Can you have a brain injury with a normal MRI?
Yes: a normal CT scan or MRI does not rule out a concussion or mild traumatic brain injury, because standard scans are built to find bleeding, swelling, and structural damage, not the microscopic injury to nerve fibers that can follow a sudden jolt to the head. Many people with lasting symptoms after a concussion have normal standard imaging.
A brain injury does not require a direct blow to the head. Rear-end collisions, falls, and pedestrian and bicycle crashes can whip the head forward and back hard enough to injure the brain. Loss of consciousness is not required either. Confusion, a gap in memory around the crash, or feeling "foggy" afterward are all worth telling a doctor about.
Symptoms often show up or become clear over days and weeks, not minutes:
- headaches, dizziness, and sensitivity to light or noise
- trouble with memory, concentration, word-finding, or multitasking
- slower thinking, fatigue, and needing more time to finish familiar tasks
- sleep changes, irritability, anxiety, or depression
- problems at work or school that were not there before
If you notice these after a crash or fall, tell your doctors specifically and ask about a concussion evaluation. Your health comes first, and accurate early records also protect your claim.
How do we prove a brain injury the scans don't show?
We prove a mild brain injury the way doctors diagnose one: through the history of the event, the symptoms that followed, objective testing of how your brain now works, and consistent observations from people who know you. No single piece carries the case. Together, they show a jury what changed and why.
Treating physicians
The most persuasive witnesses are usually your own doctors: the emergency physician who documented confusion or amnesia, the primary care doctor who referred you on, and the neurologist, physiatrist, or concussion clinic that followed you over months. We make sure their records tell a complete, consistent story and that they are prepared to explain it.
Neuropsychological testing
A neuropsychologist uses standardized tests to measure memory, attention, processing speed, language, and executive function, then compares the results with expected norms. Good testing also includes validity measures that check whether the person is giving full effort. That matters, because it answers the insurer's suggestion that symptoms are exaggerated.
Advanced imaging, and its limits
Some clients undergo advanced imaging such as diffusion tensor imaging (DTI), which looks at the brain's white-matter pathways. It can support a diagnosis, but it is not a stand-alone test for an individual brain injury, and defense lawyers regularly challenge it. Courts in all three jurisdictions screen expert testimony for reliability before a jury hears it, and rulings on DTI have varied with the facts and the expert's methods. We use it when the science supports it in your case, and we build every case so it does not depend on it.
People who knew you before
Spouses, coworkers, supervisors, friends, and teachers can describe the before and after in concrete terms: the reports you used to write in an hour, the conversations you now lose track of, the events you skip because noise wears you out. Juries believe these witnesses because they have no medical vocabulary and no stake in the science.
Vocational and economic evidence
When a brain injury affects work, a vocational expert can explain which jobs and promotions are no longer realistic, and an economist can put a number on the lost earning capacity. Job performance reviews, emails, and pay records from before and after the injury are often the strongest proof.
$350,000
Rear-end collision; neurological injury with normal brain imaging.
Results depend on the facts of each case and do not guarantee or predict a similar result in any future case. Amounts are gross recoveries before attorney's fees, case expenses, and medical liens.
What insurers argue, and how we answer
| Insurer's argument | How we answer it |
|---|---|
| "The MRI was normal." | Standard imaging is not designed to show this kind of injury. We rely on the clinical diagnosis, neuropsychological testing, and treating physicians, and on advanced imaging only where it is supported. |
| "There was barely any damage to the car." | Vehicle damage measures what happened to the bumper, not to the person inside. We use the crash facts, the medical timeline, and, in the most serious cases, engineering analysis. |
| "There were gaps in treatment." | Gaps often have ordinary explanations: waiting lists for specialists, insurance approvals, childcare, or symptoms that took time to recognize. We document the reasons with records, not excuses. |
| "It's a pre-existing condition." | A prior concussion, migraines, or depression does not end a claim. The question is what the crash added or made worse, and earlier records often show the difference clearly. |
| "It's just stress or depression." | Emotional symptoms commonly follow brain injury. Testing and treating providers can explain how the injury and the emotional effects relate. |
D.C., Maryland, and Virginia: the rules that shape a brain injury case
Contributory negligence in all three
All three jurisdictions follow contributory negligence, so if your own negligence contributed to the crash, the insurer will argue you recover nothing. Maryland's highest court has declined to abandon the rule (Coleman v. Soccer Ass'n of Columbia, 432 Md. 679 (2013)), and Virginia applies it subject to the last clear chance doctrine (Coutlakis v. CSX Transportation, Inc., 293 Va. 212 (2017)). In D.C., a pedestrian or other vulnerable road user hit by a vehicle can still recover unless their negligence was greater than the defendants' combined negligence (D.C. Code § 50-2204.52). Because a brain injury can blur your memory of the crash itself, early witness statements and video matter even more.
Maryland: the noneconomic damages cap
In Maryland, noneconomic damages in a personal injury case are capped at $980,000 for causes of action arising from October 1, 2026 through September 30, 2027 (Md. Code, Cts. & Jud. Proc. § 11-108). The cap started at $500,000 for causes of action arising on or after October 1, 1994 and rises by $15,000 every October 1, so it was $965,000 for the year before. It covers pain, suffering, physical impairment, and loss of consortium, and it applies to the injured person and everyone who claims through that person.
The jury is not told about the cap; if an award is higher, the judge reduces it (§ 11-108(d)). The cap does not limit economic damages such as medical expenses and lost earnings, which is why careful proof of future care and lost earning capacity matters so much in a serious Maryland brain injury case. The filing deadline is generally three years (§ 5-101).
