Post concussion syndrome and your injury claim: documenting an injury no one can see
Record lingering symptoms, prepare for insurer exams and meet claim deadlines
Imagine a 38 year old bank teller who was rear ended at a stoplight. The emergency room sent her home with a normal CT scan and a sheet about concussion. Three months later she still gets headaches by midafternoon and loses her place in conversations. The other driver’s insurer keeps calling to ask why she is still in treatment.
Post concussion syndrome (PCS) is a common name for concussion symptoms that do not fade after the first few weeks and sometimes last for months. You feel it every day, yet nobody can point to it on a scan or a cast.
This guide looks at why PCS claims draw doubt and how to build a record that answers it. Later sections cover insurer exams, social media, deadlines and settlements. Rules differ by state and policy, so check the details with your state insurance department or an attorney.
Why concussion claims get questioned
With a broken arm, the X-ray does much of the work of proving the injury. With a concussion, the proof is harder to point to.
Normal scans and the word “mild”
The CDC says a concussion can be identified without any brain scan, and scans are mostly used when there is a risk of bleeding [1]. Providers also tend to call a concussion a mild brain injury, mainly because it is usually not life threatening [1]. Even so, the CDC warns that the effects of this so called mild injury can be serious [1].
Delayed and missed symptoms
Some concussion symptoms appear at once, and others surface hours or days later [8]. To an adjuster, a gap between the crash and your first complaint can suggest another cause. The injured person, family members and even health care providers can miss problems, too [8].
Overlap with other causes
Headaches, poor sleep and trouble focusing can also come from stress, pain or older health problems. A 2014 systematic review of studies on adults after mild brain injury noted that crash related concussions often come with neck and back injuries, which may cause some symptoms [9]. Stress, mood and other life factors were more strongly tied to outcomes than the injury details doctors usually record [9]. None of that makes your symptoms less real, and a clear record shows how they have changed since the crash.
What medical tests can and cannot show
Brain scans
CT scans are good at finding bleeding that needs urgent care, but they can miss small changes. A 2013 study from the NIH funded TRACK TBI project enrolled 135 people seen in three trauma center emergency departments for mild brain injury [10]. More than a quarter of those whose CT scans were read as normal had small injuries that showed up on MRI [10]. Some kinds of MRI findings were linked with poorer recovery three months later [10].
Blood tests
A whole blood test called the i-STAT TBI cartridge won FDA clearance in 2024 for adults with a suspected mild brain injury [11]. It measures two proteins, GFAP and UCHL1, in people seen within 24 hours of the injury to help decide whether a head CT is needed [11]. A result that is not raised goes along with no fresh bleeding or similar injury on CT, and the test is not meant to stand alone [11]. It is cleared only to help with that CT decision, not to diagnose concussion or to predict symptoms weeks or months later [11].
Thinking tests and validity checks
Neuropsychological testing uses paper, computer and spoken tasks to measure memory, attention, speed and problem solving. The CDC notes that a concussion may not show up on these tests, even when it is there [1].
Testing includes validity measures, which check whether scores give a true picture of a person’s effort and symptoms. A 2021 statement from the American Academy of Clinical Neuropsychology calls for several validity checks in every evaluation, whether for treatment or for a legal case [12].
Failing one check is not proof of faking. The statement warns that treating any invalid result as deliberate exaggeration is too simple [12]. A single failed check can happen in people whose reports are credible, and factors outside a person’s control can affect scores [12]. If you are tested, rest the night before, mention pain or poor sleep that day, and give full effort on every task.
Building a clear record from the first days
Get care early and tell the same full story
Get checked soon after a crash, and keep up with follow up care. Long gaps can give an insurer room to argue that something else caused your symptoms. If you stop a treatment, tell your provider why so the reason is in your chart.
At each visit, describe the crash, every symptom and when it started, even ones that feel minor, such as irritability. If a visit note leaves something out or has a wrong date, ask the office how to get it fixed.
Keep a symptom and impact log
Medical visits are short snapshots, and a log fills in the days between them. Rate each symptom and note what it kept you from doing and what helped. Keep entries brief and honest, and include good days too.
Comparison compiled by Safety Behind the Wheel Foundation
A simple symptom and impact log
| Day | Symptoms (0 to 10) | What it changed | What helped |
|---|---|---|---|
| Monday | Headache 6, light 5 | Left work 2 hours early | Dark room, short rest |
| Tuesday | Headache 3, foggy 4 | Missed a recipe step twice | Wrote steps on a card |
| Wednesday | Dizzy 5 after shopping | Skipped son’s ball game | Lay down for an hour |
Example entries are made up. Change the columns to fit your own symptoms and bring the log to each visit.
