What Is the Difference Between a Concussion and a Traumatic Brain Injury?

If you have been in an accident and someone said “you might have a concussion,” and someone else said “you might have a TBI,” you are not being told two different things. A concussion is a traumatic brain injury. It sits at the mildest end of the TBI spectrum, and it produces very real symptoms that can affect work, family life, and long-term health.

Concussion vs TBI differences matter because the two terms sound like different diagnoses to most people, and insurance carriers know that. A “concussion” sounds like something a rider walks off. A “traumatic brain injury” sounds like a life-changing event. 

In real cases, either label can describe an injury that keeps a person from working, driving, or thinking clearly for months. Learning where each label fits (and where each stops) helps injured people advocate for themselves in the medical system and protect their rights in a claim.

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What You Should Know

• Rideshare accident insurance ND rules are set by Chapter 26.1-40.1 of the North Dakota Century Code, which divides every rideshare trip into three periods based on the driver’s app status.
• Uber Lyft accident claims ND proceed against three possible insurance pools: the driver’s personal auto policy, a rideshare endorsement (if the driver purchased one), and the transportation network company’s commercial policy.
• Rideshare liability North Dakota turns on the driver’s app status at the moment of the crash. Period 1 (app off) triggers personal coverage. Period 2 (app on, waiting for a ride request) triggers a mid-tier policy. Period 3 (accepted ride through drop-off) triggers a $1 million primary liability policy that Uber and Lyft carry.
• Rideshare insurance threshold disputes come from carriers arguing about when Period 2 actually began or when Period 3 ended. App records and GPS logs usually settle those disputes.
• Rideshare claim tips worth knowing: preserve the app data quickly, document the driver’s status at the scene, and understand that a personal auto policy will often deny a rideshare-related claim outright unless a rideshare endorsement is in place.

How TBI Is Graded: The Three Tiers

The Glasgow Coma Scale (GCS) is the standard tool used in the emergency department to grade brain injury severity. A treating physician records how the patient responds to eye, verbal, and motor stimuli. The score at the time of evaluation places the injury on the TBI spectrum:

• Mild TBI (concussion): GCS 13 to 15, with loss of consciousness (if any) lasting less than 30 minutes. Memory loss for events immediately before or after the incident lasts less than 24 hours. This is the tier where the term “concussion” applies.
• Moderate TBI: GCS 9 to 12, with loss of consciousness lasting 30 minutes to 24 hours. Memory loss lasts 1 to 7 days. Neurological deficits often present. CT or MRI may show abnormalities.
• Severe TBI: GCS 3 to 8, with loss of consciousness longer than 24 hours. Extensive memory loss. Imaging typically shows significant findings. Long-term deficits are common.

The GCS score is a snapshot, not a full diagnosis. A person can score 15 at admission and still have a serious concussion that produces symptoms for months. That gap between the initial score and the actual clinical course is where a lot of insurance disputes happen.

Traumatic Brain Injury Signs That Should Not Be Dismissed

Traumatic brain injury signs vary by severity. The mild end can look almost normal to a casual observer. The moderate and severe ends are usually apparent at the scene. What matters for anyone in an accident is knowing which symptoms warrant immediate evaluation and which warrant close follow-up in the days after.

Symptoms that call for immediate emergency evaluation:

• Loss of consciousness of any length
• Confusion, disorientation, or inability to answer basic questions
• Repeated vomiting or persistent nausea
• Slurred speech
• Unequal pupil size or vision changes
• Seizure
• Weakness or numbness in an arm or leg
• Clear fluid drainage from the nose or ear
• Severe headache that is worsening

Symptoms that develop or persist in the days after an accident and warrant a follow-up exam:

• Headaches that do not resolve
• Sensitivity to light or noise
• Difficulty concentrating or reading
• Memory problems
• Sleep disturbance (too much or too little)
• Irritability, anxiety, or depression that started after the accident
• Fatigue that is out of proportion to activity
• Balance problems or dizziness

A patient who feels “off” but cannot describe why is not being dramatic. Mild brain injury symptoms are frequently vague, and the vagueness is part of the diagnostic picture.

Why Concussions Often Look Normal on Initial Imaging

Emergency departments use CT scans to rule out bleeding, skull fractures, and other findings that need immediate intervention. CT is excellent at those tasks. It is not designed to detect the diffuse axonal injury that produces most concussion symptoms.

That means a normal ED CT scan says “no bleeding to worry about right now.” It does not say “no brain injury.” Insurance carriers sometimes point to a normal CT scan as evidence the patient did not have a real injury. 

That argument misunderstands what the imaging shows. Follow-up with a neurologist, a neuropsychologist, or a primary care physician who documents ongoing symptoms is often more diagnostically significant than the initial ED imaging.

