One question that seems to come up quite often to me is how pre-existing medical conditions affect an auto accident claim. Oftentimes, clients come to me after their claim has been denied or some, nominal settlement offer has been made and elicit my help in getting to the bottom of this issue. Auto insurance claims adjusters will always latch on to a prior medical history of complaints as a means to reject or reduce payouts. What does the law say on this issue?
Necessity of proving that the negligent act is the cause of your injury:
In most instances, “negligence” is the legal theory by which persons injured in automobile crashes seek legal compensation from the at fault party (assuming you are in a jurisdiction that has not adopted a “no fault” system). Negligence requires four essential elements:
- A duty on the part of the person causing harm to act in a reasonable manner;
- A breach of this duty by error (acting unreasonably) or omission (failing to act when required to do so);
- CAUSATION: The breach of duty must be the actual cause of harm; and
- Damages
When you are dealing with pre-existing medical conditions, the argument is centered around element four, causation. An injured person must prove that the injury was caused by the incident in question (i.e. the auto accident) and not by something that happened prior to the incident. Having said this, the laws of most U.S. states require the at fault party to be responsible for any “exacerbation” of a pre-existing condition (i.e. if the incident in question made the condition worse, the negligent party will still be legally responsible for and medical costs or treatment that would not have been necessary but for the auto accident). For example, in California, the law states as follows:
“Plaintiff [person claiming personal injury] is not entitled to damages for any physical or emotional condition that [he/she] had before defendant‘s conduct occurred. However, if plaintiff had a physical or emotional condition that was made worse by defendant‘s wrongful conduct, you must award damages that will reasonably and fairly compensate [him/her] for the effect on that condition.” California Civil Jury Instruction 3927
Proving exacerbation requires a medical opinion and oftentimes diagnostic studies like X-rays or MRIs, which can be compared to the medical records and films that were taken during the diagnosis and treatment that occurred at the time of the prior injury.
The “Egg Shell Plaintiff Rule”:
A related principle that is followed in most, if not all, U.S. states is known as the “egg shell plaintiff rule”. Like the old proverb about Humpty-Dumpty and his great fall, the law states that if you injure someone who is more prone to injury than the average person, the at fault party is still responsible for all of the bodily harm caused by the incident. Stated another way, the negligent party is responsible, “for all damages caused by the wrongful conduct … even if plaintiff was more susceptible to injury than a normally healthy person would have been, and even if a normally healthy person would not have suffered similar injury.” California Civil Jury Instruction 3928
Conclusion:
If you are presently in a dispute with an auto insurance carrier about whether or not their insured is liable for your injury due to a prior medical condition, it is best to consult with an attorney familiar with these issues and have that lawyer review your medical records and discuss these issues with your treating physicians. In fact, it is best to immediately, consult with a personal injury lawyer prior to engaging in discussions with insurance claims adjusters and other representatives at all. Oftentimes, claims personnel will attempt to find out your entire medical history and obtain medical release authorizations to do so if you are not represented by a lawyer. Only injuries to a same or similar body part are relevant and your medical history should be guarded accordingly. Obtaining the help and assistance of an experience accident attorney can make all the difference in these cases!
Additional Resources:
For a full discussion of this issue and other common disputes that arise with insurance companies following an auto accident, click here.
