Why brain injuries are disputed
A broken bone shows on an X-ray. A concussion or mild traumatic brain injury (TBI) often does not. Brain injury resources supported by the medical community explain that milder TBI may not involve damage that current imaging can detect, because much of it happens at the cellular level. Insurers use a normal CT scan to argue nothing is wrong. The law does not require a positive scan, and neither does the medical diagnosis.
The CDC groups concussion symptoms into four areas:
- Physical: headaches, dizziness, balance problems, nausea, fatigue, light or noise sensitivity, vision problems
- Thinking and remembering: trouble concentrating, feeling slowed down, memory problems
- Emotional: irritability, anxiety, sadness, heightened emotions
- Sleep: sleeping more or less than usual, trouble falling asleep
Some symptoms appear right away and others may not appear for hours or days. If you hit your head, or your head was jolted, tell the emergency room and your primary doctor about every one of these, and say so again at follow-up visits.
“Talk and die”: why feeling fine isn’t enough
“Talk and die” describes a person who is awake and talking after a head injury, then gets worse hours later. A common cause is an epidural hematoma, a bleed between the skull and the brain’s outer lining. University of Chicago Medicine describes the classic pattern as a “lucid interval” of minutes to hours, when the person may seem fine or have only a headache, followed by rapid deterioration: a worsening headache, agitation, drowsiness, a pupil that enlarges, or weakness on one side. It calls this one of the most time-critical neurosurgical emergencies, and a CT scan is how it’s found.
After a crash where your head was hit or jolted, go to the emergency room even if you feel all right, and get help immediately if any of those signs appear. It matters for your claim too: an emergency room record made the same day is the strongest early evidence of a head injury.
How brain injuries are proven
- Early records noting loss of consciousness, confusion, amnesia or a Glasgow Coma Scale score
- Neurological examination by a neurologist or physiatrist who treats brain injuries
- Neuropsychological testing that measures memory, attention, processing speed and executive function
- Imaging: CT and MRI rule out bleeding and structural damage; newer techniques such as diffusion tensor imaging are sometimes used
- Before-and-after witnesses: coworkers, family and friends who saw personality, memory or work changes
The closed-head injury rule
To recover pain and suffering, you must meet the serious impairment threshold. Usually, if there is no material dispute about the injury, the judge decides whether you meet it. For brain injuries the statute adds a protection. MCL 500.3135(2)(a)(ii) currently reads: “for a closed-head injury, a question of fact for the jury is created if a licensed allopathic or osteopathic physician who regularly diagnoses or treats closed-head injuries testifies under oath that there may be a serious neurological injury.”
In practice this means the right physician’s sworn testimony can keep the case from being dismissed on the threshold and put the question in front of a jury. The physician must be an MD or DO, and must regularly diagnose or treat closed-head injuries. Choosing treating doctors with that background matters.
No-fault benefits for a brain injury
| Benefit | What it covers for TBI |
|---|---|
| Medical and rehabilitation | Neurology, neuropsychology, cognitive, speech, vestibular and occupational therapy, residential or day rehabilitation, medications |
| Attendant care | Supervision and help at home; family-provided care is capped at 56 hours per week unless an exception applies |
| Wage loss | 85% of gross pay for up to three years, capped at $7,455 per 30 days for accidents from October 1, 2026 through September 30, 2027 |
| Replacement services | Up to $20 a day for chores you cannot do |
Severe brain injuries can require care for decades. If you chose a $250,000 or $500,000 PIP limit, a moderate or severe TBI can exhaust it. Medical costs above your limit become a claim against the at-fault driver; see excess medical and wage claims. If you were covered by a policy issued before June 11, 2019, Andary v USAA may protect your benefits from the 2019 cuts.
What insurers do with brain injury claims
Expect an insurer medical exam, often with a neuropsychologist who reports symptom exaggeration or a pre-existing psychological cause. Expect requests for old school and work records. The answer is consistent treatment, testing by qualified clinicians, and testimony from people who knew you before the crash.
Brain injuries and deadlines do not mix well. Memory and organization problems make it easy to miss the one-year no-fault notice deadline (MCL 500.3145) or the three-year deadline to sue the at-fault driver (MCL 600.5805(2)). A family member should track them; use our deadline calculator.
Sources: MCL 500.3135(1), (2)(a)(ii), (3)(c), (5); MCL 500.3107; MCL 500.3157(10); MCL 500.3145; MCL 600.5805(2); CDC, “Signs and Symptoms of Mild TBI and Concussion”; BrainLine, “How Is TBI Diagnosed?”; University of Chicago Medicine, “Epidural Hematoma”; Andary v USAA (Mich, July 31, 2023).
Questions people ask us
Can I have a brain injury if my CT scan was normal?
Yes. Milder brain injuries often do not show obvious damage on standard imaging, because much of the injury happens at the cellular level. Diagnosis then rests on symptoms, clinical examination and neuropsychological testing.
Does a concussion meet Michigan’s serious impairment threshold?
It can. For closed-head injuries, MCL 500.3135(2)(a)(ii) creates a jury question if a licensed MD or DO who regularly diagnoses or treats closed-head injuries testifies under oath that there may be a serious neurological injury.
What no-fault benefits are available for a brain injury?
PIP covers reasonably necessary medical care, rehabilitation and attendant care up to your coverage level, along with wage loss and household help. Family attendant care is capped at 56 hours per week unless an exception applies.
How soon do brain injury symptoms appear?
Some appear immediately, but the CDC notes that others may not appear for hours or days. Tell every provider about headaches, memory trouble, light sensitivity or mood changes, even if they seem minor.