Advanced imaging (MRI, DTI, functional MRI) can show findings that a standard CT cannot. Whether those studies are ordered depends on symptom severity, insurance coverage, and physician judgment.

Post-Concussion Syndrome: When “Mild” Stops Being Mild

Post-concussion syndrome is the term for concussion symptoms that persist beyond the expected recovery window. Most concussion patients recover in a few weeks. A meaningful minority (studies put the number at roughly 15 to 20 percent) continue to have symptoms for three months or longer.

Patients with post-concussion syndrome commonly report cognitive effects such as:

• Brain fog: difficulty concentrating, following conversations, or completing familiar tasks
• Slowed processing: taking longer to read, respond, or work through a problem
• Memory gaps: losing track of where a conversation was going, forgetting appointments, needing more notes than before
• Mood changes: irritability, anxiety, depression, emotional blunting
• Fatigue: exhaustion that is not proportional to activity
• Sleep disturbance: insomnia, waking early, or oversleeping
• Headaches: daily or near-daily, sometimes migraine-type

These symptoms are treatable but often slow to resolve. The medical answer is a coordinated treatment plan: neurology for headache and cognitive symptoms, physical therapy or vestibular therapy for balance issues, occupational therapy for return-to-work planning, and cognitive rehabilitation for concentration and memory.

The legal answer is documentation. Persistent symptoms are only compensable in a claim if the treating providers wrote them down, the patient reported them consistently, and the timeline connects them to the accident. Waiting a year to see a neurologist about brain fog that started the day after a crash creates a gap that insurance carriers use to argue causation.

The Legal Difference Between “Concussion” and “TBI”

For a personal injury claim in North Dakota, the legal significance of the label is smaller than most people assume. What matters is the actual injury and its documented effects, not which of the two synonymous terms the ED chart used.

That said, the label can shape how a claim is presented:

1. “Concussion” on the chart, months of symptoms in real life. The claim is a mild TBI case. Post-concussion syndrome, neuropsychological testing, and consistent treatment records establish the ongoing injury.
2. “TBI” or “moderate TBI” on the chart from the start. Documentation is usually cleaner because imaging findings, longer hospitalization, and specialist involvement are already present. The claim’s factual foundation is easier to build.
3. No brain injury diagnosis at the ED, symptoms in the following weeks. This is the hardest presentation. The claim requires establishing that a brain injury occurred at the crash even if no one diagnosed it that day. Early follow-up with a primary care physician or neurologist bridges the gap.

North Dakota’s personal injury statute of limitations is generally six years from the date of injury (N.D.C.C. § 28-01-16). That does not mean an injured person should wait to seek care. Waiting hurts recovery and hurts the claim.

Under North Dakota’s modified comparative fault rule (N.D.C.C. § 32-03.2-02), an injured claimant whose share of fault is less than 50 percent still recovers, reduced by that share. In brain injury cases, insurance carriers often try to shift fault to make the arithmetic worse for the claimant. Good documentation of the injury and of the other party’s conduct is what defeats that push.

For a fuller picture of how our firm approaches personal injury and brain injury claims in our region, see our Fargo personal injury lawyers page.

What Documentation a Brain Injury Claim Needs

Brain injury claims stand or fall on the quality of documentation. A rough checklist of what strong records look like:

1. Emergency department records from the day of the accident, including GCS score, any imaging results, and discharge instructions.
2. Primary care follow-up within days of the accident that records the symptoms the patient is experiencing.
3. Specialist evaluations as symptoms persist: neurology, neuropsychology, otolaryngology (for vestibular issues), or psychiatry as needed.
4. Neuropsychological testing for cognitive effects, ideally done more than a few weeks after the injury so acute symptoms have stabilized.
5. Consistent treatment records showing what the patient reported and how symptoms changed over time.
6. Lay witness observations from family, coworkers, and friends about changes in the patient’s function, personality, or capabilities.
7. Work records documenting missed time, reduced hours, accommodations, or the inability to return to prior duties.

Missing one piece is rarely fatal. Missing several pieces creates the gaps that insurance carriers exploit.

Talk With Our Team About a Brain Injury Claim

A brain injury changes what a person can do at work, how they parent, how they process a conversation, and how they experience their own thoughts. Insurance carriers approach these claims with a set of familiar arguments (the CT was normal, the ED chart said “concussion,” the symptoms came from something else), and the strongest response to those arguments is careful documentation from the beginning.

At Vogel Law Firm, our personal injury attorneys have handled brain injury cases across North Dakota and Minnesota, and we can review what has already been documented and what a claim would involve. If a crash has left you or a family member with a suspected concussion or TBI, we would rather talk to you early than late.

Call our Fargo office at 701-237-6983, our Bismarck office at 701-258-7899, or our Moorhead office at 218-236-6462.

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