Crashes get the attention, but falls do more of the damage: down stairs, off ladders, from scaffolding, and on ice outside a building nobody had treated. Being struck by something on a site, a bicycle or pedestrian collision, and assaults account for much of the rest. What the causes share is that the head is rarely the injury anyone is looking at first.
That is where the record starts going wrong. Someone arrives at an emergency department with a broken wrist and a bleeding scalp, and the wrist is what gets imaged, splinted and written up at length. The head gets a line saying the patient was alert and oriented. Months later, when the memory problems are undeniable, that single line becomes the strongest document the insurer has, and it was written by someone who had four minutes and a corridor full of people waiting.
Access to rehabilitation is uneven, and it shows up in the file rather than in the recovery. Specialist brain injury programs cluster around a handful of centers, so a patient living near one gets frequent, documented follow-up, while a patient two hours away gets a phone review and a discharge letter. The second person is not doing better. Their paperwork is simply thinner, and thin paperwork gets read as a mild injury.
A bad injury usually means a hospital stay and then months of cognitive and physical therapy, and it is that long course of treatment, far more than the place the accident happened, that sets what a claim is worth. Schools and employers hold part of that picture too, in adjusted duties, changed grades and performance reviews that nobody thinks to ask for.
