What Happens When a Work Injury Causes Traumatic Brain Injury?
A Traumatic Brain Injury, as a result of your work, can be a scary situation to navigate, but your first step should be medical care. From there, your options depend on a number of factors that are discussed in this article.
Traumatic Brain Injury or TBI is when an injury affects the brain’s function.[1]
TBIs are being diagnosed more and more because medical professionals are recognizing the symptoms. The research on how to treat TBIs is relatively new compared to other fields of medicine. It is also dealing with the brain, which continues to be uncharted territory in many ways. Dealing with a TBI when it was caused by a work injury can have an added layer of frustration.
The Many Symptoms of Traumatic Brain Injury
There is a large range of severity with TBI. Milder TBI can also be diagnosed as a concussion. Any trauma to the head can cause mild TBI. The symptoms of this type of injury could be related to learning, memory, problem solving, and concentration.[2]
The more severe a TBI is, the more severe the symptoms. More severe TBIs can be the result of a more significant impact to the head. This could be from a hard fall, object hitting the head, or a motor vehicle accident. Severe TBI has been shown to cause lifelong negative effects that disrupt almost every part of a person’s life.[3] TBI can increase the likelihood of seizures, accidental drug poisoning, infections, and pneumonia. Data also suggests that there’s only a 26% chance of symptom improvement.[4]
Some studies examine the correlation between sleep quality, disorders, and TBI.[5] The study published in Sleep found that sleep is linked with neurodegeneration and certain executive functions in people with just mild TBI. Interestingly enough, the study pointed to the possibility that TBI symptoms may improve by also enhancing a person’s sleep.
TBI has been known to cause symptoms that include cognitive deficits, behavioral and emotional problems, motor skill concerns, sensory issues, and somatic symptoms. Because the brain controls every aspect of our functionality, an injury to it can affect every aspect of our functionality. Which is how a TBI can cause one person to have light sensitivity frustrations; another, memory issues; and someone else, problems walking.[6]
Getting a TBI on the Job
A TBI, as a result of your job or work, working is something that must be navigated strategically. In Florida, there are certain benefits your employer and workers’ compensation insurance carrier are obligated to provide. The two categories of those benefits are medical and indemnity or lost wages. There are no additional categories based on the severity or type of injury; therefore, it is important to know every option and to account for medical recovery and long-term financial concerns.
TBI Medical Benefits
The medical benefits of a workers’ compensation case can be as broad as they need to be when an injured worker has a TBI. Unfortunately, the system does not always prioritize brain injuries. The Florida Statutes require employers and carriers to authorize all medically necessary treatment for work injuries with exceptions.[7] What that means, in reality, is that when an injury is first reported, the carrier realizes they must authorize medical care. If an emergency room or hospital isn’t required, they have the choice to pick what doctor is first authorized to treat the injured worker.
Typically, when an insurance carrier is notified of an injury and they don’t have hospital or emergency room records, they send them to urgent care or a walk-in clinic. Despite the common-sense outlook that certain injuries should skip urgent care and go straight to a specialist, insurance carriers almost always start with urgent care.
Urgent care clinics are not trained or equipped to give full diagnoses or treatment plans for severe injuries. This is frustrating when an injured worker has an orthopedic injury, but can be even more so with a TBI. A TBI can be more frustrating because often there is no visible sign of injury. Just because the head wasn’t cut open, doesn’t mean a severe injury has not occurred. In fact, a closed head injury is a far more common occurrence than an open wound with TBI.[8]
Since the insurance carrier is going to authorize the urgent care first, the best thing to do is get the urgent care to refer the injured worker to a specialist as quickly as possible. This is typically done by giving that urgent care doctor every reason to make that referral. Providing a full set of symptoms and a detailed description of problems will make that more likely.
For instance, telling the urgent care doctor that you got “bumped” in the head and it “hurts” is less likely to lead to a referral than saying something along the lines of the following: “My head was hit really hard and since then I have had a headache that is an 8/10 on the pain scale. I am nauseous. My vision has been blurry, and bright lights are bothering me.”
The urgent care physicians hear the first version of symptoms all the time and it doesn’t give them a sense of urgency. The second version lets them know a problem exists, that it is serious and needs to be addressed.
