Pre-Existing Conditions and Personal Injury Claims: What You Need to Know
One of the most common concerns people have when considering a personal injury claim is whether a pre-existing medical condition will prevent them from recovering compensation. The short answer is that a pre-existing condition does not automatically bar your claim, but it does add complexity. Insurance companies routinely investigate plaintiffs' medical histories in an effort to attribute some or all of their injuries and symptoms to pre-existing conditions rather than to the accident in question. This tactic, known as the pre-existing condition defense, can significantly impact the value of your claim. However, the law recognizes that an accident can aggravate or exacerbate a pre-existing condition, and you are entitled to recover compensation for the worsened condition. Understanding how pre-existing conditions are handled in personal injury law, what the eggshell plaintiff rule means for your case, how insurance companies use your medical history against you, and what strategies you can use to protect your claim is essential for anyone with a prior medical condition who has been injured in an accident. This comprehensive guide explains the legal principles that apply, provides practical advice for documenting your injuries, and offers strategies for working with your attorney to maximize your compensation despite the presence of a pre-existing condition.
What Are Pre-Existing Conditions?
A pre-existing condition is any medical condition, injury, or illness that existed before the accident that caused your personal injury claim. Pre-existing conditions can range from chronic conditions such as arthritis, diabetes, heart disease, or fibromyalgia to prior injuries such as a previous back injury, knee surgery, or whiplash from a prior car accident. The key legal question is whether the accident caused a new injury, aggravated an existing condition, or both. Insurance companies will scrutinize your medical records for any mention of prior symptoms, treatments, or diagnoses that could be used to argue that your current complaints are not related to the accident. They may also argue that your current symptoms are simply the natural progression of a pre-existing condition rather than the result of the accident. It is important to be honest and forthcoming about your pre-existing conditions because failing to disclose them can seriously damage your credibility. However, having a pre-existing condition does not mean you are not entitled to compensation. The law recognizes that an accident can make a pre-existing condition worse, and you have the right to be compensated for the additional pain, suffering, and expenses caused by the aggravation of that condition.
The Eggshell Plaintiff Rule
The eggshell plaintiff rule is a fundamental legal principle in personal injury law that protects plaintiffs who have pre-existing conditions. The rule states that a defendant takes the plaintiff as they find them, meaning that the defendant is liable for the full extent of the injuries caused by their negligence, even if those injuries are more severe than they would have been in a person without the pre-existing condition. For example, if a plaintiff has a pre-existing back condition that makes them more susceptible to injury, and a minor car accident causes a severe herniated disc, the defendant is liable for the full extent of the injury, even though a person with a healthy back would not have been injured as severely. The name comes from the analogy that if a plaintiff has an eggshell-thin skull, and the defendant negligently taps them on the head, the defendant is liable for the full extent of the skull fracture, even though a normal person would not have been injured by such a light tap. The eggshell plaintiff rule applies in all personal injury cases and is an important protection for plaintiffs with pre-existing conditions. However, the rule does not mean that the defendant is liable for the pre-existing condition itself. The defendant is only liable for the additional harm caused by the accident. The challenge is separating the harm caused by the accident from the pre-existing condition. This is where thorough medical documentation and expert testimony become critical.
How Insurance Companies Use Pre-Existing Conditions
Insurance companies are skilled at using pre-existing conditions to reduce or deny personal injury claims. Their goal is to attribute as much of your pain, suffering, and medical expenses as possible to your pre-existing condition rather than to the accident. They will obtain your medical records from before the accident, often going back many years, and look for any evidence of prior complaints, diagnoses, or treatments that could explain your current symptoms. They may hire medical experts to review your records and testify that your current condition is the result of a pre-existing condition rather than the accident. They may also use surveillance footage, social media posts, or statements you made to medical providers to argue that your symptoms are not as severe as you claim. Insurance adjusters are trained to identify gaps in medical treatment, inconsistencies between your reported symptoms and your medical records, and any other evidence that could undermine your claim. The most effective way to counter these tactics is to be proactive in documenting your pre-existing condition before the accident and your new or worsened symptoms after the accident. This includes obtaining medical records from your pre-accident treating physicians, getting a clear statement from your current treating physician about how the accident has affected your condition, and being consistent in reporting your symptoms to every medical provider you see.
Aggravation of Pre-Existing Conditions
The concept of aggravation of a pre-existing condition is central to many personal injury cases. An aggravation occurs when an accident worsens or exacerbates a pre-existing condition, causing additional pain, disability, or medical expenses beyond what the plaintiff would have experienced from the natural progression of the condition alone. For example, a person with mild arthritis in their knee who is involved in a car accident may develop severe arthritis requiring knee replacement surgery. The defendant is liable for the additional harm caused by the accident, including the cost of the knee replacement and the associated pain and suffering. To prove aggravation, the plaintiff must present evidence that the accident caused a measurable worsening of the pre-existing condition. This typically requires testimony from a medical expert who can compare the plaintiff's condition before and after the accident and opine on the causal connection between the accident and the worsened condition. Medical records documenting the pre-existing condition before the accident and the post-accident changes are essential. In some cases, the plaintiff's own testimony about the change in symptoms may be sufficient, but objective medical evidence is far more persuasive. It is important to continue treating with your doctors after the accident so that there is a clear record of your post-accident condition and the progression of your symptoms.
