How a Pre-Existing Condition Affects Your Insurance Claim in an Accident

Whether you are injured in an accident in which there is an at-fault third-party and are attempting to recover damages through the third-party’s liability insurance, or whether you’re making a first-party claim with your own health insurer, the presence of a pre-existing condition could complicate recovery somewhat.

Injury Must Be Distinct or Aggravated

In Florida, you may recover for injuries that are either distinct from a pre-existing injury, or that have simply aggravated a pre-existing injury to a substantial degree.

Distinct Injury

An injury may be new and distinct from a pre-existing injury, even if the new injury affects similar areas of the body — whether the injury is “distinct” may sometimes depend on how detailed the examination of the injury is.

For example, suppose that you are suffering from a pre-existing shoulder injury.  You are later involved in an accident where your shoulder is further injured.  Though at first glance one might assume that the injuries are one and the same, medical imaging might reveal that the new injury caused damage to previously unaffected parts of the shoulder.

Aggravated Injury

Importantly, even if you have not suffered a distinct injury, you may be entitled to make an insurance claim if your pre-existing injury was aggravated in an accident.  Aggravation of a pre-existing injury may reduce your potential recovery, however, as you will only be entitled to the losses suffered as a result of the aggravation itself (not the injury as a whole).

Let’s return to our shoulder injury example.  Suppose that the accident did not create a new injury, but simply exacerbated the pre-existing shoulder injury.  Whereas before you were suffering from occasional, sharp pinching pains in your shoulder, the aggravation has caused the pain to increase and has further limited the mobility of your shoulder.  If you can show that the aggravation has been substantial, the insurer is likely to put forth a larger settlement offer.

Important Evidence

When you’re dealing with a claim that’s complicated by a pre-existing condition or injury, it’s critical that you bring forth persuasive evidence that demonstrates that the injury is distinct, or that the pre-existing injury has been substantially aggravated.  As such, you’ll want to have the requisite medical tests performed as soon as possible after your injury.  Further, by working with an experienced health insurance attorney, you will be introduced to medical experts who will investigate the facts and testify as to the realities of your condition.

If you have been involved in an accident and have suffered injuries that are difficult to separate from a pre-existing injury, the insurer (whether or not the case involves third-party liability) will almost certainly attempt to minimize their payout by asserting that the new injuries you suffered are not “new” or “distinct” and therefore do not entitle you to damages.  A skilled health insurance attorney can navigate the roadblocks created by insurers that would otherwise prevent you from obtaining a full and fair payout.

To speak with an experienced Miami health insurance lawyer at Ver Ploeg & Marino, call 305-577-3996 today.  During your free consultation, your claims will be assessed and you a strategic roadmap will be discussed.

Share