B – 34 “The Big Five”: Mechanistic Outcome Factors Following Litigation Settlement in Patients with Mild Traumatic Brain Injury

Abstract Objective This study aimed to examine the role of litigation in shaping recovery trajectories after settlement in individuals who sustained a mild traumatic brain injury (mTBI). While prior quantitative studies have linked litigation to prolonged symptom persistence, the underlying mechanistic and experiential factors remain underexplored. This study used qualitative methods to investigate how litigation influences psychological, cognitive, and functional outcomes post-settlement among patients with mTBI. Method Ten adults (5 male, 5 female; mean age = 48.3 years) with previously litigated mTBIs were recruited through an independent medical examination referral source. All participants had reached legal settlement and met criteria for uncomplicated mTBI as defined by the American Congress of Rehabilitation Medicine. Semi-structured interviews explored litigation experiences, post-settlement cognitive and emotional recovery, and satisfaction with compensation outcomes. Interviews were transcribed verbatim and analyzed using inductive coding and thematic analysis. Two independent reviewers conducted investigator triangulation to ensure thematic consistency and reliability. Results Five key themes emerged: (1) the burden of litigation, (2) legitimization of symptoms, (3) does money matter, (4) social support, and (5) loss of identity. Participants described litigation as emotionally taxing, with prolonged legal procedures exacerbating psychological distress, delaying recovery, and diminishing self-concept. Financial settlements offered limited relief and were often perceived as insufficient. Strong familial and legal support emerged as protective, while skepticism about symptom validity by institutions intensified emotional distress. Conclusion Litigation significantly affects long-term psychological and functional outcomes in mTBI patients. Findings highlight modifiable post-settlement factors that could inform patient-centered interventions to reduce litigation-related distress and improve recovery.