Ask others what they have seen
Family, friends and coworkers notice changes you may miss. The CDC points out that a person with a concussion may not recognize or admit their own problems [8]. Ask two or three people to write a short, dated note in their own words, such as a coworker who now checks your emails for mistakes.
Danger signs that need emergency care
The CDC lists the warning signs below. If you have any of them, someone should call 911 or get you to an emergency department right away [8].
- A headache that worsens and does not ease off
- Weakness, numbness, clumsiness, seizures or convulsions
- Throwing up again and again
- Slurred speech or behavior that is not normal for you
- Pupils of two different sizes (each pupil is the dark circle at the center of an eye)
- Not knowing people or places, confusion, restlessness or agitation
- Passing out, deep drowsiness, or being unable to wake up
Your claim records checklist
Checklist from Safety Behind the Wheel Foundation
- Claim numbers, policy numbers and adjuster names for every insurer
- The police crash report number and photos of the vehicles and scene
- Dates of every medical visit, with bills and insurer statements
- Pay stubs, time sheets or an employer letter showing missed work
- Receipts for travel to care, medicines, devices and help at home
- Dated notes from family, friends or coworkers
- Copies of every letter and email about the claim
- Records of earlier concussions, migraines or mental health care, if any
Paying for treatment while your claim is open
Which coverage helps pay for PCS care depends on your state, your policies and the facts of the crash.
The NAIC, short for National Association of Insurance Commissioners, lays out the usual options in a 2011 consumer guide [13]. Personal injury protection (PIP), offered in no fault states, pays to treat you and your passengers and can also cover lost wages [13]. Medical payments coverage, or med pay, also covers medical care for you and anyone riding with you [13]. Coverage for uninsured and underinsured drivers (UM and UIM) can help when the driver at fault has no insurance, too little insurance, or drove off [13].
Comparison compiled by Safety Behind the Wheel Foundation
Where money for care may come from
| Coverage | What it may pay | What it usually needs |
|---|---|---|
| PIP (no fault states) | Medical bills, some lost wages | Prompt notice and care |
| Medical payments | Medical bills for you and passengers | Bills, records, policy limits |
| Health insurance | Covered care under your plan | Plan rules on crash injuries |
| Liability claim | Losses caused by the driver at fault | Proof of fault and injury |
| UM or UIM | Losses the other driver cannot cover | Your policy’s notice rules |
| Disability benefits | Part of lost income | Policy terms or SSA rules |
Sources: NAIC [13]; Florida and New York rules [2, 3]; Social Security Administration [14]. Your policy and state law control the details.
Two state examples of PIP time limits
Florida’s PIP law pays 80 percent of reasonable medical costs if you get initial care within 14 days after the crash [2]. Benefits for care can reach $10,000 if a physician, dentist, physician assistant or advanced practice registered nurse finds an emergency medical condition [2]. Without that finding, they stop at $2,500 [2].
New York’s required PIP coverage calls for written notice of the accident as soon as reasonably practicable and no later than 30 days after it [3]. Claims for medical bills are due within 45 days of the care [3]. Late notice may still be accepted with a clear and reasonable written reason [3].
These are only two states, and this list is not complete. Ask your insurer or state insurance department which deadlines apply to you. If PCS keeps you from working, ask about disability coverage too. Social Security disability is only for conditions that limit your work for at least 12 months [14].
Insurer medical exams
An insurer may ask you to see a doctor it chooses, often called an independent medical exam, or IME. The insurer’s side picks the doctor, and the visit is separate from the care your own doctors give you [4].
What some states require
Florida law says a person claiming PIP must attend a mental or physical exam if the insurer asks [2]. The insurer pays, and the exam must take place in the city or town where you get treatment or at a place reasonably close to your home [2]. The insurer may not materially change the examining doctor’s opinion in the report [2].
New York’s PIP rules require you to see doctors the insurer selects as often as it may reasonably require, and you may be asked to answer questions under oath [3]. If you bring a claim or lawsuit against the other driver, that driver’s insurer may also require an exam [4].
What to expect and how to prepare
Nolo, a consumer legal publisher, says the visit usually starts with your history: how the crash happened and what care you have had [4]. The doctor may watch how you move around the room and will look for signs of exaggeration [4].
- Bring a short written statement of your symptoms and how they limit your days, so nobody is confused about what you said [4].
- Ask ahead whether a spouse, partner or friend may come with you [4].
- Answer honestly, and do not play symptoms up or down.
- Afterward, write down the start and end times, who was there, and what was asked and done [4].
Online posts
A smiling photo from a birthday party can look like proof that you are fine, even if you slept 12 hours afterward. In Forman v. Henkin, decided in 2018, New York’s highest court heard a case brought by a woman who said a fall from a horse left her with memory loss and thinking problems [5].
