Long Term Disability and Post-Concussion Syndrome

If you’re experiencing post-concussion syndrome after a traumatic brain injury, you’re in no way isolated, and you may be eligible for long term disability benefits in Canada.

Prolonged, disabling symptoms linger in a significant number of individuals well beyond the original trauma, rendering it difficult or impossible to perform their job assignments or participate in activities of daily living.

At Grillo Law, our experienced disability lawyers understand the destructive and misguided nature of this condition. If you’ve been injured in a car accident, bike accident, workplace accident, or through athletic contact, our clients are advised by us through the complicated realm of concussion disability benefits.

What Is Post-Concussion Syndrome?

Post-concussion syndrome (PCS) is a neurologic disorder in which concussion symptoms persist many weeks after the typical healing period, much more than many weeks since the traumatic brain injury.

In severe cases, symptoms persist for months or even years, resulting in post concussion syndrome permanent disability.

Some recover quite well following a mild head injury, while others experience long-lasting impairments that affect their memory, concentration, mood, and energy.

PCS is often misunderstood by insurance companies, and claims of disability benefits are unfairly denied despite no visible damage on medical tests.

• Motor vehicle accidents (trauma to pedestrians or bicyclists)
• Falling or blunt trauma
• Contact sports trauma (football, hockey, etc.)
• Assaults or combat wounds
• Work-related accidents (trips, slips, equipment injuries)

In some cases, these injuries also lead to secondary diagnoses, such as post traumatic stress disorder (PTSD) or depression, that will further complicate your disability claim.

Diagnosing Post-Concussive Syndrome

Diagnosis of PCS is typically challenging as all but a few of the symptoms are subjective and won’t show up on standard imaging tests like CT scans or MRIs.

However, doctors and specialists can confirm your status using a mix of:

• Thorough symptom tracking
• Neuropsychological assessment
• Review of medical history
• Functional assessment of mental, emotional, and physical impairment

Symptoms of PCS that are qualified for long term disability include:

• Headaches
• Fatigue and lack of energy
• Dizziness or loss of balance
• Memory loss or lack of concentration
• Irritability, depression, or mood changes
• Increased sensitivity to light or noise
• Difficulty sleeping
• Anxiety or symptoms of post-traumatic stress disorder

Should these symptoms hinder your ability to work, especially in physically or mentally demanding occupations, you may be eligible for LTD benefits or EI sickness benefits through Service Canada programs or private disability insurers.

In certain situations, you may also be eligible for the Disability Tax Credit or Canada Pension Plan Disability (CPP-D).

Evaluation of Disability for Claimants with Post-Concussive Syndrome

In order to prevail on an LTD claim for post-concussive syndrome (PCS), you must demonstrate that your symptoms are of a serious, ongoing nature and seriously impair your ability to work. Insurers generally require medical evidence of both diagnosis and functional impairment.

Assessments may include:

• Clinical diagnosis by a neurologist, concussion specialist, or neuropsychologist.
• Written documentation of cognitive impairments, e.g., memory loss or lack of ability to focus.
• Evidence of emotional or psychological symptoms, e.g., anxiety, depression, short temper.
• Functional Capacity Evaluations (FCE) or neuropsychological examination revealing work-related limitations.

Many claimants also struggle with “invisible” disability, i.e., symptoms that don’t reveal themselves on standard tests but still contribute to real suffering. These sorts of cases may be more difficult to prove, which is why excellent legal and medical documentation are crucial.

Is Post Concussion Syndrome a Disability?

Yes, post-concussion syndrome (PCS) is indeed a disability, particularly if symptoms are ongoing, are severe, and interfere with someone’s ability to work or do everyday activities. Although some individuals fully recover from a concussion within weeks, others endure prolonged symptoms such as headaches, fatigue, memory issues, dizziness, difficulty with concentration, and mood changes.

These persistent symptoms can last for months or years after the original trauma and are most often present in conjunction with traumatic brain injury.

In Canada, individuals suffering from post-concussion syndrome and long term disability may be eligible for disability benefits under private long term disability insurance, EI sickness benefits, or the Canada Pension Plan Disability (CPP-D). Disability insurers will closely scrutinize concussion disability claims, however, especially when there is no objective medical evidence.

It is thus extremely important to keep detailed medical records for your diagnosis, symptoms, and the effect of your condition on your ability to carry out job functions.

If your PCS symptoms persist and affect your health or functioning at work, it is essential to seek out financial benefits through all available means. Consulting with experienced disability attorneys can educate you regarding your rights and increase your chances of an LTD award.

