Women with neck injury discussing terms with insurance agent

Pre-Existing Medical Conditions Effect on an Injury Claim 

Rodman Law Office  June 18, 2024

We are human beings, and we may suffer from different kinds of injuries and illnesses over the course of our lives. Some of these conditions are less serious and some are more serious. That’s why, in many cases, a claimant’s health may be far from perfect when they get into an accident and demand compensation for new or worsened injuries.  

However, this doesn’t stop insurance companies from using pre-existing conditions to their advantage to pay a claimant less than their claim is worth or deny their claim altogether. 

If you have a pre-existing condition and are worried about its potential effect on your injury claim, consider contacting Rodman Law Office. As a personal injury attorney in Austin, Texas, I work my hardest to get clients every penny they deserve, regardless of their circumstances.  

What Is a Pre-Existing Condition?

The Department of Health and Human Services defines a pre-existing condition as any condition a person had before the date of their insurance claim. This condition can be any injury or illness, both physical and mental.  

A person may have just about any health problem that may be classified as a pre-existing condition in their injury claim. Some common examples include: 

  • Asthma 

  • Cancer 

  • Diabetes 

  • Arthritis 

  • Joint problems 

  • Osteoporosis 

  • Chronic neck or back issues 

  • Sleep apnea 

  • Depression 

A pre-existing condition can make new injuries worse and vice versa: an accident can worsen a pre-existing condition. But does it mean the insurance company should pay for your expenses arising from the aggravation of your pre-existing condition?  

While the answer is, “Yes,” you might face opposition from the insurance company, especially if you are not represented by an attorney helping you to pursue maximum compensation.  

When choosing a personal injury attorney, make sure you choose one with experience handling cases involving pre-existing conditions.  

How Insurers View Pre-Existing Conditions

When it comes to personal injury claims, insurance companies are meticulous about pre-existing medical conditions. Their primary concern is to determine how much of your injury is due to the accident and how much is related to your pre-existing condition. For this reason, honesty is the best policy.  

Failing to disclose your pre-existing conditions can severely affect your claim. Insurers have numerous ways to uncover your medical history, and any omissions can be seen as deceptive and lead to the denial of your claim.  

Insurance companies differentiate between causation (the accident caused the injury) and aggravation (the accident worsened a pre-existing condition). They often try to attribute most of your injury to your pre-existing condition to reduce their liability and pay you less for your claim. That’s why consistent medical documentation before and after the accident can help demonstrate how the accident exacerbated your pre-existing condition.  

If your medical records are insufficient or you don’t have any, you may need to hire expert witnesses to prove to what degree your injuries are related to the current accident.  

Understanding the Eggshell Skull Rule

The eggshell skull rule is a legal doctrine that can work in your favor if you have a pre-existing condition. The rule states that a defendant (the liable party) must take a plaintiff (the injured party) as they find them.  

If a person has a pre-existing condition that makes them more susceptible to harm, the defendant is still fully liable for all damages resulting from the accident, even if the injuries are more severe than they would be for someone without that condition. 

In other words, even if your injury is more severe due to your pre-existing condition, the at-fault party cannot use this as a defense to lessen their liability. For example, if you have a weakened bone structure and suffer a fracture in an accident, the responsible party is liable for the full extent of the injury, not just what would have occurred if you had no pre-existing condition. 

Your attorney can help ensure that the eggshell skull rule doctrine is considered in your claim, providing you with the protection you deserve. 

Protecting Your Rights When You Have a Pre-Existing Condition

Insurance companies may try to use your pre-existing condition against you, making it essential to know how to protect your rights and secure the compensation you deserve. Here’s what you can do:  

  1. Inform your attorney of any pre-existing conditions: The first and most crucial step is to be completely transparent with your attorney about any pre-existing conditions you have. Your attorney needs to understand your full medical history to build a strong case and counter any attempts by the insurance company to downplay your injury.  

  1. Seek medical attention immediately: After an accident, seek medical attention. And the sooner you do it, the better, even if you don't feel severely injured. Timely medical documentation is crucial for establishing the connection between the accident and your injuries. It also helps in distinguishing between your pre-existing condition and new injuries. 

  1. Refuse to give the insurance company access to your medical records: Insurance companies often request broad access to your medical records to find any reason to minimize your claim. Avoid giving them access to your entire medical history, and let your attorney handle the release of any necessary records. 

  1. If the insurance company starts asking questions about your pre-existing condition, tell them to speak with your attorney: Attempting to answer these questions yourself can inadvertently harm your case. Your attorney can recognize and counteract tactics the insurance company may use to undermine your claim. 

  1. Don’t take the first offer from the insurance company: Often, first settlement offers are much lower than the actual worth of the injury claim and may not account for the aggravation of your pre-existing condition. Have your attorney review the offer before accepting or declining it.  

By understanding how to protect your rights and seeking guidance from an attorney, you are more likely to receive adequate compensation even with a pre-existing medical condition.  

Get Help With Your Injury Claim 

In my practice at Rodman Law Office, I’ve seen that a pre-existing condition can affect personal injury cases in a variety of ways. What I’ve also seen is that insurance companies don’t want to mess with claimants represented by attorneys. That is why I am dedicated to helping my clients overcome the challenges they may face when filing an injury claim with a pre-existing condition.  

My law firm is located in Austin, Texas, and serves clients throughout the state, including Hays County, Travis County, and Williamson County. If you need help, reach out today and schedule a consultation.