Ask the Attorney: What You Need to Know About Missed Concussions

Ask the Attorney: What You Need to Know About Missed Concussions

A concussion doesn't always look the same. After an accident, it's easy to focus on the injuries you can see and feel right away. But it’s also easy for a head injury to go unnoticed in the process. 

I’ve worked with clients in both workers' compensation and personal injury cases who later discover a concussion was missed in their initial evaluation. Here are some of the most common questions I’m asked about what that means for my client’s health and case.

How frequently do clients appear with a head injury that was never diagnosed as a concussion?

Quite often.

When someone is in an accident and goes to the emergency room, the focus is on what's obvious. Studies suggest that many mild traumatic brain injuries get missed at the ER, and part of that comes down how they evaluate concussion-like symptoms.

What I commonly see is someone who comes into my office complaining of pain in the neck, mid-back, or low back, but among those complaints there are symptoms that stand out. I work in a bright office with LED lighting, and I'll notice people squinting. I'll ask if they'd like me to dim the lights. When I do, their eyes open and relax. That's light sensitivity, and it's one of the classic signs of a concussion or brain injury.

Other symptoms I watch for include audio disturbances (like ringing in the ears), hearing changes, difficulty with depth perception, and disorientation. Headaches are probably the most common, but they don't always get the full workup they deserve.

Why do concussions get missed?

A few reasons.

Emergency care is focused on keeping you stable in the short term. Even if someone mentions headaches, the workup may not be thorough enough to identify a brain injury.

There's also a very common misconception: people come to me saying they don't think they have a concussion because their MRI was clean. A clean scan doesn't mean there's no injury.

The medical definition of a mild traumatic brain injury is a brain injury without diagnostic evidence on imaging. Mild doesn't mean insignificant — it means the injury doesn't show up on a CT or MRI. The technology has improved but it's still not comprehensive, and someone can have a clean scan and still have very real, very disabling symptoms.

There's also a category of headaches worth knowing about: cervicogenic headaches. These come from trauma to the cervical spine rather than the brain itself. Early treatment focuses on the muscles and spine first (which is appropriate), but it can mean a potential brain injury goes unaddressed for a long time.

What symptoms might point to a missed concussion?

Beyond headaches, here's what I tell clients to watch for:

• Light sensitivity: squinting in normal light, discomfort outside
• Audio disturbances: ringing, muffled hearing, or hearing changes
• Vision problems: double vision, difficulty tracking, depth perception issues
• Disorientation or cognitive changes: difficulty concentrating, memory gaps
• Headaches that don't improve: especially if they're not responding to treatment for a neck or back injury

Vision-related symptoms occur frequently in my cases. There are now FDA-approved tools, like the EyeBOX, that track eye movement and can objectively show abnormal visual function, even when standard imaging is clean. Specialized corrective lenses, including prism lenses, have produced real symptom relief for some of my clients. It's not a cure, but it can help considerably.

What questions should someone ask their doctor if they think they might have a concussion?

I'm not a doctor, and I can't give medical advice. As your attorney, though, I can help you ask better questions.

Here are a few worth raising:

• Could my headaches be related to a head injury rather than my neck?
• Should I be evaluated by a concussion specialist?
• Have you ruled out a brain injury given my symptoms?
• Is there an eye specialist I should see?

Some doctors will make those referrals on their own. Others won't, and you may have to ask. In the weeks after an accident, especially when symptoms aren't improving, being thorough with every provider matters.

Searching for "concussion specialist" will turn up real options in your community. If your doctor isn't making a referral, it's reasonable to seek one out yourself. If you don't ask, the answer is definitely no.

How does documentation affect a concussion claim, especially when a diagnosis comes late?

Good documentation matters for your health first, and your case second.

Your medical record is the foundation of what I can do for you. It's how I demonstrate to an insurance company, a compensation judge, or a jury that your injuries are real, that they've been tracked over time, and that they connect to your accident. If the early records don't reflect your symptoms — even if you were experiencing them — that creates an uphill battle later.

One of the most practical things my clients can do is keep a symptom journal. It doesn't have to be elaborate. A few notes each day about your pain levels, what you're experiencing, and how it's affecting your daily life is enough. One client of mine used a color-coded key to mark what kind of day she was having. That became a powerful piece of documentation that helped resolve her case favorably.

On the legal side, it's worth knowing that insurance companies have a right to send you to a doctor of their choosing, commonly called an "independent medical examination." But there’s nothing independent about it. 

These are doctors hired to evaluate you on behalf of the party that benefits financially from minimizing your claim. Our team has substantial experience challenging those opinions, and the documentation your own providers create is what makes that possible.

What do you do when a potential client comes to you with concussion-like symptoms but no formal diagnosis?

The first thing I do is ask about how the injury happened — and whether a brain injury could have resulted from it. From there, I ask some basic questions: Are you sensitive to bright light? Are you having trouble hearing or focusing? Where exactly are your headaches?

If the answers suggest a possible brain injury, I want to make sure a few things happen:

• Report every symptom at every appointment. Doctors can only work with what they're told, and if something doesn't make it into the record, it becomes much harder to use later. 
• Ask about specialist referrals.  For a work injury, that means making sure occupational medicine is coordinating appropriate specialist evaluations. For a personal injury claim, there's typically more flexibility to self-refer to a concussion specialist.
• Consider objective testing. In some cases, I may suggest an evaluation using something like the EyeBOX. If it comes back with findings, you’ll have a report to bring to your treating providers — and a path to further evaluation.

Throughout all of this, I tell people to be patient. Concussions can be complicated. The medical process often involves a series of treatments and course corrections before the picture becomes clear. 

What matters most is that symptoms are being documented, the right questions are being asked, and someone is helping you make sense of where things stand.

Have questions about your injury? Contact Aaron Ferguson Law to schedule a consultation.