Can Insurance Companies Deny Claims for Pre-Existing Conditions?

Dec 22, 2022 | CHASENBOSCOLO

Pre-existing conditions can make insurance claims more difficult because an insurance company may resist paying compensation when the injured party has one. Insurance companies are for-profit companies with one goal: maintaining their bottom line. As a result, an insurance company may use someone’s pre-existing medical condition to deny coverage.

If you have been injured in an accident that wasn’t your fault and had a pre-existing condition, you may want to retain an experienced attorney who will help you recover the compensation you deserve.

What Is a Pre-Existing Condition?

A pre-existing condition is an injury or health issue that affects someone before they were involved in the accident that is the subject of the claim or litigation. An insurance company may consider the following to be pre-existing conditions:

  • Back injuries
  • Neck injuries
  • Heart problems
  • Respiratory conditions
  • Spinal stenosis
  • Osteoporosis
  • Psychological conditions (e.g., anxiety, depression, etc.)

An insurance company cannot deny an insurance claim simply because someone has a pre-existing condition. However, in order to obtain compensation based on that condition, you must show that the accident aggravated or exacerbated the condition.

What if My Pre-Existing Condition Is Not Related to the Injuries Sustained in the Accident?

Generally, you are entitled to compensation for injuries that occurred in an accident that wasn’t your fault. However, an insurance company will point to a pre-existing condition as a reason to deny compensation. For example, if you had a back injury 20 years ago and are in an accident, the insurance company will suggest that the pre-existing condition is responsible for any back injuries you claim resulted from the current accident. They’ll say they don’t owe you money for your back injuries because the accident didn’t cause them.

To prove that the accident caused the injuries and they were not the result of a pre-existing condition, you can disclose your medical history. Your doctor could testify that the injury was not a result of a pre-existing condition. An experienced attorney will know how to deal with an uncooperative insurance company and fight against unreasonable claim denials.

What if the Accident Worsens My Pre-Existing Condition?

Even if you had a pre-existing condition, if the accident aggravated or made your condition worse, you might be entitled to compensation for the injury. For example, if you injured your neck ten years ago, but your day-to-day activities have not been affected by that pre-existing injury, and your neck becomes symptomatic after the accident, you may be entitled to compensation.

Medical records are your strongest method of proving that the pre-existing condition was exacerbated by the accident. Your records should show that you were asymptomatic or at a particular level of symptoms before the accident. To prove you should be compensated for a worsening of that condition, your medical records should show different symptoms than the ones you had before or symptoms that are markedly worse than before the accident. You could also use witness testimony from friends, family, and others who can describe the ways your activities have been affected by the accident.

Once you can prove that the pre-existing condition was aggravated by the accident, you may be able to pursue the following compensation:

  • Lost wages for the time you missed from work because of the accident
  • Cost to repair or replace your personal property damaged in the accident
  • Medical expenses linked to the aggravation of the pre-existing condition
  • Physical therapy and counseling linked to the worsened pre-existing condition
  • Pain and suffering resulting from the injury

To receive compensation for an injury that is aggravated in an accident, the following should be true:

  • The pre-existing condition was stable at the time of the accident, and
  • Before the accident, there was no indication that the pre-existing condition would change or worsen without an aggravating incident.

A skilled personal injury attorney can fight an unreasonable claim denial if you can show that your pre-existing was stable and that the condition would not have worsened but for the accident.

Contact Us for a Free Consultation

If you have a pre-existing condition and have been in an accident caused by someone else in Maryland, Virginia, or Washington, DC, the personal injury attorneys of CHASENBOSCOLO could pursue your best interests. Our experienced attorneys can help file an insurance claim and deal with insurance companies that have unreasonably denied a claim because of a pre-existing condition.

Our skilled and knowledgeable personal injury attorneys have experience dealing with difficult and uncooperative insurance adjusters. Contact us today for a free consultation by calling us at (301) 220-0050.