How to get TBI Disability Benefits for Brain Damage

Traumatic brain injuries (TBI) are serious, often life-changing events for people who have them and their family caregivers. Managing life after a TBI can be easier with disability assistance from the federal government. We pulled together information to help you better understand this condition and how to qualify for TBI disability benefits. Keep reading to learn income limits, your chances for a successful claim and more helpful info below.

What is a Traumatic Brain Injury?

According to the Centers for Disease Control and Prevention, a TBI is any injury that impacts how your brain functions. It’s often caused by a bump, blow or jolt. TBIs can also result from a penetration injury, like a gunshot wound. Most people get TBIs from falls, car wrecks, assaults, and firearm injuries. Anyone can get a TBI, but some people are at higher risk. TBIs are especially serious for children and may hurt their development or limit their involvement in school and other activities. 

Get more details on TBIs from the CDC.

What Are Some Common TBI Symptoms?

IMPORTANT: Some symptoms occur immediately. However, some happen days or weeks later and may evolve or change over time. So if you experience any of these after a head injury, get medical care right away.

Symptoms of a traumatic brain injury vary depending on your specific injury and health status.

Common TBI symptoms include:

• A bad taste in your mouth
• A change in sleep habits or difficulty waking up
• Behavior or mood changes
• Blurred vision or loss of vision in either one or both eyes
• Convulsions or seizures
• Confusion, restlessness, or agitation
• Dizziness or lightheadedness
• Headache
• Lack of coordination or increased clumsiness
• Loss of consciousness of any duration
• Nausea or vomiting
• Numbness or tingling
• Ringing in the ears
• Sensitivity to light or sound
• Slurred speech
• Tiredness or sleepiness
• Trouble with memory, concentration, attention, or thinking

IMPORTANT: Because even one of these symptoms can make working impossible, you may qualify for TBI disability benefits from the Social Security Administration.

What Should I Do if I Think I Have a TBI?

See a doctor immediately any time you injure your head, even if you feel OK right now.

Ask your doctor to write a medical opinion letter outlining the physical, mental, and emotional limitations that fit the SSA’s definition of disability. Also ask them to include your medical records and opinions from non-Acceptable Medical Source providers.

IMPORTANT: Can’t afford to see a doctor? An attorney can cover the cost of any tests you need or pay for copies of your complete medical records.

What TBI Disability Benefits are Available?

The Social Security Administration (SSA) offers TBI disability benefits through two programs:

• Social Security Disability Insurance (SSDI)
• Supplemental Security Income (SSI)

PRO TIP: Learn the difference between these two programs.

The SSA uses the following two-step process to determine if you qualify for TBI disability benefits:

1. Determine if you meet the income and work history requirements.
2. Evaluate the extent of your injury and how it affects your daily life.

Let’s take a closer look at how this works.

How to Qualify for SSDI TBI Disability Benefits

If you answer “yes” to all these questions, then you’re ready to apply for SSDI benefits for a TBI:

• Did you work at least 5 in the last 10 years while paying Social Security payroll taxes? Your eligibility lapses once you stop working for 60 months in a row. This is because your work taxes pay into Social Security, which provides your disability insurance coverage.
• Are you between 18 and 66, but not currently receiving any other Social Security benefits? The program stops paying at full retirement age, which is currently 67. At that point, everyone getting SSDI swaps over to regular Social Security benefits instead.
• Have you seen a doctor during the past year about your condition? If not, a Disability Determination Services (DDS) exam can confirm you’re unable to work for health reasons.
• Does your doctor expect your condition to keep you off the job for at least one year? If you can return to work sooner, then you won’t qualify for TBI disability benefits.

IMPORTANT: If you gave any “no” answers, then you may still qualify for TBI disability benefits through the SSI program.

Find out if you need a lawyer even if you’ve already filed an SSDI claim.

How to Qualify for SSI TBI Disability Benefits

If you’re blind, disabled, or at least 65 years old and meet these income requirements, you may qualify for SSI:

• Own total assets worth less than $2,000 ($3,000 for couples). This includes money in the bank and items you may sell for cash, such as stocks, bonds, lottery tickets, etc. Your car, wedding ring, a home you own and other daily living items don’t count toward this limit.
• Have monthly income from wages and/or other sources under $2,460 if you are blind and $1,470 if you’re otherwise disabled. Couples must have less than $2,827 in combined monthly income. Child support, alimony, earned interest, SNAP, TANF, etc., all count toward that total.

