Every report identifies specific tactics, gives you ready-made counter-arguments, and tells you exactly what evidence to gather.
The adjuster will likely accept basic liability for the MVC but aggressively contest the severity and duration of the claimed traumatic brain injury and chronic migraines. They will anchor on the multiple “unremarkable” diagnostic images, specifically the negative head CTs and brain MRIs, to argue this is a subjective, pain-only claim.
They will point to pre-existing degenerative findings in the cervical spine and an incidental renal cyst as evidence of unrelated health issues driving her symptoms. The adjuster will also scrutinize the long tail of expensive neurology care, including repeated Botox injections and CGRP inhibitors into 2025, framing it as overtreatment for a baseline headache condition.
Finally, they will weaponize the claimant’s return to work in February 2024 to argue she reached MMI and has no ongoing functional impairment.
“The brain MRIs and head CTs were completely normal.”
“Concussions are functional injuries, not structural ones; an unremarkable MRI is standard for MTBI. The objective loss of consciousness at the scene and persistent cognitive deficits documented by neurology confirm the injury.”
“She has pre-existing degenerative disc disease in her neck.”
“Defendant takes the plaintiff as they find them. Her multilevel cervical stenosis was asymptomatic prior to the violent twisting mechanism of this crash, which triggered a new, documented pain trajectory.”
“The Botox and chronic migraine treatments are excessive and maintenance care.”
“This is medically necessary, specialist-directed care for status migrainosus caused by the collision. The treatments are explicitly tied to her post-concussive syndrome, not elective tune-ups.”
“She returned to work full-time in February 2024, so she’s fine.”
“She returned to work with accommodations out of financial necessity while still suffering >4 severe migraine days a month. Working through pain is not the same as being cured.”
“There was a two-month gap in her Botox treatments in late 2025.”
“The delay was driven by scheduling/moving logistics, not a lack of symptoms; the records explicitly note her headache frequency increased during that gap, proving the ongoing necessity of the care.”
Adjusters heavily rely on negative MRIs to discount MTBI claims and reduce general damages.
“There is no structural damage to the brain. Her ongoing complaints of memory loss and dizziness are purely subjective and don’t match the clean imaging.”
Educate the adjuster: MTBIs do not show up on standard MRIs or CTs, which only rule out bleeds/tumors. Rely on the EMS documentation of altered mental status/LOC at the scene and consistent, standardized functional symptom scoring (e.g., scoring 113/132 on the concussion scale).
Open by reminding the adjuster of the significant MOI (airbag deployment, hitting a guardrail, EMS transport) and the documented LOC, neutralizing the "subjective only" defense immediately.
Concede the renal cyst is unrelated but explain that the ED workup was standard trauma protocol. Frame the cervical DJD as a classic eggshell plaintiff scenario.
Use the years of documented, continuous neurology care as a sword. The sheer volume of failed medications (Lexapro, Topamax, Trokendi) proves this isn't a plaintiff trying to run up bills, but a desperate patient seeking relief.
The EMS report (p. 14-16), Dr. Corey's symptom inventory scores showing objective tracking, and the initial ED records noting the head strike.
Refuse to negotiate based solely on the medical bills. Keep the focus on the permanent alteration of her daily life and the necessity of lifetime future care for chronic migraines.