Why Do Insurers Call Injuries Preexisting

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The term “pre-existing condition” is a common tactic used by insurance companies to minimize or deny payouts. While it’s true that most people have some prior medical history – perhaps an old sports injury, arthritis, or even a history of back pain – that doesn’t automatically disqualify them from recovering compensation for new injuries sustained in an accident. The core question isn’t whether you had a previous injury, but whether the accident aggravated or caused a new injury.

Insurance adjusters are trained to comb through medical records looking for anything they can point to as a prior ailment. They will often argue that your current pain is simply a flare-up of an old condition, not the result of the recent accident. This is where having an attorney familiar with the tactics of insurance defense is critical.

For over 13 years, I’ve practiced personal injury law here in San Diego. Having been trained by a former insurance defense attorney, I’ve seen firsthand how insurance companies evaluate, devalue, and deny claims. They’ll often seize on a pre-existing condition to suggest your current symptoms aren’t as severe or as directly related to the accident as you claim.

How Do Insurance Companies Determine If an Injury Is “Pre-Existing”?

Insurers typically rely on a thorough review of your medical records prior to the accident. They are looking for any documentation of similar complaints, diagnoses, or treatments. It’s important to understand that simply having a past injury doesn’t mean a current claim will be denied. The insurance company must demonstrate a direct connection between the pre-existing condition and your current symptoms.

Often, they will request you undergo an Independent Medical Examination (IME). CCP § 2032.220 states under California law, the defense is entitled to one physical examination of the plaintiff if the lawsuit seeks damages for personal injuries. While often called ‘Independent,’ these doctors are hired by the insurance company to challenge the extent of your medical claims.

During the IME, the doctor will review your medical history and perform a physical examination. They’ll then issue a report to the insurance company, opining on the cause of your injuries and the extent to which they were pre-existing. It’s essential to be honest and thorough with the IME doctor, but also be mindful that their ultimate goal is to minimize the insurance company’s liability. Preparing with your attorney before an IME can be incredibly helpful.

What Evidence Do I Need to Counter a “Pre-Existing Condition” Denial?

Successfully countering a “pre-existing condition” denial requires gathering compelling evidence that demonstrates the accident caused or aggravated your injuries. This can include:

• Detailed Medical Records: Your treating physician’s notes are crucial. They should clearly document the nature of your symptoms, the timing of their onset, and how they relate to the accident.
• Imaging Reports: MRIs, X-rays, and CT scans can provide objective evidence of injuries sustained in the collision.
• Witness Testimony: Statements from passengers, bystanders, or even the other driver can corroborate your account of the accident and your immediate symptoms.
• Expert Testimony: In some cases, it may be necessary to hire a medical expert to provide an independent opinion on the cause of your injuries.

The more evidence you can provide to support your claim, the stronger your position will be. A skilled attorney can help you gather this evidence and present it effectively to the insurance company.

What Happens If the Insurance Company Still Denies My Claim?

If the insurance company continues to deny your claim based on a “pre-existing condition,” you may have several options. One is to file a lawsuit. Litigation allows you to present your case to a judge or jury, who will ultimately decide whether the insurance company is liable for your damages. San Diego courts are familiar with these types of cases, and an experienced attorney can navigate the legal process on your behalf.

Can I Still Recover Damages If I Have a Pre-Existing Condition?

Absolutely. Under California law, the fact that you had a pre-existing condition doesn’t automatically bar you from recovering compensation. You are still entitled to recover damages for any new injuries or aggravation of your existing condition caused by the accident. Civ. Code § 1714 states California follows a ‘pure’ comparative fault system. This means that even if you were partially at fault for the accident, you can still recover damages, although your recovery may be reduced by your percentage of fault.

The insurance company may attempt to reduce your payout by the percentage of fault they attribute to your pre-existing condition, but you are still entitled to compensation for the portion of your injuries that were directly caused by the accident. An attorney can help you negotiate with the insurance company and ensure you receive a fair settlement.

What Should I Do If the Insurance Company Claims My Injuries Are “Pre-Existing”?

If the insurance company claims your injuries are “pre-existing,” don’t panic. Don’t sign any documents or make any statements without first consulting with an attorney. Contact a personal injury lawyer immediately to discuss your options. A skilled attorney can investigate your claim, gather evidence, and protect your rights.