D.C.: no general cap, but watch the PIP election
D.C. has no statute capping pain and suffering damages in an ordinary injury case, and the general filing deadline is three years (D.C. Code § 12-301(8)). Car crash cases carry one trap. A crash victim who elects D.C. personal injury protection benefits, an election made within 60 days of the accident, may sue the at-fault driver only if the injury meets a statutory threshold or the medical, rehabilitation, or work-loss costs exceed the available PIP benefits (D.C. Code § 31-2405).
One threshold is a "medically demonstrable impairment" that prevents the victim from performing substantially all of their usual daily activities for more than 180 continuous days; another is a substantial and medically demonstrable permanent impairment (§ 31-2405(b)(1)). For a concussion, meeting those words takes the same careful medical documentation described above, so talk with us before you make the PIP election if you can.
Virginia: shorter deadline, no general cap
In Virginia, you generally have two years from the injury to file a personal injury lawsuit (Va. Code § 8.01-243(A)). Virginia has no general cap on compensatory damages in an ordinary injury case; its best-known cap limits punitive damages to $350,000 in total (Va. Code § 8.01-38.1). Two years passes quickly when you are still in treatment, so Virginia cases need attention early.
What damages can a brain injury claim include?
A brain injury claim can include past and future medical care, past lost wages, lost future earning capacity, and noneconomic damages for pain, cognitive and emotional changes, and lost enjoyment of life, subject to Maryland's cap described above. A spouse may have a related claim for loss of consortium.
- Medical care: neurology, neuropsychology, vestibular and vision therapy, speech and cognitive therapy, counseling, and medication, past and future.
- Earnings: missed work, reduced hours, lost promotions, and a career that has to change course.
- Daily life: help at home, the hobbies and social life that now cost too much energy, and the strain on family relationships.
Mild brain injuries are often undervalued at first, by insurers and sometimes by the injured person. We do not set a value until the medical picture is clear enough to support it.
$750,000
Rear-ended by a commercial van; permanent post-concussion injury on under $34,000 in medical bills.
Results depend on the facts of each case and do not guarantee or predict a similar result in any future case. Amounts are gross recoveries before attorney's fees, case expenses, and medical liens.
Ryan Posey and Jacob Lebowitz are admitted in D.C., Maryland, and Virginia. For how injury law works more broadly in each jurisdiction, see our overviews for D.C. injury cases, Maryland injury cases, and Virginia injury cases.
Frequently asked questions
Can I have a brain injury if my MRI was normal?
Yes. Standard CT and MRI scans look for bleeding, swelling, and structural damage, and many concussions and mild traumatic brain injuries do not show up on them. Doctors diagnose these injuries from the event, the symptoms, and testing, and the same tools prove the injury in a claim.
How do you prove a concussion in an injury case?
We prove it through treating physicians, neuropsychological testing with validity measures, consistent medical records, and witnesses who can describe how you changed. Advanced imaging such as DTI can help in some cases, but courts screen it for reliability, so we build cases that do not depend on it.
Is there a cap on brain injury damages in Maryland?
Yes, for noneconomic damages. For causes of action arising from October 1, 2026 through September 30, 2027, the cap is $980,000 (Md. Code, Cts. & Jud. Proc. § 11-108); it was $965,000 for the year before. The cap does not limit economic damages such as medical expenses and lost earnings.
Is there a cap on pain and suffering in D.C. or Virginia?
D.C. and Virginia have no general cap on pain and suffering damages in an ordinary injury case. Virginia does cap punitive damages at $350,000 in total (Va. Code § 8.01-38.1). In a D.C. car crash, electing PIP benefits can limit your right to sue unless your injury or costs meet a statutory threshold (D.C. Code § 31-2405).
What if I had a concussion or headaches before this accident?
A prior condition does not end your claim. The question is what the new injury added or made worse, and earlier records often show that difference clearly. We gather them so the insurer cannot use them out of context.
How long do I have to file a brain injury claim?
Generally two years in Virginia (Va. Code § 8.01-243(A)) and three years in D.C. and Maryland (D.C. Code § 12-301(8); Md. Code, Cts. & Jud. Proc. § 5-101). Claims against government bodies can require written notice much sooner, so call early.
Related reading
- How a concussion claim works when the MRI is normal
- Contributory negligence in D.C., Maryland, and Virginia
- Is there a cap on pain and suffering in D.C.?
- Maryland PIP: the no-fault coverage most crash victims forget
- Why the at-fault driver's insurance limits matter most
- DMV Injury Guide: focus on treatment first
- DMV Injury Guide: what your case is worth, including Maryland's noneconomic cap
Talk to a brain injury lawyer today
Virginia allows two years to file, and in a D.C. car crash the 60-day PIP election can limit your right to sue. Call us early so your medical records and witnesses are in place before the insurer builds its "normal MRI" defense.
Posey Lebowitz PLLC · 3221 M Street NW, Washington, DC 20007
Call (202) 524-0123 or request a free consultation. No fee unless we win your injury case.
Our office is in Georgetown, at 3221 M Street NW in Washington, D.C. We meet clients by phone or video, at their home or in the hospital when that is easier, and we appear in Maryland and Virginia courts.
More than $32 million recovered.
Plus more than $22 million in other assets.
Across more than 250 matters, in the District of Columbia, Maryland, and Virginia.
These case results are examples of matters handled by Posey Lebowitz PLLC. The outcome of any case depends on the specific facts and legal circumstances of that case. These results do not guarantee or predict a similar result in any future matter. Amounts shown are gross recoveries before attorney's fees, case expenses, and medical liens. Asset values are stated as of 2026 and will change.
Responsible attorneys: Ryan C. Posey and Jacob M. Lebowitz. Posey Lebowitz PLLC, 3221 M Street NW, Washington, DC 20007.