How Pre-Existing Conditions Affect New Injury Claims

You’ve lived with chronic back pain for years. Last week, someone ran a red light and slammed into your vehicle. Now your back pain is unbearable, you can’t work, and you’re worried the insurance company will blame everything on your pre-existing condition rather than the accident.

Our friends at The Edelsteins, Faegenburg, & Blyakher LLP discuss how pre-existing conditions complicate virtually every injury claim they review. As a construction accident lawyer will tell you, having prior medical issues doesn’t disqualify you from compensation, but it does change how we approach your case.

The Eggshell Plaintiff Rule Protects You

Insurance companies want you to believe that pre-existing conditions eliminate your right to compensation. They’re wrong. Legal doctrine holds that defendants take victims as they find them. This principle, often called the eggshell plaintiff rule, means the at-fault party is responsible for all injuries their negligence causes, even if you were more vulnerable to injury than the average person.

If someone with osteoporosis suffers worse fractures in an accident than a person with healthy bones would have experienced, the at-fault driver still pays for all the injuries. Your pre-existing fragility doesn’t reduce their liability.

Aggravation Vs. New Injury

The distinction between aggravating an existing condition and causing a completely new injury matters significantly. Both are compensable, but insurance companies fight harder against aggravation claims.

New injuries are straightforward. You never had shoulder problems before the accident. Now you have a torn rotator cuff. The medical records clearly show the injury appeared immediately after the collision.

Aggravation claims require more proof. You had mild arthritis in your knee that caused occasional discomfort. After the accident, you need a knee replacement. Was the accident the substantial cause, or would you have needed surgery anyway? Medical evidence becomes absolutely vital in these situations.

What Insurance Companies Do With Your Medical History

Defense attorneys subpoena years of medical records looking for anything related to your current injuries. They’re building a narrative that your problems existed before the accident and the collision merely revealed symptoms that were inevitable.

This is where pre-existing conditions genuinely complicate claims. If your medical history shows:

• Previous treatment for the same body part now injured
• Prior complaints of similar symptoms
• Past diagnoses matching your current condition
• Historical imaging showing degenerative changes

The insurance company will argue these records prove the accident didn’t cause your current problems. They’ll find medical professionals willing to testify that your symptoms would have appeared regardless of the accident.

The Apportionment Battle

When you have a pre-existing condition, insurance companies often concede that the accident made things worse but fight over how much worse. They want to pay only for the aggravation, not the underlying condition.

If you had managed your chronic back pain with occasional over-the-counter medication before the accident but now require prescription painkillers and physical therapy, the difference between your pre-accident and post-accident treatment represents the compensable aggravation.

Calculating this apportionment requires detailed medical documentation showing your baseline condition before the accident. Without that evidence, insurance companies lowball their offers and claim you’re seeking payment for problems that predated the collision.

Why Complete Medical Disclosure Matters

Some people hide pre-existing conditions hoping it will strengthen their case. This strategy always backfires. Insurance companies obtain your complete medical history eventually. When they discover conditions you didn’t disclose, they accuse you of fraud and use the concealment to undermine your entire claim.

We need to know about pre-existing conditions upfront so we can build the strongest possible case despite them. Your prior medical issues aren’t shameful secrets. They’re facts we work with to demonstrate how the accident changed your life for the worse.

Comparing Before And After

Strong pre-existing condition cases rely on concrete comparisons between your life before and after the accident. Medical records tell part of the story, but your daily activities tell another part.

If you golfed twice weekly despite arthritis before the accident but haven’t touched your clubs since, that change matters. If you managed a warehouse on your feet all day with occasional knee pain but can’t stand for more than an hour now, that’s meaningful evidence of aggravation.

Documentation of your pre-accident capabilities strengthens these comparisons. Work attendance records, gym memberships, recreational activity receipts, and similar evidence all help establish your baseline function.

The Role Of Independent Medical Examinations

Insurance companies often demand independent medical examinations when pre-existing conditions are involved. These exams aren’t truly independent. The insurance company pays the doctor and expects opinions favorable to their position.

The examining physician reviews your records, conducts a brief physical examination, and provides an opinion about whether the accident caused or aggravated your injuries. These doctors often minimize accident-related injuries and emphasize pre-existing conditions.

We counter these examinations with opinions from your treating physicians who know your medical history intimately and observed the changes following the accident. Treatment providers carry more credibility than one-time examiners paid by insurance companies.

Settlement Value With Pre-Existing Conditions

Pre-existing conditions typically reduce settlement values compared to identical injuries in previously healthy people. This reality frustrates many clients, but it reflects how juries would likely view these cases.

The reduction doesn’t mean your claim lacks value. It means we focus compensation on the measurable aggravation the accident caused rather than your total current condition.

Moving Forward With Your Claim

Having a pre-existing condition doesn’t mean you should accept whatever the insurance company offers or abandon your claim entirely. It means you need skilled representation to separate accident-related damages from your prior medical issues. If you’re worried about how your medical history might affect your injury claim, reach out to discuss your specific situation and learn how we can build a strong case despite your pre-existing conditions.