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Law Office of Cohen & Jaffe, LLP

How Pre-Existing Conditions Impact Personal Injury Claims

Injuries can happen to anyone, old or young, healthy or infirm. When people are injured due to the negligence of others, pre-existing health conditions can create an obstacle to compensation. Insurance companies commonly use pre-existing medical problems as an excuse to deny coverage, depriving seriously injured victims of compensation. Remember that no matter how clever or friendly their advertisements, insurance companies make their money by charging customers premiums, then finding any loophole or excuse possible to deny payment.

What is Considered a Pre-Existing Condition?

A pre-existing condition is a medical or physical condition, problem, or ailment that existed before your injury. Say you were in a car accident and hurt your back. A prior back injury from a couple years earlier would be a pre-existing condition. Here are some common pre-existing conditions insurance companies look for when evaluating your claim:

  • Prior back injuries
  • Neck or head injuries
  • Past surgeries
  • Heart problems
  • Respiratory conditions
  • Previous pain treatments (medications, TENS units, chronic pain, etc…)
  • History of chiropractic care
  • Degenerative disc disease
  • Spinal stenosis
  • Arthritis
  • Diabetes
  • Osteoporosis
  • Emotional or psychological issues

What if Pre-Existing Conditions are Not Related?

The insurance company does not care if the condition is related. If you had a neck injury 20 years ago, and the current injury is a broken leg, you can rest assured that they will stretch logic as far as they can in order to try to make a connection. Fortunately, it is not entirely up to the insurance company.

Your Options if the Insurance Company Tries to Reduce Compensation Based on Pre-Existing Conditions

When insurance companies unreasonably deny or undervalue claims, an experienced personal injury lawyer can help you fight for the compensation you deserve, including pursuing a civil lawsuit against the person who caused your injuries. In many cases, this can take the decision away from the insurance company and put it in the hands of a jury. Then you must convince a jury that your current pain and suffering are caused by the defendant’s negligence, rather than the pre-existing condition. There are several ways that a good lawyer can help to show that your injuries were caused in the present accident or event, rather from the prior condition:

  • Good Documentation: First, you should make sure you discuss any pre-existing conditions with your healthcare professionals. Ask them to be clear about explaining whether your current problems and symptoms are due to the accident or the prior condition. You must also be honest and open about your prior condition when speaking to your attorney. Hiding information puts your lawyer at a disadvantage when negotiating with the insurance company.
  • Eggshell Plaintiff Rule: This is an old legal theory that basically says you take your plaintiff as you find him or her. Defendants do not get to avoid liability just because someone was especially susceptible to injury. A good example would be a frail, elderly person who gets struck by a car, killing her. The same impact may have done nothing more than cause bruising to an 18-year-old in good health, but the defendant does not get to argue that they should be allowed to not pay, just because the victim was elderly and frail.
  • Unrelated Pre-existing Conditions: If the pre-existing condition has little to do with the current injury (e.g. neck vs. broken leg), your attorney can argue that evidence of your pre-existing condition not even be allowed into evidence, as it would be completely irrelevant. Now, this may or may not work in all cases, but an experienced lawyer can also use your medical evidence to help a jury realize the lack of a connection.

Long Island Personal Injury Attorneys – Fighting for Full Compensation

If you have been hurt in a car crash or in some other form of personal injury in NYC or Long Island, call the Law Office of Cohen & Jaffe, LLP today. The Centers for Disease Control and Prevention (CDC) reports that about 27.6 million people are treated for injuries in American emergency rooms annually. Therefore, almost everyone at some point may suffer some kind of injury. You do not lose your right to be compensated just because you were hurt before. For a free consultation and to discuss your situation, call or visit us online today.


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