Understanding TBIs: The Most Common Catastrophic Injury in Workers’ Compensation

Traumatic brain injuries (TBIs) of varying severity are the most frequently occurring catastrophic injury in workers’ compensation. About 24% of the 2.8 million TBIs that occur annually happen in the workplace, and it is estimated that around 1,200 are fatal. These injuries carry lifelong ramifications for an injured worker, making the approach to treatment and recovery a critical component to achieving the best possible outcomes.

“The key to optimal outcomes is access to prompt brain injury-focused medical care and rehabilitation with stakeholder involvement throughout the process,” said Stacy Whalen, Senior Medical Manager at Safety National. “This includes diligent and focused claims management prioritizing the needs of the injured worker.”

Here, we outline some of the TBI treatment, recovery, and return-to-work options for a catastrophic work injury.

Treatment Options

Developing the right treatment plan for a TBI starts with the appropriate classification and prognosis of the level of injury. Common classification methods, like the Glasgow Coma and Rancho Los Amigos Scales, can track the extent of the injury by assessing how the employee is responding post-incident. The type of injury, level of treatment, and existing comorbidities can all impact prognoses.

In catastrophic TBI cases, medications may be administered during emergency care to minimize inflammation, bleeding, or reduced oxygen to the brain. These can include anti-seizure drugs, coma-inducing drugs, and diuretics, which can help reduce pressure inside the brain and the amount of fluid in tissues. Surgery may also be necessary to reduce bleeding, repair skull fractures, or remove a section of the skull to allow room for tissue swelling. In most instances, rehabilitation will be necessary for individuals to regain their ability to perform daily activities and potentially basic skills.

Rehabilitation and Recovery

Comorbidities play a critical role in how likely an individual is to recover from a TBI. Patients with pre-existing psychological conditions and individuals over 55 may not recover or have a much more difficult path to recovery based on the brain’s ability to heal. The most significant element in recovering from a brain injury can be the quality of the rehabilitation care they receive, making it especially important to send brain injury patients to a center of excellence for their rehabilitation. These groups provide specialized care for specific conditions, often utilizing more advanced technologies, experienced staff, and rigorous treatment plans.

A meticulously planned rehabilitation program will continue after an individual is discharged. Follow-up treatments should include a day program and outpatient therapy to maintain their progress. Post-acute rehabilitation facilities, such as transitional learning centers, can help individuals regain their independence through a structured environment and comprehensive treatment. These programs may focus on physical, cognitive, and behavioral skills. Model systems are federally-funded rehabilitation centers that provide multidisciplinary care to improve the outcomes of TBIs. They often conduct research and collaborate with other centers to develop their approach to care. Community-based care may be an option for injured workers ready to return to independent living and potentially work. According to the Brain Injury Association of America, these programs generally focus on developing higher-level motor, social, and cognitive skills, like community safety, social interactions, and money management.

Return-to-Work Outlook

Around 35-50% of patients who experience a moderate to severe TBI will return to work. That proportion is much higher in mild TBIs, with injured workers returning at a rate of 89% after one year post-injury. For those with moderate to severe TBIs, recovery may take weeks, months, or even longer before returning to work. In rare cases, some will need long-term care, requiring home health and more intense demands of their family and support structure.

Accommodations such as modified work schedules, part-time duties, or different roles can help ease the transition for those returning to work. Early intervention and support, like employment assistance and vocational rehabilitation, can also facilitate a successful return to work. Work participation can vary based on ongoing symptoms, so it is critical for employers to adapt occupational duties to an injured worker’s needs. Long-term employment stability will depend on the challenges of reintegrating into the workforce, which can vary based on the occupational industry of an injured worker. Cognitive and functional improvements, as well as access to resources and support, will also drastically impact an individual’s job stability.