Yle finds assessment gaps fueling brain injury insurance disputes

Inadequate examinations and the long-term effects of mild brain injuries are driving insurance disputes, Yle’s investigative programme MOT found after reviewing nearly 100 cases.

About 20,000 people in Finland sustain a brain injury each year, many of them young. Falls are the most common cause, often involving a blow that damages brain tissue.

In 2011, a lorry travelling at about 80 km/h struck the back of a stationary car in Mikkeli. The car’s rear was destroyed, and its driver was taken to hospital. He later experienced problems with memory and concentration, as well as emotional changes, and had to stop working.

The man eventually sued the insurer, asking a district court to confirm that brain and neck injuries from the crash had left him completely unable to work. The insurer disputed his claim to a full disability pension, arguing that his brain injury had initially been classified as mild and that people usually recover well from such injuries. It also said he had previously had similar health problems. The man said he had been healthy before the crash.

The insurer called neurologist and chief physician Jari Honkaniemi as an expert witness. Honkaniemi said the man’s inability to work was explained not by his injuries but by psychiatric and personality-related problems, alcohol use and problems with the workplace atmosphere. He also said legal proceedings related to the injury could have prolonged the symptoms, and concluded that the man had no permanent impairment from the crash.

MOT’s review found that initial examinations and records of brain injuries often have serious shortcomings. The initial classification, based on factors including consciousness, memory and imaging, is central to assessing long-term effects. That assessment can also significantly affect the level of insurance compensation.

Memory should be assessed carefully and repeatedly when a brain injury is suspected, but that does not always happen in emergency departments. MRI scans may also be delayed beyond recommended times. In some cases, key criteria for classifying the injury cannot be reliably assessed.

“A person suffers a head injury and loses consciousness. If there are no witnesses, there is no certainty about how long they were unconscious. That alone creates sources of error,” said neurosurgeon Teemu Luoto, who chairs the group behind Finland’s clinical guidelines on brain injuries. Uncertainty can lead to an injury being classified as milder than it is, he said, adding that this happens often.

MOT found a recurring pattern in its cases: people have serious, long-lasting symptoms and may be unable to work, even though their brain injury was classified as mild. Disputes often centre on whether the symptoms are caused by the injury or something else. Expert witnesses play an important role in helping courts assess medical questions. Court records show Honkaniemi has testified in about 80 cases.