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Figuring Out Social Security Benefits After a TBI

Comments [9]

Michael V. Kaplen, Esq., BrainLine

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I was injured in a car accident two years ago and sustained a serious traumatic brain injury. Now, I'm not able to work and my doctors tell me I'm permanently disabled. I applied for Supplemental Security Income through Social Security and was just denied. What am I supposed to do now?


Unfortunately, your situation is not unusual. But here are some suggestions and ideas that may help.

Don't take "no" for an answer
People who have sustained a brain injury often face a great deal of frustration when applying for Social Security benefits, but they should never give up if their first claim is denied. Never take the denial by the Social Security administration as the final answer. In many instances, the applicant is granted benefits after reconsideration or after an appeal, so it is important to pursue your rights in a timely fashion.

File your request for reconsideration or appeal in a timely manner
It is important to know that following a denial, an applicant has up to 60 days to ask for reconsideration and to file an appeal with the Social Security administration. You can go to your local Social Security office and obtain the necessary forms to apply for benefits, ask for reconsideration, and file an appeal. You can also obtain the forms online at http://www.ssa.gov/online. After you fill them out, file them with your local Social Security office.

Why was my application for benefits turned down?
Applications for Social Security disability benefits are frequently turned down because the applicant did not supply sufficient information to document their disability, the Social Security administration did not obtain all of the claimant's records, or the claim was not properly considered by the claims examiner. In asking for a reevaluation or preparing for a hearing, it is vital that proper information be submitted to substantiate the claim of disability.

Obtain legal assistance to help you
Because a person with a brain injury can sometimes get frustrated easily, be a poor record keeper, or experience problems focusing and relating information, it makes sense to seek assistance filling out the required Social Security paperwork. In addition to family and friends, there are attorneys who will help people with Social Security appeals on a contingency fee basis, meaning that the individual does not have to pay the attorney a fee unless he or she is successful in obtaining benefits. The fees that these attorneys can charge are limited by the rules of the Social Security administration to no more than 25 percent of past due benefits up to a maximum of $5,300.

How are disability claims evaluated?
Social Security disability claims are evaluated not on the basis of the severity of the original brain injury sustained by the applicant, but by the level of recovery and by the Social Security administration's own definition of disability. In short, the Social Security administration looks at the deficits an individual currently has and determines if those deficits prevent the individual from obtaining any sort of gainful employment. It is not enough that the individual is disabled; the disability must prevent the person from gainful employment.

What records do I need to submit?
Any application for Social Security benefits, applications for reconsiderations following a denial, and requests for a hearing should contain ALL of the claimant's medical records following his or her brain injury. These records should include not only the original hospital or emergency room records but the records from any physician or other healthcare professional who has evaluated the individual.

Records should be requested from neuropsychologists, neurologists, eye care specialists, vestibular specialists, rehabilitation specialists, psychologists, and neuropsychologists as well as from the applicant's family physician. In addition to forwarding records to the Social Security administration, it is helpful if a healthcare practitioner also writes a narrative report outlining the nature of the person's current complaints, his or her current disabilities, any testing done to support the medical conclusions, and a firm, definite statement that the individual is disabled and unable to be gainfully employed as a result of the injury and disability.

Many individuals who are applying for benefits — and even their healthcare providers — mistakenly believe that it is sufficient to merely state that the person sustained a TBI, is suffering from post-concussive syndrome or other TBI-related condition, and is currently disabled and unable to work. It is important that the application and supporting documents clearly outline the full extent of the impairments that the person with TBI experiences.

It is important for people with a brain injury to obtain assistance in filling out the Social Security administration's questionnaire where applicants are asked to set forth their disabilities and impairments. It is also important that individuals seek assistance in obtaining their medical information so that a complete set of documents can be considered. In many instances, a properly filled out questionnaire along with proper documentation will prevent a claim from being denied in the first instance, or be accepted on reevaluation without a need for a hearing.

What should my healthcare provider include?
Here is what the Social Security administration states should be included in medical reports submitted on behalf of a claimant:

Medical reports should include:

  • medical history;
  • clinical findings (such as the results of physical or mental examinations);
  • laboratory findings (such as blood pressure, x-rays);
  • diagnosis;
  • treatment prescribed with response and prognosis;
  • a statement of what the claimant can still do despite his impairments;
  • if the claimant is an adult, age 18 or over, this statement should describe, but is not limited to, the claimant's ability to perform work-related activities, such as sitting, standing, walking, lifting, carrying, handling objects, hearing, speaking, traveling;
  • in cases involving mental impairments or cognitive limitations, this statement should describe the claimant's capacity to understand, to carry out and remember instructions, and to respond appropriately to supervision, coworkers, and work pressures in a work setting.

