Originally published in Brain Injury Professional
The very nature of TBI rehabilitation means that rehabilitation professionals normally don’t have access to patients and their families until after the critical care component of treatment is over.
During the critical stages of recovery, the medical team is focused on stabilizing the patient, and more often than not, the family receives very little information regarding the long term care and treatment the patient is going to require. During the transition from critical to rehabilitative care, the communication between the two teams is not optimal, and it is not unusual that families arrive at the rehab facility ill-equipped to deal with the difficult road they have ahead of them.
This gap in communication can be bridged, and patient and families can benefit greatly, by the often overlooked, and frequently disregarded, legal team.
Aside from the critical care team, the legal team is often among the first responders who are fielding the families concerns and helping them with the countless problems they face. Unlike the critical care team who treat the patient for a limited time period, the legal team is unique in that it is with the family on day one, continues to assist the family throughout the continuum of care from resuscitation to rehabilitation. In catastrophic cases, it is not uncommon for the legal team to stay involved with the patient and family for years. Because of the longevity of the legal team’s involvement, they can provide the necessary bridge between critical care, rehabilitative care, and reintegration into the community.
This bridge can also help address some of the major obstacles faced by rehabilitation professionals in the care and treatment of TBI patients and their families which include:
- 1) Providing information and education to patients and their families regarding resources, healthcare, insurance, rehabilitation and long term care;
- 2) Serving as advocates for the patient and families to ensure that adequate funding is available to provide the rehabilitation and long term care the patient needs and;
- 3) The value of patient/family centered team approach.
Education & Resources:
Initially, patients and families are overwhelmed with possible life threatening issues, the confusion of insurance, navigating the healthcare system, and the lack of complete information regarding their loved one’s condition. By the time the patient reaches rehabilitation, their families are mentally and physically exhausted. The responsibility then falls upon the rehabilitation professional, who aside from their usual rehabilitative functions, must manage a family in crisis. Families want to know how soon their loved one will be well, who is going to pay for their care and how they are going to face the overwhelming task of caring for the patient if they do not make a full recovery.
Traditionally, the legal team’s functions were limited to liability and funding issues, however many law firms have realized that their roles must necessarily be expanded to provide a more comprehensive and collaborative approach to their clients. Law firms that specialize in catastrophic injury are now employing social workers and nurses as part of their legal team. These expanded roles allow the legal team to closely collaborate with the critical care and rehabilitative teams and ultimately improve the patient outcomes.
Through early intervention, the legal team can begin the process of educating the family and connecting them to resources early on. Qualified legal teams will ensure that families register with local and state brain injury programs, apply for Medicaid, file claims with automobile policies and apply for disability benefits. As advocates for the patient, the legal team can also ensure that health insurance policies provide the maximum benefits available, and any liability and worker’s compensation insurance benefits can be taken advantage of.
Educating the families about the injuries and their long term effects and what other resources are available can help manage the patient and families expectations long term. Families should also be informed about what rehabilitation facilities are available, coordinate tours of the facilities, and set up evaluations when necessary to determine what rehabilitation facilities are most appropriate for the patient. Connecting the families to other local resources such as support groups, all contribute to the families greater understanding of the injury and how they can play a manageable role in their loved one’s recovery. A qualified legal team should be able to bridge this gap in education and resources and play a key role is properly preparing both the patient and the family for rehabilitation.
It is well established that the #1 barrier to care are insurance and financial issues. One of the greatest obstacles rehabilitation professionals face is the lack of funding resources available. More than any other individuals, rehabilitation professionals appreciate how timely and appropriate rehabilitation can make a huge difference in the outcome of patients. This very perspective makes it particularly frustrating when rehabilitation is obstructed by a lack of funds.
All of us intuitively and empirically realize, there is a direct correlation between access to insurance and financial resources and improved outcomes in TBI patients. Rehabilitation professionals often deal with insurance providers who deny claims for services that were clearly medically necessary. By working with a qualified legal team, insurance companies often overturn their decision to deny a claim after an appeal has been filed but this often takes a team effort. Legal teams frequently facilitate the communication between the treating doctor, the rehabilitation professional and the medical director of the health insurance company to get claims paid.
Auto or liability insurance can have the greatest impact in the availability of funds. Much like the way immediate medical intervention helps save someone’s life, the early intervention of a legal team is critical in determining whether funds from car or liability insurance will be available for medical needs. These funds are above and beyond health insurance coverage and can cover both past and future medical expenses.
Regrettably, all too often I have represented clients that have experienced relatively the same injury but with comparatively vastly different outcomes. To preserve confidentiality of any client’s case, I offer the following composite profile of two TBI cases with disparate results:
Johnny and Brad were two 17 year old boys travelling in the rear seat of an automobile that was involved in a violent collision with another vehicle. Both boys were unconscious at the scene and bleeding profusely from their heads. Both were transported to the local trauma center where they were independently diagnosed with severe TBI’s involving subarachnoid hemorrhaging, diffuse axonal, injury and frontal lobe injury. Both boys would require in-patient rehabilitation and long term care.
This is where the story diverges. Unfortunately, the drivers of the vehicles responsible for the boy’s accident was driving on a suspended license with no insurance available whatsoever. Johnny’s parents were both fortunate and financially able to purchase Uninsured Motorist (U.M.) benefits that allowed our firm to pursue Johnny’s own insurance company for the injuries he sustained in the accident. Additionally, Johnny had private health insurance albeit with limited capped coverages and exclusions. Sound familiar?
Brad was not so fortunate. Brad’s parents had elected not to purchase U.M. benefits. However, Brad did however have limited health insurance available to him. Our law firm care management team got involved almost immediately following the accident to assist the family through each phase of the care. And to begin to lay the groundwork for what would be a long road to recovery.
Both families were connected to local state and federal resources that would be vital to their ongoing care. Additionally, the families were provided with the appropriate psychosocial support by the care management team. Ultimately though, we were frustratingly unable to pursue a claim on brad’s behalf due to the lack of any available auto insurance. This lack of funding for Brad prevented him and his family from gaining access to necessary in-patient rehab, support and services. His health insurance covered two weeks of rehab. He would require a lifetime of care. Today, Brad has been in and out of the criminal justice system due to behavioral and cognitive issues related to his TBI.
Johnny on the other hand has fared better. Following his hospital stay Johnny was transferred to a leading rehabilitation facility where he was able through the recovery from the legal case pay for extended care. Additionally, Johnny was able to gain access to high quality healthcare, support and services that have made all the difference in his life. Today Johnny has made a good recovery and is slowly making his way through college.
Reporting their two accounts are bitter sweet for me. I am happy for Johnny and his family. But everything in me wanted to do more for Brad.
Funding, particularly and almost always through the legal process provides an excellent opportunity for improved outcomes in TBI patient/families.
Patient/family centered team:
While funding is more often than not pivotal to recovery, it is the value of a patient/family centered team that is mostly needed. I strongly believe that it is only through the collaborative and multidisciplinary team approach between patient/families, the healthcare and legal communities along with community resource providers that give TBI families the best chance at a successful recovery.
It is for this reason that our family founded, the Toral Family Foundation, to partner with healthcare systems in research, education and the provision of resources to families living with TBI. The foundation gives us a platform to discuss the absolute necessity of working together.
I have learned the value of a team approach to representing TBI families. I have also learned that no one of us is as smart as all of us.