How Do Prior Medical Records Affect Settlements

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The insurance company’s tactic is common: they’ll argue that Ethan’s existing back pain isn’t solely caused by the accident, but rather a pre-existing condition. They’ll attempt to reduce the settlement amount by discounting the portion of his damages they deem attributable to his prior health issues. Understanding how these records are used – and how to counter their arguments – is critical to maximizing your recovery.

One of the first things we did with Ethan’s case was obtain all of his medical records dating back years. This allowed us to establish a clear timeline of his health and pinpoint exactly when his symptoms began to worsen following the collision. We then worked with his treating physicians to create a nexus report, directly connecting the accident to his current injuries and differentiating them from any pre-existing conditions.

I’ve spent over 13 years representing individuals injured in accidents throughout San Diego, and during that time, I’ve learned one undeniable truth: insurance companies are masters at leveraging prior medical records to minimize payouts. Having been trained by a former insurance defense attorney, I possess intimate knowledge of how they evaluate, devalue, and deny claims, and the strategies they employ to do so. Their goal isn’t fairness; it’s profitability.

Will Prior Injuries Prevent Me From Recovering Damages?

Not necessarily. Having a pre-existing condition doesn’t automatically disqualify you from seeking compensation. California law recognizes that individuals are often already coping with existing health issues when an accident occurs. The key is demonstrating that the accident exacerbated a pre-existing condition, or caused a new injury on top of it. The insurance company is obligated to compensate you for the additional harm caused by their insured’s negligence.

The insurance adjuster will likely request your complete medical history, going back several years. This isn’t uncommon, and it doesn’t mean your claim is automatically doomed. What they’re looking for is evidence to suggest that your current symptoms are simply a continuation of a prior problem, rather than a new injury resulting from the accident. However, even with a documented history of similar complaints, you can still recover damages.

We will work with medical experts to provide opinions on how the accident has aggravated your pre-existing condition and the extent to which the accident contributed to your overall injuries. A qualified doctor’s testimony is invaluable in explaining the distinction to the insurance company and potentially a jury.

How Do Insurance Companies Use Prior Medical Records?

Insurance companies employ several strategies when scrutinizing prior medical records. They will attempt to paint a picture of a claimant with a long history of complaints, suggesting that the current injury isn’t new or serious. They’ll focus on any prior diagnosis of similar symptoms, even if the injury mechanism was entirely different. The goal is to create doubt in the adjuster’s mind, and ultimately, devalue your claim.

Specifically, they will likely look for gaps in treatment, inconsistencies in your reported symptoms, and any instances where your prior complaints were resolved or managed. They will also examine your medical records for any evidence of pre-existing conditions that could be contributing to your current pain and suffering. They may even use this to argue that the accident was not the primary cause of your symptoms.

Another tactic is to request a complete and thorough review of your medical records by their own medical professional. It’s important to remember that these medical professionals are hired by the insurance company and are incentivized to minimize their liability. A second opinion from an independent doctor is almost always necessary to balance their findings.

What Steps Can I Take to Protect My Claim?

Proactive documentation is key. It’s crucial to be transparent and honest with your treating physicians about your pre-existing conditions, and to clearly articulate how the accident has exacerbated your symptoms. This will help create a strong medical record supporting your claim. Additionally, gather any documentation related to prior treatment, including medical records, bills, and correspondence with your doctors.

It’s also vital to avoid exaggerating your current symptoms or claiming new injuries that aren’t directly related to the accident. Honesty and consistency are paramount, as any discrepancies could be used against you. Finally, be cautious about posting information about your injury on social media, as this could be used as evidence against you.

Working with a qualified attorney is essential in navigating the complexities of prior medical records and maximizing your settlement. We will proactively gather all relevant documentation, build a strong medical case, and aggressively advocate for your rights throughout the negotiation process.

How Does Comparative Fault Apply With Pre-Existing Conditions?

California follows a “pure” comparative fault system. This means that you can recover damages even if you were partially at fault for the accident. However, your recovery will be reduced by your percentage of responsibility. Insurance adjusters often use pre-existing conditions to argue that you bear some of the blame for your current injuries, even if the accident significantly worsened your condition. Civ. Code § 3294 details the potential for punitive damages in cases involving negligence.

For example, if you had a history of back pain and the insurance company argues that the accident only aggravated your pre-existing condition, they might try to reduce your settlement by 50% if they believe your prior condition contributed equally to your current symptoms. It’s important to challenge this assertion with expert medical testimony demonstrating that the accident was the primary cause of your damages.

Building a strong medical case with clear evidence linking the accident to your injuries is crucial in overcoming the insurance company’s attempts to shift blame. We will work with medical experts to establish a definitive connection between the collision and your current pain and suffering, ensuring you receive fair compensation for your losses.

What if the Insurance Company Denies My Claim Based on Prior Medical Records?

If the insurance company denies your claim based on prior medical records, it’s not the end of the road. You have the right to appeal the decision and pursue legal action. It’s highly recommended to consult with an attorney at this stage, as they can help you navigate the complex legal process and build a compelling case. Civil Code § 3333.4 covers non-economic damages, which may be affected by the insurance company’s denial.

The attorney will review the denial letter, gather additional evidence, and potentially consult with medical experts to refute the insurance company’s arguments. If a fair settlement cannot be reached through negotiation, we can file a lawsuit on your behalf and pursue your claim in court. We will aggressively advocate for your rights and fight to ensure you receive the compensation you deserve.

Don’t let a prior medical history discourage you from seeking the compensation you deserve. Contact my office today for a free consultation, and we will thoroughly evaluate your case and discuss your legal options.