Michael V. Kaplen, Esq. Michael V. Kaplen, Esq. is a partner in the New York law firm, De Caro & Kaplen, LLP. He is the chairperson of the New York State Traumatic Brain Injury Services Coordinating Council and the immediate past president of the Brain Injury Association of New York State.

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Comments [9]

I totally understand. My husband is getting workup for a brain injury from childhood. He has had no intervention most of his life except special-Ed. Also, multiple head traumas in childhood and he has several symptoms of brain injury/TBI. He has fallen through every crack in the system. It's disgusting. He refused help for the last 11 yrs and he is old enough to make his own decisions. Recently through a back door approach, I got him to start seeing 2 providers. I have been advocating for him, but it has been extremely difficult because he is in his mid 30's and well adjusted to his ways. On top of that, there's a lot of professionals/providers who act like you are faking it -- and for someone living it every single day... every struggle, every hump along the way -- it is offensive that they treat you like are making it up. That is until they realize that a test comes back supporting what I have been saying for a long time. Only now they are concerned and sending him to a Neurospecialist.

Jan 8th, 2017 5:29pm

I sustained multiple contusions and a cracked skull in 1995. Since then I've had difficulties with keeping a job, memory, balance and various other issues. No one believes me when I tell them about my head pains or the occasional dizzy spells I suffer from even to this day. I find work then soon after I'm discharged for not being able to learn fast enough or for not being able to handle the work. I applied for ssi but was denied. Since then I've worked very limited jobs but I can't ever seem to be able to hold on to one for more than a year or so. I understand the frustrations of hearing oh well you walk and talk just fine there is nothing wrong with you! I feel for all that suffer from TBI issues after their injuries. Something should be done to help people with these conditions. Especially those with no one to help.

Apr 15th, 2016 8:31am

I to am dealing with social security and am a disabled widow who was denied 5 years s.s.I. and s.s.I.d. benefits, I almost hemeraged to death and am in operable and allergic to 30 or so medications. I lost a home, my ability to work, my husband, and almost my life, and as of a year ago I now am a caregiver to a Veteran that is also disabled from T.B.I. from a m.v.a. sometime we get help from churches for a motel stay, but most of the time we hold a sign for help financially. Back in may 2014 I requested a copy of All of our records and found out the adjudication office in stone mountain Georgia is Hiring doctor s to FALSEIFY claims....I filed a dispute and they refuse now to answer me at all..Kenneth's t.b.I. has left him without the ability to write past his name...so when I'm well enough I have to do all the writing of letters and applying for help we were even turned down in ga for even Medicaid... So I have to spend months finding a church that will help with the cost of medical evaluation s and his parents refuse to help him..this have been unreal...i m asking for prayers and encouragement we really need the help financially and otherwise, thank you . p.s. my heart and prayers go out to all who suffer with the residual s of T.B.I..

