When insurance adjusters review your medical records, they pay careful attention to your doctor visits and diagnoses. They’re on the lookout for any mention of an old injury or illness. They will happily point it out as proof that the symptoms you’re currently experiencing were already present before your accident. A preexisting injury can certainly complicate your claim, but it doesn’t necessarily mean that you will automatically be ineligible for compensation for the harm you suffered.
Why Insurance Companies Focus on a Preexisting Injury
Insurance companies know that if they can establish that a preexisting injury is responsible for your condition, they can avoid paying you. This is why they examine your medical records so closely, looking for any other explanation besides the accident for the pain and suffering you’re experiencing. If health records show you’ve been fighting a back-related problem for a couple of years, your insurance company could argue that the new pain you’re currently experiencing is caused by your earlier injury and not your recent car collision. In fact, they could cite any number of other explanations, such as:
- Arthritis or age-related degeneration
- An earlier car accident
- Previous neck, back, or joint surgery
- A workplace or sports injury
- Chronic headaches or migraines
- Anxiety, depression, or another prior diagnosis
Insurance companies may use a preexisting condition to deny a claim or to justify making a low offer. It’s a common tactic to offer an insufficient personal injury settlement to resolve a case quickly. Prior injuries and illnesses matter, but the existence of an earlier diagnosis does not answer the entire question of causation. For example, someone who occasionally experienced mild back pain before an accident may face a very different situation afterward, such as constant pain, reduced mobility, an inability to work, or the need for surgery.
Can You Pursue a Personal Injury Claim With a Prior Condition?
In many cases, you can pursue a personal injury claim, even when you have a prior condition. Personal injury law generally recognizes that a negligent person must account for the condition of the person who was harmed. This concept is sometimes called the “eggshell plaintiff” rule. A person does not lose legal protection simply because an existing condition made them more vulnerable to serious further injury.
There is an important distinction, however. A claimant generally cannot recover compensation for symptoms and limitations that would have continued even without the accident. The claim concerns only the additional harm caused by the accident, which may include:
- Increased pain or more frequent symptoms
- New physical or cognitive limitations
- Accelerated deterioration of an existing condition
- Additional medical treatment
- A new need for surgery, therapy, or medication
- Lost income caused by worsened symptoms
- Reduced ability to perform household or recreational activities
Specific legal standards vary by state. For example, New Mexico’s civil jury instruction on preexisting conditions explains that a claimant must establish the extent of an aggravation with reasonable certainty. An attorney can help you evaluate which rules apply in the jurisdiction where your accident occurred.
How Is Aggravation of a Preexisting Condition Evaluated?
Evaluating the aggravation of a preexisting condition begins with comparing the person’s health before and after the accident. Medical evidence, the timing of symptoms, treatment recommendations, and changes in daily functioning can all contribute to that analysis.
Doctors may consider whether the accident:
- Produced new symptoms
- Increased the intensity or frequency of existing symptoms
- Caused objective changes visible through imaging or testing
- Made more extensive treatment medically necessary
- Accelerated the expected progression of a condition
- Reduced the patient’s ability to work or complete ordinary activities
Preexisting conditions can also affect the course of recovery. For example, one study of road traffic injuries found that certain preexisting health conditions were associated with greater healthcare use and recovery costs. Research has also found that those with cervical degeneration may have longer-lasting symptoms following whiplash. While these findings do not establish the cause of an individual patient’s symptoms, they illustrate why physicians must consider both the accident and the patient’s medical baseline in evaluating an accident’s effects.
How Medical Records Can Support a Prior Injury Accident Claim
Given how critical a patient’s health baseline is for determining the damage caused by an accident, older medical records are often key pieces of evidence, providing valuable information about a person’s condition before the accident.
Suppose someone had received occasional treatment for a chronic knee condition but remained able to work, walk without assistance, and participate in recreational activities. After a slip-and-fall, that person begins experiencing severe pain, requires frequent appointments, and can no longer climb stairs. The earlier records help establish the baseline, while the later records document the change.
Evidence supporting a prior injury accident claim may include:
- Records showing the frequency and severity of earlier symptoms
- Imaging taken before and after the accident
- Notes describing new symptoms or limitations
- Changes in medication or treatment frequency
- A treating physician’s opinion about causation
- Testimony from relatives, coworkers, or friends
- Employment records showing missed work or modified duties
Consistency also matters. Claimants should give healthcare providers a complete and accurate account of their medical history, current symptoms, and how those symptoms affect daily life. Concealing an earlier condition can damage credibility and give the insurer another reason to challenge the claim.
What Should You Do if the Insurer Blames an Earlier Injury?
If an insurer blames an earlier injury, you should continue receiving medically appropriate care and follow your providers’ recommendations. Gaps in treatment may allow an insurance company to argue that the symptoms resolved or were never serious. You should also avoid signing a broad medical authorization or giving a recorded statement without understanding how the information may be used. An insurer may request years of records, including material with little connection to the injuries being claimed.
If symptoms appeared after a delay, document when you first noticed them and when they began to interfere with your activities. Some injuries are not immediately obvious, and delayed injuries can and do happen.
Get Help Proving How the Accident Changed Your Condition
A personal injury claim involving a preexisting injury requires a careful analysis of medical history, causation, and damages. An attorney can gather the relevant records, work with medical professionals, document the difference between your pre-accident and post-accident condition, and respond when an insurer attempts to attribute all your symptoms to the past.
If an insurance company says your injuries were already there, you do not have to accept that conclusion without further review. Contact Kane Personal Injury for a free consultation. We’ll review the accident, your medical history, and the compensation that may be available for the harm the accident caused.