Documenting Your Medical History
Thorough documentation of your medical history is the most important step you can take to protect your personal injury claim when you have a pre-existing condition. Before the accident, you should gather all relevant medical records from your treating physicians, including records of any prior injuries, surgeries, diagnoses, and treatments. These records will serve as a baseline against which your post-accident condition can be compared. After the accident, you should seek medical treatment promptly and continue treating until you reach maximum medical improvement. You should be honest with every medical provider about your pre-existing conditions and about how your symptoms have changed since the accident. Inconsistent reporting of your symptoms can seriously damage your credibility. You should also keep a pain journal documenting your daily symptoms, the impact of your injuries on your daily activities, and any changes in your condition over time. Photographs of visible injuries can also be helpful. Your attorney will work with you to gather and organize all of this documentation and to identify any gaps in your medical records that need to be addressed. The stronger your documentation, the better your ability to prove that the accident caused an aggravation of your pre-existing condition and to rebut any arguments by the insurance company that your symptoms are solely the result of your pre-existing condition.
Strategies to Protect Your Claim
There are several strategies you can use to protect your personal injury claim when you have a pre-existing condition. First, be completely honest about your medical history. Do not hide or minimize a pre-existing condition, as the insurance company will inevitably discover it through medical records requests, and any dishonesty will destroy your credibility. Second, seek medical treatment immediately after the accident and be specific with your doctors about how your symptoms differ from your pre-existing condition. For example, if you had prior back pain but the accident caused a different type of pain or pain in a different location, make sure that is documented. Third, follow your doctor's treatment recommendations strictly. Gaps in treatment can be used by the insurance company to argue that your condition is not as serious as you claim or that it is related to your pre-existing condition rather than the accident. Fourth, avoid making statements that could be used against you, such as telling an insurance adjuster that your condition is the same as it was before the accident or that you are fully recovered when you are not. Fifth, limit your activity on social media, as insurance companies frequently monitor plaintiffs' social media accounts for evidence that contradicts their claims of injury. Finally, and most importantly, work with an experienced personal injury attorney who understands how to handle cases involving pre-existing conditions and who can develop a strategy for presenting your case in the most favorable light.
Working With Your Attorney
Having an experienced personal injury attorney is especially important when you have a pre-existing condition. Your attorney will help you navigate the complexities of your case, including gathering and organizing your medical records, identifying the appropriate medical experts to testify about the aggravation of your condition, and developing a legal strategy that maximizes your compensation. Your attorney will also handle all communications with the insurance company and will be prepared to counter any arguments the insurance company raises about your pre-existing condition. In many cases, your attorney will retain a medical expert who can review your medical records and provide a detailed opinion about how the accident aggravated your pre-existing condition. This expert testimony is often critical to proving your case and can significantly increase your settlement or verdict. Your attorney will also advise you on how to respond to discovery requests from the defendant, including requests for medical records, and will ensure that your privacy rights are protected. The relationship between you and your attorney should be collaborative, and you should keep your attorney informed of any changes in your condition, any new medical treatment you receive, and any communications you receive from the insurance company. With the right legal representation, a pre-existing condition does not have to prevent you from obtaining the compensation you deserve for your injuries.
Frequently Asked Questions
No, a pre-existing condition does not automatically prevent you from recovering compensation. You are entitled to recover compensation for any new injuries caused by the accident and for any aggravation or worsening of your pre-existing condition caused by the accident. The defendant is liable for the full extent of the harm caused by their negligence, even if that harm is more severe than it would have been in a person without your pre-existing condition. This is known as the eggshell plaintiff rule. However, you will need to present evidence that separates the harm caused by the accident from your pre-existing condition, which often requires medical records and expert testimony.
The eggshell plaintiff rule is a legal doctrine that holds a defendant fully liable for the injuries caused by their negligence, even if the plaintiff had a pre-existing condition that made them more vulnerable to injury. The rule takes its name from the hypothetical scenario of a plaintiff with an eggshell-thin skull who suffers a catastrophic injury from a minor blow that would not have injured a normal person. The defendant is liable for the full extent of the injury because they must take the plaintiff as they find them. This rule protects plaintiffs with pre-existing conditions and ensures that defendants cannot escape liability simply because their victim was unusually susceptible to injury.
Proving that your injury is new or that your pre-existing condition was aggravated by the accident requires thorough medical documentation. You should seek medical treatment immediately after the accident and be specific with your doctors about how your symptoms differ from any pre-existing symptoms. Your doctors should document their findings, including objective evidence such as X-rays, MRI scans, and physical examination findings. Your attorney may also retain a medical expert who can review your pre-accident and post-accident medical records and provide an opinion that the accident caused or aggravated your condition. Consistency in reporting your symptoms to all medical providers is also critical for establishing credibility.
Yes, you generally have a duty to disclose your relevant medical history in a personal injury claim. When you file a personal injury lawsuit, you place your medical condition at issue, and the defendant is entitled to discover medical records that are relevant to your claim. However, the scope of discoverable medical records is limited to those that are relevant to the injuries you are claiming. Your attorney can help you respond to discovery requests and can object to requests that are overly broad or seek irrelevant information. It is important to be honest and forthcoming about your medical history because any attempt to conceal relevant information can seriously damage your credibility and your case.
Yes, the insurance company can obtain your pre-accident medical records as part of their investigation into your claim. They will typically request your authorization to release medical records, and if you refuse, they may subpoena the records once a lawsuit is filed. Insurance companies routinely review years of medical history looking for evidence of pre-existing conditions that could explain your current symptoms. This is why it is important to be honest about your medical history from the outset. If the insurance company discovers a pre-existing condition that you did not disclose, they may argue that you have been dishonest and may use that to undermine your entire claim. It is better to be upfront about your medical history and to work with your attorney to develop a strategy for addressing any pre-existing conditions in your case.