Pre-Existing Conditions And Insurance Claims: What You Need To Know
If you’ve been injured in an accident and you had a health condition before the crash, you might worry that your insurance claim is doomed. After all, how can you prove your pain is from the accident and not from something you were already dealing with? The short answer is this: having a pre-existing condition doesn’t disqualify you from compensation. But it does complicate things, and insurance companies will absolutely use it against you if they can.
Understanding how pre-existing conditions affect insurance claims can mean the difference between fair compensation and getting stuck with medical bills you shouldn’t have to pay.
Below, our friends at Warner & Fitzmartin – Personal Injury Lawyers explain how pre-existing conditions can factor into insurance claims.
What Counts As A Pre-existing Condition
A pre-existing condition is any health issue you had before your accident. We’re talking about chronic illnesses like diabetes, arthritis, or heart disease. Previous injuries like old back problems, prior surgeries, or joint issues that never fully healed. Even mental health conditions like anxiety or depression count as pre-existing conditions if they existed before the accident.
The thing is, most people have something. Very few accident victims were in perfect health the moment before the crash. You might’ve had a sore knee, chronic migraines, or an old shoulder injury that flares up occasionally. Insurance companies know this, and they’re trained to find these conditions in your medical history and use them to reduce what they pay you.
The Insurance Company’s Favorite Tactic
Here’s how insurance companies typically handle claims involving pre-existing conditions. They dig through your medical records looking for anything they can point to. Once they find a previous injury or condition that’s even remotely related to your current complaint, they argue that your pain isn’t from their insured’s negligence—it’s just your old problem acting up again.
For example, let’s say you had mild back pain that you managed with occasional over-the-counter pain relievers. Then you’re rear-ended in a crash and now you can’t get out of bed without significant pain. The insurance adjuster will pull up your records showing you mentioned back discomfort to your doctor two years ago, and they’ll claim the accident didn’t really hurt you—you already had a bad back.
This tactic works because it sounds reasonable on the surface. But it ignores a crucial legal principle that protects injury victims.
The Eggshell Skull Rule
There’s a legal doctrine called the eggshell skull rule, sometimes known as the “take your victim as you find them” rule. It comes from an 1891 Wisconsin case involving two schoolboys, but it’s been recognized in every state and remains just as relevant today.
The rule says that if someone injures you through their negligence, they’re responsible for all the resulting harm, even if you were more vulnerable to injury than the average person. Think of it this way: if someone bumps into you and you happen to have fragile bones that break easily, they don’t get to say “Well, a normal person wouldn’t have broken a bone from that bump, so I’m not responsible.” They’re on the hook for the full extent of your injuries because they caused the accident.
This doctrine applies whether your pre-existing condition made you more susceptible to injury, or whether the accident aggravated something that was previously under control. The at-fault party can’t escape liability by pointing to your medical history.
What You Can Actually Recover
Here’s the critical distinction: you can’t recover compensation for injuries or conditions you had before the accident. But you absolutely can recover for any worsening of those conditions or new injuries that resulted from the accident.
If your chronic back condition was manageable before the crash and now requires surgery, you can seek compensation for that deterioration. If your anxiety was controlled with minimal medication and now you need intensive therapy after a traumatic accident, that’s compensable. If an old knee injury that hadn’t bothered you in years is now causing daily pain after a slip and fall, you can pursue damages for that aggravation.
The key is proving the connection between the accident and the worsening of your condition. That requires solid medical documentation showing what your condition was like before the accident and how it’s changed since.
The Documentation You’ll Need
Insurance companies and courts need clear evidence that the accident caused your current problems or made your pre-existing condition worse. Medical records from before the accident are crucial because they establish your baseline health. If you saw a doctor for back pain once a year but could still work and exercise normally, that’s very different from chronic, debilitating pain.
A good car accident lawyer knows that records from immediately after the accident matter too. If you sought treatment right away and your doctors documented significant changes in your symptoms or functionality, that helps prove the accident’s impact. Gap in treatment is something insurance companies love to exploit. If you wait weeks or months to see a doctor after the accident, they’ll argue you weren’t really hurt that badly.
Professional medical testimony often becomes necessary in these cases. Your doctor might need to explain how the accident activated a dormant condition, triggered a significant flare-up of a chronic issue, or caused new damage on top of existing problems. This kind of testimony can be the difference between winning and losing your claim.
What Not To Do
The biggest mistake people make is trying to hide their pre-existing conditions. You might think keeping quiet about your medical history will strengthen your claim, but it does the opposite. Insurance companies will find out. They’ll request your medical records, and when they discover conditions you didn’t disclose, your credibility is shot.
Be upfront with your attorney about everything in your medical history. Let them figure out how to handle it strategically. They might be able to show that your condition was completely asymptomatic before the accident, or that you’d successfully managed it for years until the crash.
Another mistake is minimizing symptoms or skipping medical appointments. If you tell doctors you’re fine when you’re not, or if you don’t follow treatment recommendations, insurance companies will use that to argue your injuries aren’t serious. Consistency matters. Your statements to doctors, what you tell your attorney, and how you describe your limitations need to align.
The Bottom Line
Pre-existing conditions complicate insurance claims, but they don’t eliminate them. The law protects your right to full compensation for injuries caused or worsened by someone else’s negligence, regardless of your medical history. Insurance companies will use your pre-existing conditions to try to pay you less, but they can’t legally deny you compensation just because you weren’t in perfect health before the accident.
Understanding the eggshell skull rule, maintaining detailed medical documentation, and being honest about your health history from the start gives you the best chance of recovering fair compensation. Your vulnerabilities don’t reduce the other party’s responsibility for the harm they caused.
