Traumatic brain injury
The defining problem in a brain injury claim is that the most common test comes back normal. A CT scan in the emergency department is looking for bleeding that needs surgery tonight. It is not designed to find the injury most people actually have.
What the scans do and do not show
A head CT rules out the emergencies — subdural and epidural hematoma, skull fracture, mass effect. It is excellent at that, and it is the right first test.
What it does not show is diffuse axonal injury: microscopic shearing of nerve fibers caused by the brain rotating inside the skull. That is the mechanism behind most mild and moderate TBI, and it is largely invisible to conventional imaging.
Where the diagnosis matters, specialist imaging may add something — diffusion tensor imaging, susceptibility-weighted sequences, or functional studies. Their admissibility and weight vary and they are not a magic answer, but the correct starting point is a proper neurological and neuropsychological assessment rather than a scan.
How a brain injury is actually documented
- Neuropsychological testing. A battery of standardised tests measuring memory, processing speed, attention, executive function and language against normative data. This is the backbone of a TBI claim: objective, quantified, and difficult to dismiss.
- The contemporaneous record. What the paramedics and emergency staff noted — loss of consciousness, confusion, amnesia for the event, Glasgow Coma Scale. Brief entries written before anyone was thinking about a claim carry weight.
- Before-and-after witnesses. A spouse, a colleague, a manager describing the specific change: the person who now cannot follow a recipe, loses their temper, needs the television subtitled, cannot work a full day. Concrete examples, not adjectives.
- Work and academic records showing performance before and after. Objective and often devastating.
- A symptom diary kept contemporaneously, because by the time anyone asks, two years of gradual adaptation have blurred the memory of how bad it was.
What the insurer will argue
- Nothing on the scan. Addressed above.
- The symptoms are from something else — depression, pain, poor sleep, medication, stress. Often there is genuine overlap, which is why formal testing matters.
- Malingering or exaggeration. Neuropsychological batteries include validity and effort measures specifically designed to detect this. A clean set of validity indices is powerful evidence of the opposite.
- There was no loss of consciousness. Loss of consciousness has never been required for a concussion diagnosis. Most concussions involve none.
- The impact was too minor. Brain injury correlates with head acceleration and rotation, not with how the bumper looks.
What it means for the claim
A moderate or severe TBI is a catastrophic injury claim and needs a life care plan and a vocational assessment rather than a tally of bills.
Even a mild TBI with persistent symptoms can be the most valuable component of a claim, because of what it does to earning capacity. Someone who can still do their job but can no longer be promoted, or who can work six hours instead of nine, has suffered a large financial loss that no medical bill records.
Questions people ask
My CT scan was normal. Does that mean I do not have a brain injury?
No. A CT scan looks for bleeding and fractures that need urgent treatment. It does not show diffuse axonal injury, which is the mechanism behind most mild and moderate traumatic brain injuries. A normal CT means no surgical emergency, nothing more.
I never lost consciousness. Can I still have a concussion?
Yes. Loss of consciousness is not required for a concussion diagnosis and most concussions do not involve it. Confusion, feeling dazed, or being unable to remember the moments around the impact are all consistent with it.
How long do post-concussion symptoms last?
Most people improve substantially within weeks to a few months. A minority have symptoms that persist much longer, and that group is where the serious claims are. Persistent symptoms should be assessed properly rather than waited out indefinitely, both for your health and because the record matters.
What is neuropsychological testing?
A structured day or more of standardised tests measuring memory, processing speed, attention and executive function against population norms, including validity measures that detect exaggerated performance. It turns 'I feel foggy' into measured, comparable data, which is what makes it so valuable in these claims.
Related
Reviewed October 2026 by Simon Aziz Budhwani, Esq., the attorney responsible for this site. Legal statements here name the California code section they rely on, so you can check them rather than trust them. This is information about the law in general, not advice about your situation.
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