How Are Traumatic Brain Injuries Diagnosed?
Diagnosing a Traumatic Brain Injury (TBI) is a multi-step process that starts with the patient’s condition at the scene.
Critical questions need to be answered early on, like:
- Was there a loss of consciousness? If so, for how long?
- Does the person have any memory of the incident, or are they amnesic?
- Do imaging studies show a brain bleed or any evidence of a TBI?
- How do people who knew the patient before the TBI describe their behavior before and after the incident?
Loss of Consciousness Doesn't Always Look the Same
Doctors and first responders assess whether an injured person lost consciousness and, if so, for how long. They also check whether the person can remember what happened right before and after the incident, a gap known as post-traumatic amnesia. Both feed into a standard assessment called the Glasgow Coma Scale (GCS), which doctors use to gauge severity in the hours after an injury.
- Mild TBIs score between 13 and 15
- Moderate TBIs score between 9 and 12
- Severe TBIs score between 3 and 8
The severity of your GCS score will also influence your TBI lawsuit. A mild score on the Glasgow Coma Scale does not mean a mild case. Insurance adjusters often seize on a 13 to 15 score to argue the injury was minor, and the claim should be valued accordingly, even when the person's life has changed in ways the number does not capture. This is one of the most common friction points in a brain injury claim: The GCS was designed to help doctors triage patients in the first hours after an injury, not to measure how a life will look six months or a year later.
The score can also be misleading for reasons unrelated to the actual severity of the brain injury. Alcohol, sedatives, other injuries, intubation, or being combative in an ambulance can all pull a GCS score down or make it impossible to assess accurately at the scene. When that happens, the recorded score may not reflect the true extent of the brain injury, and it becomes something the case has to work around rather than rely on.
At the other end, a moderate or severe score changes the conversation with an insurance company. These scores are harder to dispute and tend to support broader claims because they connect more directly to long hospital stays, rehabilitation, and permanent changes in someone's ability to work or care for themselves. A lower score also opens the door to future damages, since moderate and severe TBIs carry a higher risk of long-term complications that a jury or insurance adjuster needs to account for.
Because of how much weight adjusters and defense attorneys put on this single number, a GCS score can’t be treated as the full picture when building a claim. It needs to be paired with other evidence, imaging, memory gaps, and testimony from people who knew the injured person beforehand, so the claim reflects what happened rather than a score recorded after impact.
Imaging Studies
Imaging is often one of the first things an insurance company looks at when reviewing a brain injury claim, and it's also where claims can run into trouble.
A CT scan or MRI can confirm a brain injury beyond question, but it can also come back “clean” when the person is still dealing with headaches, memory problems, or a personality that doesn't match who they were before the accident.
A normal scan is treated by insurers as proof that nothing is wrong, when in reality, it often means the injury is real but too subtle for the scan to detect.
Different imaging tools are built to catch different things, which is why a single scan rarely tells the whole story on its own.
- CT scan: Usually the first scan ordered in an emergency room because it's fast and widely available. It's good at finding bleeding, skull fractures, and swelling that need immediate attention, but it can miss the kind of microscopic damage that comes with a concussion or mild TBI.
- Standard MRI: More detailed than a CT scan and better at picking up smaller areas of bleeding or bruising on the brain. Still, a standard MRI can come back normal in cases where real injury exists, particularly with milder trauma.
- Diffusion tensor imaging (DTI): A specialized MRI technique that looks at the brain's white matter tracts, the connections nerve cells use to communicate. DTI can pick up diffuse axonal injury, a type of damage caused by the brain twisting or shearing inside the skull, which a standard CT or MRI typically cannot see.
- Susceptibility-weighted imaging (SWI): Another advanced MRI technique, SWI is tuned to detect tiny areas of bleeding called microhemorrhages that are common in more severe TBIs.
- PET and SPECT scans: These measure brain activity and blood flow, not just structure. They're used less often, but they can show functional changes in a brain that looks structurally normal on a CT or MRI, which makes them useful in cases where someone is exhibiting symptoms but had a “normal” standard scan.
In a lawsuit, imaging serves as clear, objective evidence. When a scan shows a bleed, a lesion, or axonal injury, it's difficult for an adjuster or defense attorney to argue that the person wasn't hurt. That's why claims with strong imaging tend to move faster.
The more difficult cases are the ones where the first scan comes back clean. This is where the choice of imaging—and knowing when to push for something beyond a standard CT or MRI—is critical.
A DTI or SWI study may reveal an injury that a standard scan missed, and that finding can be the difference between a claim that insurers are willing to fight and one they're ready to resolve.
The People Who Knew You Before
There is a third form of proof that does not involve medical equipment: before-and-after witnesses, aka the spouse, coworker, or longtime friend who can describe exactly how someone changed after a head injury.
People with a genuine brain injury do not always recognize every way it has altered them. Family and coworkers tend to notice first: missed appointments, a shortened temper, a once-routine task that now takes twice as long. A firsthand account fills in what a scan or a coma-scale score cannot capture on its own.
Insurance adjusters reviewing a brain injury claim tend to weigh the imaging and how quickly treatment began. Testimony from the people who knew the injured person before rounds out what those records alone cannot show: what actually changed in their day-to-day life.
How Cutt, Kendell & Olson Can Help
Cutt, Kendell & Olson has represented injured Utahns since 2000, recovering more than $950 million in verdicts, settlements, and arbitration awards, including brain injury cases. For someone dealing with a traumatic brain injury after an accident caused by someone else's negligence, or a family managing the claim on a loved one's behalf, we provide:
- Direct access to the attorney handling the case. We intentionally limit our caseload to serious injuries only to ensure we can give each client the time and resources their case warrants. Here, clients are not handed off to a paralegal or a rotating case manager while a claim moves forward.
- Coordination of the medical evidence a brain injury claim requires. This includes working with treating physicians, arranging advanced imaging when a standard CT or MRI does not capture the full extent of an injury, and organizing records into a claim.
- Help identify and prepare before-and-after witnesses. Family members, coworkers, and friends are often unsure how their observations fit into a claim; we help gather and present that testimony.
- Representation for family members pursuing a claim on someone else's behalf. When a brain injury leaves someone unable to manage their own legal claim, a spouse, parent, or guardian can step in, and Cutt, Kendell & Olson guides that process from start to finish.
- No upfront cost. Initial consultations are free, and we do not collect legal fees unless we recover compensation for the client.
If you or a family member is dealing with a brain injury after an accident, even one without a clean scan or a loss of consciousness, Cutt, Kendell & Olson's brain injury attorneys can evaluate what happened and explain your options. Call (801) 901-3470 or message us online to schedule a free initial consultation.