The court ruled that the test for sharing is relevance, so privacy settings do not settle the question [5]. It let the defense get photos of her posted privately after the fall, plus data on when she posted messages and how long they were [5]. It also said courts should fit such orders to the injuries claimed and can shield sensitive material [5].
Courts in other states may see this differently. Still, posting less while a claim is open is a simple step. Ask an attorney before you delete old posts once a claim is under way.
Things you do in public can be seen by others while a claim is open. That is no reason to stop living, but if you go to a ball game, note in your log how you felt afterward.
Earlier injuries and health problems
The other side may challenge a claim by pointing to your health before the crash [15]. Under a legal idea called the eggshell plaintiff rule, a person liable for an accident must answer for all the injuries it causes, even to someone more fragile than most [15]. In general, that covers harm the crash made worse, though not a condition that was already there [15].
Records from before the crash can help show what changed [15]. Be open with your providers about earlier concussions, headaches or mental health care. Leaving them out can make your account harder to trust if they come up later.
Deadlines, settlements and getting help
Deadlines to file a lawsuit
Each state sets a statute of limitations, the deadline to file a lawsuit. If you miss it, you may lose the right to sue.
- Under the 2026 Florida Statutes, a lawsuit based on negligence generally must be filed within two years [6]. Florida cut this from four years in 2023, for claims arising after March 24 of that year [16].
- In New York, a lawsuit for personal injury generally must be filed within three years, with some exceptions [7].
Other deadlines may apply to your case, so check your own state’s current law soon after a crash.
Settlement timing and releases
Most adults with a mild brain injury recover within 3 months to a year, but a sizable minority keep having symptoms [9]. Until your care team has a clearer view of your recovery, it is hard to know what your claim is worth.
The NAIC guide says not to feel rushed or pushed into agreeing to anything you are not comfortable with [13]. In Texas, the state insurance department explains that when the at fault driver’s insurer offers a settlement, it will ask you to sign a release [17]. That is a promise not to file more claims for the crash, and the department suggests talking with your doctor about future treatment before you sign [17]. Wherever you live, ask what rights a release would give up and what happens if symptoms get worse later.
When the claim itself wears you down
An Australian study followed 332 people who were hospitalized with serious injuries and later claimed compensation through transport accident or workers’ compensation schemes [18]. It was not limited to brain injuries. In an earlier report on the same group, people who found the claims process stressful were more likely to have disability, depression and anxiety six years later [18]. The authors stress that the early factors in their models are markers of risk, not causes [18].
Some studies have also found that people in litigation after a mild brain injury report more symptoms, though the 2014 review rated the evidence overall as weak and mixed [9]. These are associations, which cannot show that a claim causes symptoms. If the process is wearing you down, tell your care team and let someone you trust take some of the calls.
When to get help
Consider talking with a personal injury attorney if symptoms last more than a few weeks, an insurer cuts off benefits, or someone offers a settlement. If a dispute with an insurer is not resolved, the NAIC guide suggests asking your state insurance department’s consumer services staff for help [13].
Questions to ask your insurer or an attorney
Question checklist from Safety Behind the Wheel Foundation
- What notice, treatment and lawsuit deadlines apply to my claim in my state?
- Which coverages on my policy, such as PIP, med pay, UM or UIM, apply to this crash?
- Will my health plan expect to be repaid from a settlement?
- If you deny or cut a benefit, will you explain why in a letter?
- Do I have to attend this exam, who will do it, and how do I get the report?
- If I settle now, what rights would I give up, and what if my symptoms get worse?
Frequently asked questions
Can I still make a claim if my brain scans were normal?
Yes. The CDC says a concussion can be present even when tests look normal [1]. Medical notes, a symptom log and statements from people who know you help show what changed.
The bottom line
Recommendation from Safety Behind the Wheel Foundation
A concussion that lingers is real, even when scans are clear. A claim for it leans on prompt care, the same story at every visit, a simple symptom log and notes from people who see you often. Learn your policy’s deadlines early, and get ready before any insurer exam.
Rules differ by state, policy and type of claim, so check your policy and take questions about it to your state insurance department. Before you sign a release, ask your doctor what care you may still need [17]. A qualified attorney can explain what a release would give up.