Making an LTD Claim for Post-Concussive Syndrome

It takes thorough documentation and careful strategy to file a long term disability claim for post-concussion syndrome. Unlike obvious physical trauma, PCS consists of subjective complaints, including mental confusion, fatigue, and emotional upset, which are actually more difficult to document. The insurance company can dispute your claim, citing that there is no objective medical evidence or that your symptoms are not disabling.

It is necessary to:

• Get extensive medical records from your treating professionals like neurologists, psychologists, and occupational therapists.
• Detailed record your symptoms thoroughly such as how often and to what degree they limit your daily activities.
• Provide supporting documentation in the form of CT scans, neuropsychological tests, or independent medical exams if available.
• Get statements from your employer regarding changes in your work or your absence from work due to your condition.

Why Are LTD Claims Denied?

Insurers deny PCS-related disability claims because:

• Claimant appears “functional” despite symptoms.
• No objective test (i.e., MRI) confirms a brain injury.
• The insurer presumes the condition would have resolved in a few weeks.
• Incomplete or contradictory medical records.
• No confirmation of how symptoms impact work duties.

Insurance companies generally claim that PCS is “subjective” and lacks clinical evidence, but the condition is thoroughly documented in medical literature. If your claim is denied, you may have the decision reviewed or sue for wrongful denial of benefits.

How to Increase Your Chance of Being Approved for Benefits

If you’ve been diagnosed with post concussion syndrome (PCS) and are applying for long term disability (LTD) benefits, it’s important to understand that success often depends on more than just having a diagnosis.

Many claimants with PCS struggle to get their benefits approved because their symptoms are “invisible,” fluctuate over time, and can be difficult to measure objectively.

This makes strong evidence and legal guidance essential.

To assist in raising your chances of being approved for disability benefits, remember the following:

1. Obtain Consistent Medical Records

The severity of your symptoms must be well and consistently reflected in your medical reports. Reports must describe how PCS affects your work performance or participation in daily activities.

Ensure that all of the symptoms pertinent to your case, like memory loss, fatigue, migraines, dizziness, light sensitivity, anxiety, and cognitive impairment, are duly documented by licensed experts, such as neurologists, psychologists, and occupational therapists.

2. Be Assessed by Specialists

Seeing a neurologist or neuropsychologist can reinforce your claim. A neuropsychological evaluation offers objective, performance-based testing that records how PCS compromises your cognitive functioning, something insurance companies consider seriously when they review LTD claims.

3. Ensure Treatment Compliance

Adhering to prescribed treatments, such as physiotherapy, cognitive behavioural therapy, or vestibular rehab, is critical. Gaps in treatment or inconsistent attendance can be used against you, with insurers suggesting your condition is not severe or that you’ve recovered.

4. Keep a Symptom Journal

Maintaining a daily diary of symptoms and how they impact your life can provide valuable information that complements your medical records.

This may be concentration problems, inability to tolerate screen time, headaches brought on by noise or light, or fatigue after minimal amounts of activity.

5. Avoid Inconsistencies

Be cautious with social media and public appearances. Posts or images showing high-functioning activity can be taken out of context and used by insurers to argue that you’re capable of working.

6. Get Legal Support Early

Getting a long term disability lawyer involved early can help you steer clear of problems and in strengthening your record. A lawyer can also represent you in communications with your insurance carrier, ensuring that your claim is legally and medically appropriately presented under PCS legal and medical criteria.

Speak to Our Disability Lawyer About Your Claim

Post concussion syndrome can be disabling to deal with, especially if you’re having trouble getting the disability benefits you need to recover.

If symptoms are preventing you from returning to work, or your long term disability claim has been denied or delayed, legal representation can make a tremendous difference.

At Grillo Law, we’ve dedicated decades to helping clients with complex injuries and invisible conditions, like PCS, receive the benefits they’re entitled to.

We understand the challenges brain injury survivors face, and we’ll ensure your voice is heard.

We can assist with:

• Preparation and filing of a strong LTD application
• Collecting strong medical evidence and expert reports
• Deciphering and addressing insurance company tactic
• Representing you at appeals and independent medical examinations (IMEs)
• Suing where insurers are acting in bad faith or delaying your claim

If your LTD benefits were denied, terminated early, or you’re simply getting frustrated with the claims process, we’re here to help. We’re understanding, client centered, and we take cases on a contingency fee basis, so you don’t pay unless we win.

Schedule a free consultation today with a seasoned long term disability lawyer at Grillo Law.