in the technical language of insurance policies, and can use that familiarity to your advantage.

Because our lawyers are familiar with the industry and “speak the insurance company's language,” we can sometimes obtain better, faster results than you might get negotiating with the insurance company alone.

If we can get you the results you need by writing a letter or negotiating with your insurance company without going to court, that's usually what we want to do! We have no interest in dragging a dispute out.

But sometimes, no matter how skilled or persuasive your lawyer is, insurance companies won't budge. It is in those cases that you must hire a brain injury lawyer that is prepared to take your insurance company to court.

Insurance Litigation

There are several types of claims against your insurance company.

First, as we said, when you pay for insurance, you are entering a contract with your insurance company. That contract obligates the insurance company to pay claims as long as they are covered by the terms of the contract. When the insurance company fails to follow the contract, you can sue.

Additionally, the law usually recognizes a separate cause of action when your insurance company acts in “bad faith.” When your insurance company refuses to honor a valid claim, they are committing a legal wrong. An experienced bad faith insurance attorney, like those at Munley Law, can help you decide if you have a breach of contract claim, a bad faith claim, or both.

Regardless of the type of claim, bad faith claims lawyers can help you collect the compensation you and your family deserve.

What Is a Bad Faith Claim?

“Bad faith” has a specific meaning in insurance law. In Pennsylvania, a bad faith action by an insurance company means “any frivolous or unfounded refusal to pay proceeds of a policy . . .[which suggests] a dishonest purpose and means a breach of a known duty (i.e., good faith and fair dealing), through some motive of self-interest or ill will.” Clunie-Haskins v. State Farm Fire & Cas. Co., 855 F. Supp. 2d 380, 388 (E.D. Pa. 2012).

Bad faith can look many different ways, but put simply, this means that you may have a bad faith claim when your insurance company fails to pay you what you are owed under your policy, not because of a mistake or a miscalculation, but because they were acting in their own self-interest or actively wanted to avoid paying your claim.

This is different from a legitimate denial; an insurance company does not act in bad faith by acting negligently or by exercising bad judgment (though you may still have a cause of action if that bad judgment resulted in a breach of your insurance contract).

What Can I Recover?

In a lawsuit against their insurance companies, TBI victims may be eligible for several different types of compensation, depending on your claim.

If your insurance company denies your traumatic brain injury claim Munley Law can help you receive the compensation you deserve, which may include:

• The original claim under your policy. This usually means medical care you've already undergone, and sometimes future medical expenses.
• Interest on the claim
• Punitive damages in cases where the bad faith act was especially egregious
• Court costs and legal fees

How Long Will A Brain Injury Case Take?

The timeline for every brain injury insurance dispute is different. In some cases, your brain injury lawyer may be able to obtain a fair settlement from your insurance company by issuing a demand letter.

This is a formal letter drafted by your attorney to challenge the insurance company's decision. If your insurance company responds in good faith, they may reverse their previous decision and pay what you're due quickly. These cases can be resolved in just a few weeks to a few months.

However, if the company refuses to pay a TBI victim what they are due after a demand letter, the case may go to court. While our lawyers are ready to fight for you, formal proceedings in court involve a lengthy process that can take months, or even several years, depending on the complexity of the case.

Our lawyers will never let the insurance company drag their feet, but the process of building and litigating an effective bad faith insurance claim takes time.

What If My Insurance Company Offers Me Some Money, But It's Less Than What I Think I'm Owed?

You should always check with an attorney before accepting any deal proposed by, or even speaking with, your insurance company following brain injury. While sometimes insurance companies are willing to pay the money owed to you under your policy, if they agree to pay only after you catch the company acting in bad faith, you may be foregoing your ability to recover more.

Furthermore, sometimes by signing a deal before getting an attorney involved, you accidentally sign away rights you might otherwise have. For example, a claim against a third party.

While we hope the insurance company is just recognizing that it owes you money, it is still best to check with an attorney to make sure accepting a deal, or signing a document, is in your best interest

The Experienced Traumatic Brain Injury Lawyers at Munley Law Can Help

The lawyers are Munley Law represent those whose insurance companies failed to provide the coverage specified in their insurance policies in brain injury cases. If you believe your insurance company has failed to give you fair compensation under your insurance policy, our lawyers may be able to help.

Call or use our online form to speak to our experienced staff right now. Speaking to Munley Law is completely free, and you won't pay anything out of pocket. We don't get paid unless we win, and we get paid out of the money we win for you, never out of your pocket.