If the injured worker is recognized to have had a TBI, there are tests that should take place to assess the extent of the damage. The initial test is often the Glasgow Coma Scale.[9] Additionally, there are two types of imaging tests that can help assess the injury. The first is a Computerized tomography scan or CT scan, and the other is Magnetic resonance imaging or MRI. [10] These can get an internal view of what is happening to the brain with much more value than an X-ray.
The treatment for a TBI can range from surgeries to medications to physical therapy. Here are some examples:
Surgery:
- If the TBI is caused by a large hematoma or contusion that is putting pressure on the brain, a part of the skull can be removed. Brain surgery can be performed, and the patient is observed for recovery.
Medications[11]:
- TBI Medications have the goal of reducing immediate damage to the brain or the effects of the chronic symptoms.
- When stopping the immediate damage, the types of medications that are considered could be diuretics, magnesium, anticonvulsants, or sedatives.
- Long-term treatment medications could include antidepressants, muscle relaxers, pain relievers, and stimulants.
Therapy[12]:
- There are a broad range of therapies that might be appropriate for someone suffering from a TBI. Those therapies need to be tailored to what symptoms are presenting. This could be physical therapy, physical medicine, occupational therapy, psychiatric care, psychological care, speech and language therapy, or social support therapy.
- The range of symptoms means all types of therapies need to be considered.
Doing research on what types of treatments are available for TBI is important. Your knowledge can help when you speak with a physician who may not be well versed in treating the condition. Unfortunately, this happens more often with workplace injuries because the injured person does not have control over the medical treatment. Medical treatment is controlled by the employer and the insurance carrier. That doesn’t mean that as an injured worker, you can’t go into the doctor’s office and ask questions about what types of treatment you think will improve your condition. As long as it’s done in a respectful way, most physicians will not be offended by the discussion of solutions.
TBI Indemnity Benefits
TBI Indemnity Benefits are governed by the Florida Statutes. [13] However, TBI indemnity benefits commonly risk being cut off too early.
The law states that an injured worker is entitled to temporary lost wages when they are being treated by an authorized physician, have not reached maximum medical improvement, have work restrictions, and cannot be accommodated in the workplace. For a TBI, work restrictions go beyond the typical physical ability to move an object.
Sometimes, the physician treating the TBI doesn’t realize the effect the symptoms have on a person’s ability to complete tasks at work. If the TBI is causing symptoms such as migraines, sensitivity to light, or dizziness, then these might not technically restrict their ability to lift and move objects. Work restrictions allow the injured worker to heal without triggering symptoms by putting them back to work too soon.
Another consideration with a TBI is whether the injured worker will be able to return to their same line of work. The injury might prevent the type of work that was being done and so the injured worker needs to consider what other possibilities there are. There is a section of the statute that gives options for injured workers to consider being re-educated or re-trained.[14] These benefits are not automatic in the workers’ compensation system, but they can be very useful when the injury is career-altering.
When an injured worker reaches maximum medical improvement, they are typically assigned an impairment rating, which translates to workers' compensation impairment benefits checks. The rating tells the insurance company the number of weeks are required for checks. What is important, is to make sure the physician providing the rating is aware of all the issues that can be considered before issuing the final impairment. Things like an altered gait, or changes to sleep, along with other neurological issues can make a big difference in the rating. The increase in the rating can mean thousands of dollars of difference getting paid to the injured worker. The key is to understand the rating guide: the 1996 Florida Uniform Permanent Impairment Rating Schedule.[15]
It also must be considered a possibility that the injury will prevent the injured worker from returning to any type of employment. If that is the case, then the only option is for the injured worker is to seek Permanent Total Disability Benefits. These benefits in detail require a separate article, but the basics are that, if they qualify, an injured worker will get paid every two weeks until they turn 75 years old. It is a long-term financial solution for someone who suffers a severe injury at work with a TBI.
At Carrillo Injury Law firm, we understand the ins and outs of the complicated legal system that provides care for injured workers, and we can help you determine your next steps. If you believe you’ve suffered a traumatic brain injury, reach out to us today at office@carrilloinjurylaw.com.
[1] https://www.cdc.gov/traumaticbraininjury/index.html
[2] https://www.cdc.gov/traumaticbraininjury/concussion/index.html
[5] https://academic.oup.com/sleep/article/44/6/zsaa272/6024975
[6] https://tracktbi.ucsf.edu/patients
[8] https://www.ncbi.nlm.nih.gov/books/NBK557861/
[11] https://www.medicinenet.com/types_of_traumatic_brain_injury_tbi_medications/article.htm
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