Personal Injury Claims: A Previous Injury or Pre-existing Condition Does Not Necessarily Lower the Value

I was involved in an accident with a woman who is now making a personal injury claim against my insurance company. Apparently she had a bad back before this accident, and now she claims that she needs surgery. I get that the accident was my fault, but why is my insurance company going to have to pay for something that she was probably going to need anyway? Andrea, Austin


This is what is known as an aggravation of a prior condition or a pre-existing condition.

The insurance adjuster handling your case, and the attorney defending you if the case has already made it into Suit, will review all of the claimant’s medical records. In this case, since she has a prior condition or injury that she has apparently admitted to, the insurance company will want to review her prior medical records also. Unless one of her doctors made a note indicating that she did indeed need surgery and had even gone so far as to schedule that said surgery, she will likely be able to relate the need for the surgery to your accident.

The reason is that she can always say that her back condition or injury was not bad enough or painful enough for her to consider surgery, and there would be no evidence to refute her claim. The insurance adjuster handling her case may make a big deal out of her having prior back problems, but sometimes the fact that a prior condition or injury existed will actually make a personal injury claim worth more money.

Here is a comparison that one of our contributors made years ago: if you have one completely healthy thumb but your other one is bruised up and arthritic, and you absolutely must choose to hit one or the other of them with a hammer, which one do you think will hurt more when hit? (No, you cannot answer “neither”; this is a hypothetical exercise and you should play along or you will not see the point.) Obviously, the sore one will obviously hurt more than the healthy one if that is the one you choose to hit.

Many times claimants attempt to hide prior conditions or injuries, but they are usually found out by an insurance adjuster who actually requests and reads treatment records. If a claimant is found to have hidden or lied about a prior condition, it does not look good for them. The fact that this woman was apparently honest about her prior back problems makes her a more sympathetic and possibly a more credible claimant.

This is not to say that you owe to make this woman completely healthy again, because that would be making her better and insurance claims are not intended for betterment. A settlement or Court award is intended to make the person whole again: to put her back as she was before the accident. But if this woman now needs surgery and claims that your accident was the event that pushed her pain level over the edge of what she could bear, your insurance company will need to pay her claim.

This article is written for informational purposes and is not intended to take the place of competent local legal counsel.

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