Post-Concussion Syndrome: BIIA Says No Objective Proof Required—But Also “Never Gets Worse”

By John M. Zanetti, Attorney at Law

The Board of Industrial Insurance Appeals recently issued the significant decision In re Didier Lappin.[1] The case involved a truck driver who sustained a head injury in 2017 after being struck by the hood of his truck. His claim was closed in 2018, a reopening application was denied in 2019, and in 2022 he sought once more to reopen, alleging worsening of his post-concussion symptoms.

In its decision, the Board held that post-concussion syndrome should be treated as a psychiatric condition. That classification matters—under long-standing precedent, psychiatric conditions, as opposed to physical conditions, do not require objective medical findings to establish either allowance or reopening. By making that classification, the Board clarified the evidentiary bar for claimants, who may now more openly rely on subjective symptoms rather than objective clinical measures.

At the same time, however, the Board in Lappin affirmed the denial of reopening, finding the worker’s symptoms had not worsened. Notably, in explaining its reasoning, the Board went further, stating “…post-concussive syndrome only rarely lasts beyond two years and never gets worse….” That pronouncement creates an inherent tension. On the one hand, the condition is treated as psychiatric, allowing reopenings based on subjective complaints alone. Yet on the other hand, the Board declared that by its nature, post-concussion syndrome never worsens.

For self-insured employers, this tension is critical. Employers can likely expect more reopening applications citing subjective symptoms; however, Lappin also provides strong arguments and language undermining the evidentiary requisite of reopening claims for post-concussion symptoms.[2] For practical purposes, that also means employers should focus on pinning down terminal dates, carefully reviewing records, and pressing experts to address whether and how any reported changes over time could truly reflect worsening—versus simply the natural expected continuation of a condition the Board stated “never gets worse.”

The decision is now on appeal. But however the courts resolve it, Lappin highlights both the risks and potential defenses surrounding post-concussion syndrome reopenings, and employers would be well served to keep the Board’s reasoning in mind in such cases.

For any employer navigating a case involving post-concussion syndrome, the attorneys in our Washington practice group are happy to discuss how Lappin may affect your planning or strategy.

[1] BIIA Dec., 23 11489 (2024).

[2] It should be noted that claims involving post-concussion syndrome can and often do involve additional conditions that could involve a separate basis for filing a reopening application.