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How Might Pre-Existing Medical Conditions Affect My Personal Injury Claim?

Gama Law Firm LLC Feb. 21, 2023

The topic of “pre-existing medical conditions” was a key target of the Affordable Care Act. According to the Kaiser Family Foundation, an estimate of non-elderly people with conditions that would have likely made them uninsurable before the ACA ranges from 102 to 133 million.  

However, pre-existing conditions are also used by insurance companies to deny or undervalue personal injury claims. The plaintiff’s age, in particular, can make it easy. Consider the prevalence of degenerative disc disease, which is an estimated 40% at age 40 and 80% at age 80 and older. If you suffer back or neck injuries after being rear-ended in a car accident, for example, odds are the insurance adjuster is going to cry “pre-existing injury.”    

It is fair that pre-existing medical conditions are taken into consideration in personal injury claims, but they should not close the door on compensation for new injuries. At Gama Law Firm, we use our experience as personal injury attorneys to get fair compensation for our clients who would still be better off if someone else had not been negligent. If you have been injured in an accident in Aurora, Denver, Castle Pines, Parker, or Centennial, Colorado, let us help.   

How Do Insurance Companies Value Personal Injuries? 

The overall goal of virtually every insurance adjuster is to place the lowest monetary value on every claim they handle. After all, settling for as little money as possible keeps the insurance company raking in massive profits.   

There are several tactics adjusters employ to devalue third-party claims, and all share the characteristic of “blame.” Adjusters will try to place fault on the injured party instead of their insured. They try to blame injuries on events unrelated to the accident. Last but not least, they look for anything they can use as evidence of a pre-existing condition to lower the threshold of “new” injuries and damages.   

Every experienced car accident attorney knows that adjusters play the blame game at all three levels, and at Gama Law Firm, we know how to make them play fair. Negligent parties who injure people are only financially responsible for the damages they cause, not those their victims were already suffering from.   

What Are Some Common Pre-Existing Medical Conditions? 

There are some pre-existing conditions insurance companies cannot use against you. After all, you cannot develop cancer from a car accident. However, companies will certainly be looking for signs of degenerative disks and joints and previous surgical procedures.   

They will also check for any history of respiratory illness, heart disease, osteoporosis or other bone conditions, arthritis, stroke, seizure disorders, diabetes, and emotional and mental health issues. They will look for any physical or mental health issue that might lead to a propensity for physical or mental health complaints after an accident. 

How Could My Pre-Existing Condition Affect My Personal Injury Claim? 

Insurance company adjusters open a claim with the assumption that most people, especially older ones, will have pre-existing conditions. Adjusters and their attorneys will explore your medical records for documentation of complaints before the crash that relate to complaints after it. For example, if you sought chiropractic treatment for minor back pain within ten years prior to the accident and then complain about back pain and require surgical intervention after the accident, they will devalue the complaint and the cost to repair whatever is wrong.   

Or, let’s say someone suffered a few absence seizures as a young child, but as most children do, the seizures went away. Following a head injury suffered in a car accident in their 40s, an injury victim started suffering from seizures. The insurance company would attempt to claim the post-crash seizure activity as a pre-existing condition and therefore attempt to deny the victim compensation for them.   

Medical malpractice cases involving birth injuries are complicated. Insurance companies will work to prove any injury is related to a birth defect that formed in the womb rather than as a result of medical malpractice or negligence. Birth defects are pre-existing conditions that can be used to lower the value of a claim. However, if the doctor should have known about the birth defect and taken steps to mitigate the potential for birth injuries, that doctor is nonetheless negligent and therefore, liable.   

Can I Be Compensated for a Pre-Existing Condition in My Personal Injury Settlement? 

You cannot be compensated for a pre-existing condition in a personal injury settlement but you can be compensated for the aggravation of that condition, the degree of worsening of that condition, or for an injury you were particularly susceptible to.   

In fact, there is a legal theory referred to as the “eggshell plaintiff,” which states that a person’s pre-existing condition made them even more susceptible to injury by a negligent party, which amplifies the negligence rather than provides the negligent party with an excuse to lower the value of the injury victim’s claim.   

Reach for Help From an Experienced Personal Injury Attorney 

The best step you can take if you have pre-existing conditions and want to file a personal injury claim is to work with an attorney with experience working with such challenging claims. At Gama Law Firm, we know how to get the best results possible for our personal injury clients who have pre-existing medical conditions that insurance companies will attempt to skew to their advantage. In fact, we welcome the challenge.   

If you have been injured by a negligent party in Aurora, Denver, Colorado, or any neighboring communities, call our office now to schedule a free case consultation