Insurance

How Pre-Existing Medical Conditions Can Impact Personal Injury Claims

Ranging from car accidents to slip and fall injuries, personal injury cases cover a wide range of accidents. Filing a personal injury lawsuit is a challenging process. Attorneys or other legal representatives handling personal injury cases need to collect and scrutinize a number of medical records and other bills from various healthcare providers who may have treated the injured person. The data in the medical records helps the legal professional to decide whether the claim is genuine and the covered person is eligible for compensation. Detailed medical record review can bring to light mistakes in the medical records, lack of medical records, and tampering in the medical records. Considering the importance of medical records in determining claims, injured persons must disclose their complete medical history including – earlier injuries to the body part injured in the current accident, or any pre-existing conditions such as hypertension or diabetes. However, unlike a normal claim, one that involves a plaintiff with pre-existing conditions can have many challenges when it comes to holding the person at fault liable. Often, injured people are confused as to how to file their claims and whether they will get a fair compensation. Prior injuries have to be investigated as the claimant may not be eligible for getting compensation for medical treatment for an injury that occurred before the accident at issue. Moreover, if an injured person is hypertensive or a diabetic, these pre-existing conditions could slow down his/her recovery and even cause complications in healing.

Understanding What a Pre-Existing Medical Condition Is

In most accident or injury cases, one of the common questions that the injured person faces is about pre-existing medical conditions. Injuries can be physical, mental or a combination of the two, and for an injured person, these pre-existing conditions can have positive or negative effects on a personal injury claim. The initial step is understanding the role that pre-existing conditions can play in a personal injury case. It is important to correctly analyze and know what a pre-existing condition truly is.

  • For the purpose of a lawsuit, a pre-existing condition is an illness, injury or any other medical condition that a person has experienced before getting involved in an accident. Some of the most common pre-existing conditions include – degenerative disc disease, muscle disorders, nearsightedness or farsightedness, migraines, diabetes, depression, cardiovascular issues (like high blood pressure and heart murmurs), asthma, arthritis and other joint issues. There are several factors that determine how a pre-existing injury will affect a personal injury claim –
  • The body parts affected by the old and new injuries
  • The length of time between the diagnosis of the pre-existing injury and the new injury
  • The status of recovery from the pre-existing injury
  • Whether the new injury has caused your pre-existing injury to worsen

A pre-existing condition may complicate a personal injury claim and lower its value. The best way of proving pre-existing conditions is by providing evidence from the medical records. A claimant always needs to be ready with their medical records as they contain information related to the medical findings, diagnoses and prognosis that can prove all of their relevant pre-existing medical conditions. The data in the medical records helps the legal professionals decide whether the claim is genuine and the covered person is eligible for compensation. If a person provides inaccurate or incomplete medical history, it can have serious health consequences as well as negatively impact the compensation claim.

Importance of Disclosing Prior Injuries or Conditions

Once a person gets injured in an accident, it is important for him/her to remain honest with their injury attorney about the specific conditions they suffered at the time of the event. Failure to adequately disclose these conditions can reduce the victim’s chances of a favorable and fair settlement. Concerned that their claim may be denied, many persons do not reveal information about earlier injuries and illnesses. Disclosure is vital, particularly when a new injury affects the same body area as an old injury, and an entire claim can be jeopardized by a victim’s non-disclosure. Therefore, it is always best for injured persons to disclose all pre-existing injuries with physicians or attorneys to prove how the accident has aggravated these conditions. By being honest about a medical condition before an accident that resulted in a re-injury, a claimant can put herself in the law’s good graces and increase their credibility during the insurance claims process. On the other hand, those persons who deny or hide a previous condition set themselves up to fail and they can face possible court sanctions because of the omission. When an insurance adjuster or an opposing attorney encounters a claimant with no prior complaints or injuries (particularly if the person is above 30 years of age), their past medical conditions may come under complete scrutiny. An insurer may use a person’s pre-existing injuries and claims history to question the claims made after a subsequent accident.

The Eggshell Plaintiff Legal Theory

The “Eggshell Plaintiff Legal” rule states that the accident victims can’t have pre-existing conditions used against them to minimize the level of damage done to them when the pre-existing condition gets aggravated. When a person is involved in an accident and suffers an injury when they already have a pre-existing condition and the injury gets worse or complicates the pre-existing condition, then they still have the right to receive compensation. This comes from a theory that says if a man with a skull as soft as an “eggshell” gets involved in an accident and gets hit in the head, the at-fault party is fully liable for the injuries they caused, despite not knowing of the weakness of the man’s soft skull. Even if they have a pre-existing condition that makes them more vulnerable to injury, the eggshell rule guarantees that those who are at fault are held liable for the damage they caused. In fact, it does not matter what pre-existing conditions the injured party had before the accident.

Importance of Medical Record Documentation

The important thing is to provide honest, objective documentation. It is vital to explain medical conditions or injuries before and after an accident to the medical and legal teams, to be correctly treated and accurately compensated for the accident’s consequences. The existence of documentation can be beneficial to a personal injury lawyer as they can discuss these results with medical witnesses during a court trial. If the injuries have left a person permanently disabled, the presence of medical records can serve to document the disability.

In any personal injury case, correct medical records prove how an accident has aggravated a person’s prior condition. The detailed past medical history about prior conditions included in the medical reports will be sent to the third-party administrator or carrier for medical chart review. Remember that any evidence provided could affect the claim benefits. An experienced personal injury attorney, with the support of a medical review company, would follow up all the case details and work towards securing a better claim settlement for their clients.

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MOS has been providing quality, affordable medical record review services for the medico-legal industry across all 50 states in the US. We provide affordable medical record review, medical chart review, physician peer review for the medico-legal industries.

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