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Valerie lives in Maryland, a state whose insurance laws mandate a minimum of five thousand dollars in personal injury protection (PIP) for every driver. This insurance is meant to cover the policyholder's initial medical expenses in the event of an automobile accident. The assumption is that an injured party can sue to recover expenses above that amount if necessary. Valerie — like most of the 98 percent of Marylanders who purchase only minimum PIP coverage — never considered that the five thousand dollars might be inadequate. She discovered this only after her accident. Valerie also didn't realize that being injured in an accident might make it impossible for her to obtain medical insurance — until a sharp premium increase forced her to cancel an existing medical policy after her accident. For three years, she was repeatedly denied replacement coverage, until a lawyer suggested that she purchase open-enrollment insurance. This is a costly and very limited type of hospitalization and catastrophe coverage that cannot be denied to anyone, regardless of preexisting conditions. Valerie says that the benefits provided by this policy are a disappointment, but at least it covers most catastrophic hospital bills — a concern due to her family medical history.
Valerie sees herself as a victim of the auto accident that ended her artistic career, and also as a victim of the legal and healthcare systems that were supposed to help her. She is lucky to have a family that has been able to assist her financially. Even so, she has at times thought about moving with her husband to his native Italy, where the government-run healthcare system would afford her better care than she has received in the United States.
Mild Traumatic Brain Injury (MTBI) carried with it two main financial issues: lost wages due to layoff, firing, or a change in employment; and medical bills for the extensive services that are often needed after an injury of this type. This chapter examines both of these issues and gives advice concerning the types of financial help that may be available to you, as well as suggestions for dealing with reductions in income and tips to help you cut through the red tape that so often surrounds the insurance process.
Obviously, after an injury like MTBI, a certain recovery period is usually required before you can return to work. In some job situations, it is possible to take a medical leave of absence with pay. In others, you may be paid during your recuperations from illness or injury only to the extent of accumulated sick and vacation time. If you are self-employed or have no employer-provided benefits, you may not be able to get paid time off at all.
Regardless of your employment situation, you may attempt to return to work during your recovery only to discover that your ability to function on the job is not what it was prior to injury. You may see the need to take a different job that calls for less intellectual processing, for example, or you may even have to stop working — at least for the present. Many people with MTBI end up losing their jobs because their work performance doesn't measure up after what their employers consider a "reasonable” period of time. Others leave voluntarily or abandon a business rather than face daily frustration and embarrassment.
The result is that many people with MTBI find themselves earning less money after injury than before. Meanwhile, normal household expenses remain more or less constant and medical bills mount up rapidly. Because it is often impossible to predict how fully you will recover from MTBI, or how long recovery will take, it is important to know how you can obtain financial compensation to help you with your expenses.
"Before my accident, I had a successful two-office psychology practice. Fortunately, I carried overhead insurance to cover fixed expenses such as rent, utilities, phone bills, advertising, managerial and secretarial help, and my answering service. I had income disability insurance and, because I was also an employee of my corporation, workers' compensation coverage. My overhead insurance covered my business expenses until I was able to close my office and, because my accident occurred as I was returning to my home office from visiting a patient, I also qualified for workers' compensation benefits. I was required to undergo four separate neuropsychological examination and several consultations with an independent physician, but for the first four years, the workers' compensation agency was cooperative, congenial, and efficient. Then policy and personnel changes brought a rude awakening. Bills were delayed for months and then paid only in part, many more evaluations and tests were required, and my new claims representative hinted that many of my expenses would no longer be covered. I was forced to seek legal counsel.”
The possibility of compensation for lost wages and medical bills is determined by the circumstances of your MTBI. These injuries most commonly result from auto accidents, sports mishaps, falls, blows to the head, or assault. If your MTBI occurred in a car accident, financial support may be provided through automobile insurance. If your injury happened on the job, you can seek assistance through workers' compensation. Liability and health insurance usually cover sports and other injuries that take place on school premises; homeowner's insurance, health insurance, or, in some cases, government assistance may cover injuries that happen at home. Some states have victims' compensation laws that provide for financial assistance for persons injured as a result of physical assault.