Can a Pre-Existing Condition Affect My Injury Claim?

Whether you’ve been injured by another party or in a workplace accident, it’s often a frightening and frustrating experience. In addition to the physical pain and emotional distress, there’s medical bills piling up and you may not be able to work.

It’s important that you receive the compensation you’re entitled to for damages, losses, and injuries. If you have a pre-existing condition, however, it could impact your claim.

This article is a generalized guide to a very complex topic. If you’ve been injured and have a pre-existing condition, it’s wise to contact an experienced injury attorney right away. They can advise you on the best way to handle your case and receive fair compensation.

Pre-Existing Conditions & Personal Injury Claims

Most people automatically assume a pre-existing condition will hurt their personal injury claim; however, this is not always the case. The totality of facts must be considered, including the details of the pre-existing condition and of your current injury.

Insurance Disputes

It’s common for insurance companies to use a pre-existing condition as a reason to reduce the amount of compensation they must pay. If you’ve been injured and also have a pre-existing injury, consult a personal injury attorney as soon as possible. An attorney acts as a mediator between you and the insurance company, and can determine how the pre-existing condition may impact your personal injury claim.

Insurance companies often argue that the current condition was not caused by the accident, and that you’re simply using it as a way to continue treatment or try new treatments for a pre-existing condition. They may state that only a small portion of your treatment is related to injuries sustained in the accident. If this is the case, the value of your personal injury claim could decrease because the actual damages (i.e. medical bills, lost wages, etc.) and non-economic damages such as pain and suffering are lowered.

Insurance companies may also request a signed medical release to “verify your injuries” and settle your claim. Never sign a release without consulting an attorney first. The insurance company is using a common tactic designed to gain access to your medical history to poke around for pre-existing conditions it can use to mitigate its liability.

An experienced attorney will advise you properly and work to maximize your chance of recovering the full value of your case.

As I Am: The “Egg-Shell Plaintiff” Theory

On the other hand, a pre-existing condition could actually increase the value of your personal injury claim. The egg-shell theory states that the accident victim must be accepted in the condition they were in at the time of the accident. In other words, if the accident victim is a healthy, 20-year-old bodybuilder who is in great physical shape, they may not sustain the same severity of injuries as a 60 year old who has osteoporosis.

Due to their current states, the older victim may be more susceptible to broken bones, a lengthy recovery time or complications, while the younger victim may break the same bone but heal quickly with few or no complications. In either case, it’s not the accident victim’s fault they were injured by another person. They deserve to receive the level of treatment required to reach maximum medical recovery and compensation that is fair and just based on their unique situation.

In most cases, in order to receive compensation for injuries that aggravated or worsened a pre-existing condition, a medical provider must state that the complications and current condition are a result of the most recent injury. The pre-existing condition may have impacted the current medical condition, but the accident was the cause of the current complications or injuries, even though the damages may be higher due to a pre-existing condition.

Pre-Existing Conditions and Workers’ Compensation Claims

Workers’ compensation is a no-fault system that protects employees who are injured at work. It pays for the medical expenses and treatments related to the workplace injury, in addition to other benefits, such as a percentage of lost wages.

“New” Injuries With a Pre-Existing Injury

Though workers’ comp laws vary by state, most states allow compensation for workplace injuries even if a pre-existing condition existed at the time of the accident, provided the current injury is a “new” injury unrelated to the pre-existing condition. In the case of a “new” injury, the injury will be treated on its own merits as if the pre-existing condition did not exist.

“New” can refer to an injury to another part of the body, or the same part of the body as the pre-existing condition. In this context, “new” would be something like breaking a leg where the bone had already been weakened by bone disease, or a severe case of whiplash after the neck had been injured in a previous fall a few years ago.

Workplace Injuries Related to a Pre-Existing Condition

A pre-existing condition can complicate a workers’ compensation claim, but it’s not an automatic denial (though some insurance companies will try).

If the workplace injury is related to the pre-existing injury, most states will still allow the injured employee benefits under workers’ compensation if the worker can show that the accident aggravated, accelerated, or worsened the pre-existing condition. This often requires medical experts who can testify how the current accident and/or injury caused the pre-existing injury to become worse.

Under Oregon’s workers’ compensation laws, when a worker has a pre-existing condition that combines with the injury event, the result is referred to as a combined condition. The insurance company should cover combined conditions, provided the injury event is the major cause of the combined condition. However, insurance companies like to deny these claims and place the burden of proof on the injured worker.

A Few Final Words

Complex rules and laws govern injury claims when a pre-existing condition exists, and insurance companies will frequently try to use a pre-existing condition to their advantage. If the insurance company can successfully argue that the accident did not result in a new injury or an aggravation of an existing injury, your claim could be denied.

It’s extremely important that you contact an attorney with experience in workers’ compensation and/or personal injury laws as soon as possible after an accident involving a pre-existing condition. Never hide your pre-existing condition from your attorney. An attorney who is “surprised” at trial by this evidence may not be able to undo the damage to your case. However, if you are upfront with your attorney, they may be able to use their skills, knowledge, resources, and expert witnesses to prove that your injury qualifies for benefits.