TBI Claims and Your Insurance Case Manager: Know Your Rights

Following a traumatic brain injury (TBI), you may be eligible for an insurance claim that pays for many of the expenses and care you need for your recovery. Overcoming the symptoms of a TBI can take years or even a lifetime. Worse, you may not have the tools to do this alone, which is what a case manager is here for.

Unfortunately, you may worry that your insurance case manager is not respecting your rights or providing the support needed for your recovery. When this happens, you may have grounds to take legal action to secure your rights as a TBI victim with help from an Atlanta traumatic brain injury lawyer at The Stoddard Firm. We have the tools and resources to help you navigate your rights as an injury victim and as an insurance policyholder so that you can get the treatment you need following your injuries.

What is an Insurance TBI Case Manager?

When you have suffered a severe head injury, you may need months, years, or a lifetime of care. Managing that care can be complex, and even if you have insurance coverage that can support you at this time, it can be difficult to understand what your insurance will cover and how to manage those benefits. In fact, a study published in the National Library of Medicine found that high-severity TBIs may cost up to nearly $35,000 per year for patients with private health insurance, making case management a vital tool to manage costs.

When examining your insurance coverage, you may have difficulties determining what is covered. After all, the cost of medical care has increased over the years, and you may need substantial financial help just to survive, let alone to get the best possible outcome for your care. Your case manager is responsible for collaborating with all parties involved, coordinating your care, and helping to ensure that care continues as you recover from high-cost injuries.

When you are injured on the job, the workers compensation system will help provide insurance for your medical bills, and under that system, you will be assigned a case manager.  Having a case manager on your side is especially helpful for your insurance claim, but unfortunately, case managers are often on the side of the insurance company that hired them. To be sure, cas managers can provide valuable information at times concerning the costs of this care, what services are covered, and whether you may have opportunities for coverage through public programs may be beyond the time and energy you have during recovery. But case managers are typically hired by the workers compensation insurer and that insurer has incentives to show that you are not hurt or do not need further care.

What Are Their Responsibilities?

When you have suffered a TBI on the job, a case manager will be assigned to help you. Their aid begins with identifying the severity of your case from your initial evaluation, determining whether you are eligible for public assistance or TBI-specific services, and maintaining contact with all involved parties, including the following:

• The patient
• Your family
• The insurance company
• Your physicians
• Any physical or emotional therapists
• Your attorney
• Your employer
• Community groups involved with your case.

The responsibilities go beyond this, however, and include coordinating plan benefits, arranging special services, and making referrals to specialists for your care. Your workers compensation insurance TBI case manager may also help you determine what is covered under your insurance policy, whether you can receive in-home care, and more. Your case manager is supposedly responsible for helping you navigate the best path forward to recovery, but often times they are not your real ally.  That is where a good lawyer comes in.

What Are Their Qualifications?

Not everyone is eligible to become a case manager. In one aspect, case management requires expertise, including degrees in the field and potentially with further training, such as being a registered nurse or social worker. Having the right qualifications in education and experience is vital to ensuring you get the care you need for recovery.

However, your case manager should also be prepared to approach your case with compassion and clear communication. You and your family have experienced a traumatic, life-changing situation, and your case manager should keep that in mind as they approach your case. Your case manager should provide essential support and resources in the resolution of your complex insurance claim.

How to Request a Different TBI Case Manager

You would expect your case manager to be knowledgeable, trained, and ready to help you best recover from your injuries. However, you may find that you are unhappy with your case manager. In these cases, you can request a change in your case manager.

If your case manager is failing to pursue high-quality care and help control costs, you can always request a case manager change. If you feel that your case manager is not properly trained or does not have the experience necessary for your case, you have the right to choose your case manager. If you struggle to complete the step, you may need to seek our guidance.

How a TBI Injury Attorney Can Help You Request a Case Manager Change

In most cases, your workers compensation insurance plan provides these case management services. These case managers are meant to help with high-cost medical conditions, so if your insurance company has provided a case manager, remember that you can still request a new one. However, your insurance company may not be so willing to offer the support you need.

In fact, you may find yourself struggling to get results from your insurance company without support. If your brain injury leaves you unable to easily communicate your needs to your insurance company, or if they refuse to assign a new case manager to you, we are here to act as an advocate when you need one. Talk with our personal injury team for guidance on your case and pursue compensation if the insurance company acts in bad faith.

Our Firm Is Here to Serve the Community

Following a traumatic brain injury, you may face complications and issues that impact your ability to live as you once did. At The Stoddard Firm, we understand the impact of these difficulties and how they can make getting the compensation you are due much more difficult. Fortunately, we offer the tools to help.

We offer decades of experience with cases involving Georgia tort laws, guiding you to the results you need following an accident. That includes helping many injury victims deal with the complex field of injury law. That helps us better act as advocates for our clients.

These efforts have paid off for many of our clients. We have succeeded in securing multimillion-dollar settlements for numerous clients. We are prepared to take action for you and help you pursue compensation when the at-fault party fails to compensate you.

Protect Your Rights with a Compassionate, Dedicated TBI Injury Lawyer When Your Insurance Company Fails to Help You

When you have suffered a TBI, your health recovery can be a complex road, and progress is not always linear. In these cases, an insurance case manager may be assigned to your TBI claim, but you may be concerned that your rights are not being respected.

At The Stoddard Firm, we strive to help TBI victims recover from the suffering they have experienced and secure their rights as insurance policyholders. If you believe your case manager is not respecting your rights, we can help you request a different TBI case manager. When you are ready to learn more about your opportunities for action, do not hesitate to reach out by calling 470-467-2200 or completing our online contact form.