Sep 23rd, 2014 1:46am

I was in a car wreck on 1/15/1999. It was 5 days after I turned 16 AND I was not driving. I am now 31 years old. My life has been miserable, at best, since my car wreck. I suffered a TBI AND deep vein thrombosis in my left leg. My TBI consists of damage to my right and left frontal lobes as well as damage to the basil ganglia. My blood clot goes from my knee to my hip in my left leg. My brain injury is so much more, but I do not have my medical records with me and have found it almost impossible to remember what all is wrong with my brain. I've been trying for OVER 10 years to get disability and right now, I'm on my third time filing. This time I have some help though as my girlfriend is filling out the paperwork for me. She has my medical records on her at work, so thats why I cannot look up what all damage I have. I have been considered a disabled person in every aspect of life BUT when dealing with Social Security. I even went through vocational rehab for help with my schooling and going to college, which I did and graduated with honors. It took me 10 years to graduate college with a 4 year degree. But still, Social Security kept telling me I'm not disabled. I have not been able to find full time employment my entire life due to my TBI. Right now, my brother is helping me out by letting me work PT for his company, but I feel as if working for him is slowly killing me. Regardless, I still try to push forward. I have NEVER had FT employment for more than 2 months at a time. I cannot handle it. Working FT wears me out to the point I lose my ability to focus/function and then I end up hurting myself even more. I've broken over 12 bones and suffered 3 concussions and 1 TBI and 1 DVT. I raced motocross before my car wreck and did so on a high level. I am jumping around in my story now, or so it feels like, I'm sorry thats not on purpose. so, that's roughly been my life- TBI at age 16 and pretty much life over for me it feels like. Bouncing from job to job that then turned into NO ONE even calling me back for a job interview after I applied to 400+ jobs. If it was not for my AWESOME family, I would be homeless and more than likely, dead. The social security system in America has played a HUGE role in destroying my life after my TBI. Their constant denial of my disabilities has left me feeling like I'm just a big baby looking for free handouts. It's not like that at all though as i WANT to work, but I'm finding out that even working PT is causing my health to deteriorate even faster. I've spent over 10 years lying to myself, thinking that its my own fault that I cant find and keep FT work, but thats not the case, or so I'm finding out now. For the first time, My GF and I are looking through my medical records to see what all is in them.... Turns out theres A LOT MORE in there than what doctors have told me. We contacted a lawyer about filing for disability again and was told to fill it out by ourselves first... then when I was denied, give them a call! So much for getting help filing! My girlfriend accepted the task and has done WONDERFUL things since. What I want EVERYONE with a TBI to know from my experience is this..... Yes, it sucks! Yes, it is a constant struggle and you WILL want to kill yourself from time to time, but please don't as it is NOT the proper answer. The biggest thing to try to understand is that each TBI is different and that each person is different too. What works for patient A WILL NOT work the same for patient B, 99% of the time. Don't give up though! The secret is understanding what YOU have and ACCEPTING the fact that you have it! Learn to function/live within your limitations and come to turns with the fact that you might not be able to do all that you once did. DO NOT LET The Social security system or US Government make you feel like a con-artist. They did that to me and I lost over 10 years of my life due to that! How you say? Well, depression is HUGE with respect to TBI's. Being already depressed and then having the Government tell me I'm not disabled made me feel like it was my fault. So i spent years and years battling the "trying to work with a TBI" rat race. Over the past 10 years, I was able to bring in a COMBINED income of roughly $32,000. Yeah, go ahead and try to live off that! Like I said earlier, I LOVE MY FAMILY AND OWE MY LIFE TO THEM because without them, I'd be homeless or dead. It's not going to be easy, but that does not mean that you aren't disabled. NEVER GIVE UP!!!!!!! I am STILL not considered disabled by the social security system and have NEVER received any governmental help. Does not mean that I do not need help though. If you would like to help, I will graciously accept any and all monetary donations :) I think I left out why I wrote all of this... something to do about a brain injury and SS.... OO! Social security denies OVER 95% of applicants on first go round.... you MUST appeal decision.  I just learned that this last go round and am currently awaiting my third denial paperwork so I can appeal it and hopefully get somewhere! A SS denial DOES NOT MEAN your are NOT disabled! DO NOT GIVE UP!  


Aug 15th, 2014 1:11pm

My husband had a moderate TBI 3 brain bleeds and brain sheer . Along with both lungs collapsed and broken bones. From A quad wreck. Knowing I was a mess and his memory was gone. I hired A attorney within the first 2 weeks post injury. He was approved for SSD in less then 90 days. I think hiring A attorney to fill out the original application is necessary. And the best decision I made. The big reason for denied is filling the papers out wrong or poor wording.

Mar 14th, 2014 2:32am

When should this process be started. My stepson was in a motorcycle accident and is still in the hosptial - we have only been told that it will be months/years minimum of two years before we know everything permanently lost or residual issues. He has 4 children that will not be provided for by him now....

Apr 3rd, 2012 8:00pm

Just to update the numbers, the maximum fee under SSA's rules and regulations is now $6,000.00. In addition to attorneys, there is a national organization called NADR (National Association of Disability Representatives) made up non-attorney advocates who represent applicants for SSDI/SSI. Also, it is important to remember that even if an individual is found eleigible for disabilty benefits, he or she can still work under the provisions of Social Security's return to work incentives and programs, called PASS plans. PASS stands for Plan to Achieve Self-Sufficiency.

Feb 21st, 2012 7:46pm

We succeeded at stage 2 - after being denied and filing for reconsideration. Took a year. Tip: Be sure you study the SS definition of gainful employment very carefully. It is Key. Good luck and God bless.

Oct 8th, 2011 9:54am

Does this apply to a minor? My daughter suffered a TBI @ age 8, it would be characterized as an organic trauma.

Apr 5th, 2011 5:22pm

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