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Effect of Pre-Existing Conditions on Your Claim


One of the insurance company’s most utilized methods for limiting the amount of money you receive after an accident is to claim that your injuries or damages were pre-existing. Some insurance adjusters will attempt to establish a negative correlation between your current condition following an accident and injuries or conditions that you suffered from before the accident. Although you cannot recover compensation for the pre-existing injury itself, you can still recover compensation for an aggravation or exacerbation of a pre-existing injury or condition.

Medical Records Will Tell the Story

Your medical bills and records tell a story about your accident. It is important to ensure that you understand what that story is and to ensure that your narrative of the events before, during, and after the accident draw appropriately from your medical bills and records. With this, it is typically not a good idea to permit the insurance company to collect your medical bills and records on their own.

If you allow the insurance company to gather your medical bills and records by providing them a blank HIPAA release, the insurance company will inevitably request copies of your medical records. By simply allowing the insurance company to gather these essential documents without providing a narrative or theory of liability, you are allowing the adjusters to interpret the records in any manner they deem fit.

However, should you provide all the medical bills and records with your demand package, you may be able to control the version of events and the treatment you receive to a greater degree. This matters more if you have pre-existing conditions or injuries.

Your medical records will essentially tell the story of your pre- and post-accident condition for the adjuster. If your medical records are inconsistent about your prior medical history or if you appear to have been dishonest with your medical professionals about your pre-accident condition, it will show up in your records, and it will inevitably hurt your chances of recovery.

However, medical records often contain mistakes regarding details that go back many years, such as previous medical history. Therefore, you should complete your own review of the medical records to ensure that they are free of errors that would cause the adjuster to make the wrong inferences regarding your pre-accident state.

Aggravation of Pre-existing Injuries

It is a common occurrence for a person to be involved in an accident and to have that accident affect pre-existing injuries or conditions. The aggravation of a pre-existing condition should not be considered a bar against your possible recovery. You may have heard of the concept “take your plaintiff as you find them,” also known as the “eggshell plaintiff” theory. This theory essentially states that a person who is more susceptible to injuries from an accident due to a pre-existing condition should still be able to recover compensation for the exacerbation or aggravation of the pre-existing condition.

For example, let’s assume you fractured your arm playing football and then you were in a car accident. Following the accident, your doctors discover that your arm is fractured in a more substantial way from that of the football injury. You have not sustained a new injury but rather exacerbated or aggravated a pre-existing injury. Now, if you were also complaining of back and neck pain following the accident and you had never been previously treated for back and neck pain, these would likely be considered new injuries.

In the above example, you could receive compensation for both the new injuries to the spine and the exacerbation of the arm fracture, despite not having sustained the original arm fracture in the car accident. You were more susceptible to an aggravation or exacerbation of the arm fracture due to the previous event, but had you not been in the car accident, your arm would have eventually fully healed and you would not be expecting as long of a recovery.

Proving Causation for Exacerbation of a Pre-existing Injury or Condition

As with any other personal injury claim, you must still prove that an aggravation of the pre-existing injury is “causally related” to the underlying accident. Most insurance adjusters like to argue that an exacerbation of an injury may be causally related to something other than the motor vehicle accident. Should you not be able to show that the aggravation of your injuries was directly and proximately caused by the accident, your compensation will like be mitigated or limited.

Of course, insurance adjusters rely on more than just medical records when arguing that alleged damages are related to pre-existing injuries or conditions. For example, if the injured person is an adult and claiming back and/or neck injuries following an accident, the adjuster may assert that human beings are predisposed to degenerative disc disease as they age, and the injured person’s damages should be reduced to reflect their pre-existing condition.

Can I Recover Compensation for Exacerbation of a Pre-existing Injury?

If you have a pre-existing injury or condition that was exacerbated as a result of an accident, you can still recover compensation for medical expenses and pain and suffering. However, you cannot recover for the pre-accident medical expenses or the pain and suffering you experienced prior to the accident.

The amount of your compensation will partially depend on the nature and severity of your pre-existing injury. Moreover, it could depend on a variety of factors, including the level of injury demonstrated on recent medical records, the degree of the new injury and whether the injury involves further complications that require different forms of treatment. These issues can be less clearly demonstrated from the medical records and often require a medical professional to render an independent medical opinion concerning your progress.

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