After a car accident, an insurance company might deny an injury claim if the adjuster believes that the claimant's injuries were not actually caused by the recent accident. Sometimes this is a legitimate argument, but just as often the cause of an injury is not as cut and dried as the insurance company makes it seem. Learn what you need to do if you're caught between an old and new injury when making a car accident claim.
Initially, it helps to understand exactly what the insurance company is talking about when it says your injury is pre-existing. A pre-existing injury or condition is some disease or disorder of the body that affected you before the auto accident that gave rise to your present claim. There are usually two types of pre-existing conditions.
The first type of pre-existing condition is an old injury to the same part of the body that was injured in the most recent accident. For instance, you hurt your back gardening last year and went to the doctor, who prescribed medication and physical therapy. Now, you've been in a car accident and your lower back is hurting again. The insurance company will likely consider this a pre-existing injury, especially after reviewing medical records related to your treatment for the gardening-related injury.
The second type of pre-existing condition is a physical disorder that you had before the recent accident. Typically, these are conditions such as
Often, the condition might not even be discovered until an automobile accident causes symptoms. For example, let's say you’re in an accident and go to the emergency room afterwards because your neck hurts. The doctor takes an x-ray and tells you that you have degenerative disc disease. The condition is pre-existing, because it is a disease that develops slowly over time, and the condition wasn't itself caused by the accident.
The short answer is, it depends. The insurance company may be able to rightfully deny your claim if the latest automobile accident (the one giving rise to your claim):
While this seems complicated, it is usually pretty simple. Say you are scheduled for hernia repair surgery, but on the way to the hospital you are in an automobile accident. Under this circumstance, even if the other driver caused the accident, the hernia itself was not caused by the collision, and therefore, the insurance company will not pay for the hernia repair or other damages related to the hernia surgery. (Learn more about who pays medical bills after a car accident.)
On the other hand, if the same automobile accident also caused your bad back to hurt again, when you hadn’t had any back pain for years, the insurance company is likely obligated pay damages for your injury to the extent it was made worse by the automobile accident.
Unfortunately, unraveling the causes of an injury can be complicated. Take the gardening example above. If you get into an automobile accident a week or two after you strained your back gardening, it may be difficult to determine whether you suffered additional back injuries in the accident, unless your symptoms are significantly different or your doctor runs tests showing that your back is much worse than it was several days ago.
Conversely, if you injured your back gardening ten years ago, and since then have had no treatment with any doctor for back pain, the recent accident is likely the cause of your back pain.
Typically, the extent to which a prior injury or condition is aggravated is a medical determination, one that will require consideration and comparison of all medical records pertaining to both the previous injury and the recent automobile accident. In addition, it may take diagnostic tests -- such as MRIs, x-rays and CAT scans -- to pinpoint when the injury occurred or how much your condition worsened as a result of the accident.
Ultimately, the determination of the aggravation of a pre-existing condition and the extent to which it was made worse by an automobile accident will come down to your doctor’s opinion. And be prepared for the insurance company to request an independent medical examination to get its own medical opinion.
If your pre-existing injury or condition really was made worse by an automobile accident, be sure to tell the insurance company and your doctors up front that you had a previous health issue that could be related to your current claim. Especially if your claim progresses beyond the preliminary stages, chances are that your medical records (which the other side is entitled to access and review) will reveal the pre-existing condition anyway, as part of the personal injury discovery process.