How Does the SSA Determine Medical Eligibility for TBI Disability Benefits?

The SSA requires a lot of evidence to award monthly TBI disability benefits. According to the SSA website, once they verify you meet all technical requirements, a medical evaluation is the next step.

First, the SSA looks for problems that last at least three months after your injury:

1. Disorganization of motor function in two extremities that severely limit your ability to stand up from a seated position, maintain balance while standing or walking, or using your arms.
2. Noticeable limitations in your ability to physically function and at least one limitation in mental functioning, including:
   • Understanding, remembering, or applying information.
   • Interacting with others.
   • Concentrating, persisting, or maintaining your usual pace.
   • Adapting or managing yourself.

This is how they determine your “residual functional capacity,” a fancy term for how well you function every day. It helps measure your remaining ability to meet your job’s physical, mental, sensory, and other requirements after your injury. An SSA reviewer considers only your current limitations and restrictions that result directly from your TBI. Then, they decide if your condition keeps you from doing your job now and will keep you from any gainful employment for at least 12 months.

The SSA gathers this information in two forms:

• Physical Residual Functional Capacity Form lists how much you can exert yourself at work and your ability to handle required physical tasks.
• Mental Residual Functional Capacity Form provides an inventory of your mental, emotional, and intellectual ability to do your job. 

PRO TIP: Ask your doctor to help you complete both residual functional capacity forms. Proving you qualify for disability may be harder than you realize. Plus, you may not know all relevant symptoms or how they affect your ability to hold any job.

Do I Need an Attorney to Get TBI Disability Benefits?

No, but hiring a lawyer specializing in Social Security claims can improve your odds of getting the benefits you deserve. PRO TIP: Learn what a Social Security disability lawyer can do for you.

Studies show that:

• You’re almost three times more likely to get benefits within 6 months if a lawyer files your paperwork. The average time to get SSD benefits with a lawyer is 152 days, vs. 400+ days for those who apply without one.
• 58% of people who apply with lawyers get benefits on their very first try. However, only 20% of those filing on their own are successful.
• You’re 70% more likely to get mental health-related benefits with an attorney. We can connect you with a lawyer to help you file a TBI disability benefits claim free of charge.

How Does the TBI Disability Benefits Process Work?

According to the Brain Injury Association of America, the process usually works like this:

1. Apply for TBI disability benefits from the Social Security Administration. Complete your claim online or at your local SSA office. If you apply online, you’ll get a confirmation electronically or by mail. PRO TIP: Get step-by-step instructions directly from the SSA.
2. Be patient. It often takes 90-120 days to complete the initial application process. During that time, the SSA may contact you for more information. The agency only approves about 30% of initial claims.
3. Denied benefits? File for reconsideration. If the SSA denies your TBI disability benefits claim for medical reasons, request an appeal online or via Form SSA-3441 and Form SSA-827. If you receive a technical denial, either appeal on the SSA site or via Form SSA-561. You must appeal within 60 days. It can take up to 2 months to get a decision. Less than 15% of people appeal denied claims at this stage, so consider working with an attorney.
4. Request a hearing with an administrative law judge. Still no benefits after your reconsideration appeal? You have another 60 days to ask for a hearing before a judge. Most (60%) cases that get this far receive benefits, but it can take a year or more.
5. Go before the Appeals Council. If you’re one of the few people still wishing to appeal after your denial in court, submit your request to the Appeals Council. PRO TIP: Find out more about how this process works from the SSA.

IMPORTANT: You can decide to go to Federal Court if the Appeals Council denies your claim again. This kind of case requires expert legal help and can be quite expensive.

See what happens when the SSA awards you TBI disability benefits.

Can I Get Free Expert Help Filing for TBI Disability Benefits?

Working with an experienced Social Security attorney doesn’t have to cost a fortune.

Expert help can triple your chances of winning TBI disability benefits without paying anything out of your own pocket.

IMPORTANT: If the SSA doesn’t award you benefits, then you owe $0 for expert assistance. And if you’re successful, then you only pay one small fee after your benefits begin.

We can connect you with a nearby claims expert by phone today for free application help.

Want to talk to a local disability expert for free, in private? Click the button below now to start your free online benefits quiz and see if you may qualify:

Get Your Free Benefits Evaluation