Sources and further reading
- 1Centers for Disease Control and Prevention. About mild TBI and concussion. Updated September 15, 2025. cdc.gov/traumatic-brain-injury/about/index.html
- 2Florida Statutes section 627.736, Required personal injury protection benefits; exclusions; priority; claims. 2026 Florida Statutes. Florida Senate. m.flsenate.gov/Statutes/627.736
- 3New York State Department of Financial Services. 11 NYCRR 65-1.1, Mandatory personal injury protection endorsement (Regulation 68). Amended February 8, 2023. Via Legal Information Institute. law.cornell.edu/…/11-NYCRR-65-1.1
- 4Nolo. The independent medical examination (IME) in a car accident case. Updated March 12, 2024. nolo.com/…/the-independent-medical-examination-ime-in-a-car-accident-case.html
- 5Forman v Henkin, 30 NY3d 656, 2018 NY Slip Op 01015 (N.Y. Court of Appeals, February 13, 2018). nycourts.gov/…/2018_01015.htm
- 6Florida Statutes section 95.11, Limitations other than for the recovery of real property (subsection (5)(a)). 2026 Florida Statutes. Florida Senate. m.flsenate.gov/statutes/95.11
- 7New York Civil Practice Law and Rules section 214, Actions to be commenced within three years. Most recent revision February 25, 2022. New York State Senate. nysenate.gov/legislation/laws/CVP/214
- 8Centers for Disease Control and Prevention. Symptoms of mild TBI and concussion. Updated September 15, 2025. cdc.gov/…/signs-symptoms/index.html
- 9Cassidy JD, Cancelliere C, Carroll LJ, et al. Systematic review of self-reported prognosis in adults after mild traumatic brain injury: results of the International Collaboration on Mild Traumatic Brain Injury Prognosis. Archives of Physical Medicine and Rehabilitation. 2014;95(3 Suppl 2):S132-S151. doi.org/10.1016/j.apmr.2013.08.299
- 10Yuh EL, Mukherjee P, Lingsma HF, et al. Magnetic resonance imaging improves 3-month outcome prediction in mild traumatic brain injury. Annals of Neurology. 2013;73(2):224-235. doi.org/10.1002/ana.23783
- 11U.S. Food and Drug Administration. 510(k) substantial equivalence determination decision summary, K234143: i-STAT TBI cartridge with the i-STAT Alinity system. Decision date March 27, 2024. Reproduced by Innolitics FDA 510(k) database. fda.innolitics.com/device/K234143
- 12Sweet JJ, Heilbronner RL, Morgan JE, et al. American Academy of Clinical Neuropsychology (AACN) 2021 consensus statement on validity assessment: update of the 2009 AACN consensus conference statement on neuropsychological assessment of effort, response bias, and malingering. The Clinical Neuropsychologist. 2021;35(6):1053-1106. doi.org/10.1080/13854046.2021.1896036
- 13National Association of Insurance Commissioners. A consumer’s guide to auto insurance. 2011, Tennessee Department of Commerce and Insurance printing August 2016. tennessee.gov/…/Consumer_Guide_Auto_Insurance.pdf
- 14Social Security Administration. Who can get disability. Updated January 26, 2026. ssa.gov/disability/eligibility
- 15Nolo. How a pre-existing condition can affect a personal injury claim. Accessed October 2026. nolo.com/…/what-if-my-accident-made-a-pre-existing-injury-worse.html
- 16Greenberg Traurig. Tort reform overhauls Florida’s litigation landscape (GT Alert). April 20, 2023. gtlaw.com/…/tort-reform-overhauls-floridas-litigation-landscape
- 17Texas Department of Insurance. Auto insurance guide. Last updated December 11, 2025. tdi.texas.gov/pubs/consumer/cb020.html
- 18Spittal MJ, Grant G, O’Donnell M, McFarlane AC, Studdert DM. Development of prediction models of stress and long-term disability among claimants to injury compensation systems: a cohort study. BMJ Open. 2018;8(4):e020803. doi.org/10.1136/bmjopen-2017-020803
This article reflects the safety priorities of concussion recovery and road safety education. It offers general education about how injury claims and auto insurance usually work, not legal, insurance or medical advice. Claim rules, deadlines and policy terms differ by state and change over time, so check your policy, your state insurance department and other official sources, and talk with a qualified professional or your own care team about your situation. Reviewed October 2026.
Special thanks to our contributors
We appreciate the professionals, experts, and community members who share their knowledge and perspectives to help make this resource better. Your insights are always welcome and appreciated.
Have professional expertise, firsthand experience, or a perspective that could make this resource better?
We welcome your input. Your knowledge and experience can help us make this resource more useful, accurate, and meaningful to the people who rely on it.
Thank you. Your contribution is on its way.
We’re grateful you took the time to share your knowledge with us. Our team reviews every contribution with care. If it helps improve this resource, we’ll update the page and recognize you the way you chose.
Keep learning
Safe Driving Resource Center
Guides, self-checks and articles for drivers, parents of new drivers, and families recovering after a crash.
Social media, surveillance and your health history