Financial planning for clients who have suffered traumatic brain injuries

These types of injuries can be among the most difficult to plan around.
By Julie Papievis and James Sullivan, CPA/PFS

Each chronic disease or serious injury presents its own set of financial challenges. For that reason, it's helpful for CPA financial planners to spend time getting to know the health history of affected clients and the prognosis of the condition they suffer from.

One type of trauma CPAs need to be aware of is traumatic brain injury (TBI). It's likely that CPA financial planners will have a client, or a client with a family member, who has suffered a TBI. The Centers for Disease Control and Prevention (CDC) estimates that each year there are over 2.5 million TBI-related visits to emergency departments and over 50,000 deaths. Adults age 75 and older have the highest rates of TBI-related hospitalizations and deaths.

A lifetime of careful financial planning can become irrelevant in seconds due to head trauma suffered in a fall or accident. In this situation, as in any sudden health care event or new diagnosis of a serious illness, CPAs need to be prepared to assist clients and their families facing new financial problems due to changing health care needs.

TBI symptoms aren't always apparent at first glance

Acquired brain injury (ABI) is any injury to the brain that is not hereditary, congenital, degenerative, or caused by birth. Causes include stroke, tumor, and oxygen deprivation. A TBI is a type of ABI. It is caused by trauma to the brain from external force. The CDC defines a TBI as "an injury that disrupts the normal function of the brain."

A TBI can occur without warning, and at any point in a person's life. At age 29, Julie Papievis (a co-author of this article) was in a car accident. She suffered a severe brain stem injury. Only 4% of those suffering such an injury survive. And many of those who do survive spend the remainder of their life in a nursing home.

TBI is often seen by many as an "event" that, once treated, requires little ongoing treatment. The impact of a TBI, however, can be lifelong. (Although Papievis, for instance, recovered to the extent where she can walk and compete in triathlons, she still suffers from vertigo and fatigue 26 years after her accident.)

The effects of a TBI are not always evident to the casual observer. Papievis, for example, has sustained permanent damage to her eyesight and nervous system that has made it impossible for her to work full time. Because sufferers often have no obvious symptoms, TBI is often referred to as the "silent epidemic."

A CPA financial planner will need to know an affected client's health history to properly plan. Specifically, CPAs must understand the characteristics of their client's TBI, especially those that aren't immediately evident, their ongoing care needs, and the impact on their finances.

The impact of TBI on a client's financial plan

When clients are diagnosed with TBI, they will need a new or revised financial plan, which must consider their prognosis. Each instance of TBI has its own prognosis and the condition impacts everyone differently. A "cookie-cutter" approach is inadequate.

The chart below shows some of the issues that must be considered for a client with a TBI:


Address clients' cognitive health concerns

The CPA should also ask the client about future health concerns. Many TBI patients are concerned that they have a greater chance of developing dementia later in life. A dementia, such as Alzheimer's, can cause the patient's executive planning functions to deteriorate — making them susceptible to costly financial errors and financial abuse.

Knowing this, the CPA can work on a financial plan to address clients' fears about cognitive health and the proper management of finances should their fears be realized. For example, does the client have a support network of family and friends nearby? Should the client consider a move closer to their support network? How can the client's finances be simplified to make them easier to manage should cognitive problems increase?

It can be difficult to put together a financial plan for a client with a TBI, as each TBI patient presents differently even if their underlying injuries are similar. Recovery is very individualized and patients' financial plans need to take into account those differences.

Julie Papievis is a national speaker on the physical, emotional, and financial impact of TBI. She tells her story in her book Go Back and Be Happy. She can be reached at James Sullivan, CPA/PFS, is a financial planner in Wheaton, Ill. He specializes in working with clients suffering from chronic illness. To comment on this article or to suggest an idea for another article, contact senior editor Courtney Vien at


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