If you have suffered a personal injury, you deserve to receive compensation for that harm. But there are several reasons that an insurance company might try to deny your claim. One of those reasons is that the insurance company might claim the harm you suffered was a pre-existing condition not covered by the policy.
Is this legal? The answer depends on the circumstances of your case. Typically, though, even if you have a pre-existing condition, that doesn’t mean the insurance company can deny the entirety of your claim.
What is a pre-existing condition?
A pre-existing condition is any form of harm that you were experiencing before you suffered a personal injury. Thus, if you had pink eye before the personal injury, it would be considered a pre-existing condition that you couldn’t request compensation for.
The Effect of a Pre-Existing Condition on Your Claim
Whether a pre-existing condition affects your claim depends on several factors, including what the condition is and what you are trying to get compensation for.
Consider the pink eye example. If you were seriously injured in a car accident, that pre-existing condition shouldn’t affect your compensation. The injuries you suffered are not related to pink eye, and that pre-existing condition isn’t a legitimate excuse for the insurance company to deny your claim.
But the situation is rarely that simple. Often, pre-existing conditions complicate compensation in some way.
When the Pre-Existing Condition Is Similar to the Injuries Claimed
Suppose that you have a broken arm before you slip and fall and dislocate the shoulder of the same arm. While the dislocated shoulder is a new injury, it is similar and close in proximity to your original injury. You can request compensation for treatment for the dislocated shoulder, but not for the broken arm.
This may be complicated by the fact that the same doctor may treat both injuries, possibly at the same time. In a situation like this, you must carefully document what treatment is for which injury to ensure you get the money you deserve.
When the Insurance Company Claims Your Pre-Existing Condition Caused the Injury
An insurance company may insist that your pre-existing condition caused the injury. In this situation, you are in dispute with the insurance company over whether you suffered a personal injury that is eligible for compensation.
One of the elements of a personal injury case is that the other party must be liable for the harm you suffered. To counter this, you will need to prove that your condition wasn’t responsible for your new injury.
If an Injury Aggravates Your Pre-Existing Condition
Another possibility is that an injury aggravates a pre-existing condition. When this happens, you can request compensation for the worsened condition. But you are limited to only getting compensation for treatment that wouldn’t have been required before the personal injury.
If you want to ensure you get the appropriate compensation for this, you will need to document the treatment you received before suffering the personal injury and the treatment you required after. The insurance company should compensate you for the difference.
In Cases of Medical Malpractice
One case where a pre-existing condition should help your claim is medical malpractice. If a physician fails to diagnose a condition and that failure causes it to worsen in some way, proving that the condition existed before you received the misdiagnosis can help your case.
Consult a Lawyer if You Have a Pre-Existing Condition
Before filing a claim for a personal injury, you should consult with a lawyer if you have a pre-existing condition. An experienced personal injury lawyer can determine whether your condition affects your case and how you should document it.
If you have a pre-existing condition and were injured due to someone else’s negligence in Los Angeles, a skilled and compassionate injury attorney from Saeedian Law Group may be able to help. Contact us today to speak to a personal injury attorney about your case.
