How a Pre-Existing Condition Can Affect a Personal Injury Claim

Your personal injury claim can be complicated by a pre-existing existing health condition, but your case isn't doomed.

By , J.D. · Villanova University School of Law
Updated by David Goguen, J.D. · University of San Francisco School of Law

Whether it's a chronic condition, an old injury, or some other health issue, it's not uncommon for someone to be in less than optimal health when an accident takes place. So, what happens when an accident aggravates an existing injury or health condition?

  • A pre-existing health issue can complicate things, but it shouldn't automatically prevent recovery of fair compensation in your personal injury case.
  • Careful analysis and accurate characterization of your medical records are often crucial when an injury claim involves a pre-existing condition.
  • A big challenge can be determining a proper "pain and suffering" figure when the personal injury claimant was already experiencing some level of chronic discomfort before the accident.

Types of Pre-Existing Injuries or Conditions

While the possibilities are almost limitless, some of the most common pre-existing injuries that might come into play in a personal injury claim include:

  • previously broken bones
  • chronic back or neck issues
  • herniated disc
  • history of concussion
  • traumatic brain injury, and
  • strain and sprains

It's important to note that accidents don't always make pre-existing injuries worse. They can also exacerbate pre-existing medical conditions. Or, to put it another way, a pre-existing medical condition can enhance the effects of the accident. Some examples are:

  • arthritis
  • degenerative disc disease
  • diabetes
  • fibromyalgia, and
  • cardiovascular disease.

How Pre-Existing Conditions Complicate a Personal Injury Claim

When you decide to make a personal injury claim after an accident, it's a well-established rule that any money you receive ("damages") will not include compensation for injuries or conditions that existed before the accident.

However, if the at-fault party's negligence or other wrongful conduct made your pre-existing condition worse, then the at-fault party can be held financially liable for those effects. This rule may sound simple, but given the complexity of the human body and the difficulty inherent in proving causation in certain cases, the existence of a pre-existing injury or condition can make it more difficult to determine liability and calculate damages.

Liability, Causation and Pre-Existing Injuries

Showing that an accident caused a specific injury is typically the most challenging aspect of cases involving pre-existing injuries. For example:

  • If you have no back pain and no history of back injury before a car accident that results in severe back complications, it's pretty clear that the accident was the cause.
  • But if you have lower back pain due to a slipped disc from your prior job as a construction worker, and you later get into a car accident, obtaining recovery could be more difficult.

In the second example above, now the at-fault driver or the car insurance company can argue that the back pain you're feeling now is caused by your pre-existing back injury.

You can theoretically try to show that your pre-existing back injury was of a certain type and severity before the accident, and that now it's different in terms of nature and/or intensity. For instance, you can emphasize that your occasional back pain "flare-ups" were easily managed with over-the-counter pain relievers before the accident. But now, you need prescription painkillers and weekly visits to the chiropractor just to be able to get out of bed each morning.

Of course, there is a large degree of subjectivity here, and an insurance adjuster or the defendant in a personal injury lawsuit will almost certainly argue that you're exaggerating the effects of the latest accident and/or understating the impact of the older one. This is when it becomes crucial to have the help of an experienced injury lawyer. More on this later.

"Damages" and Your Pre-Existing Condition or Injury

Even if you can prove the accident made your pre-existing injury worse, it can be a challenge to establish the precise amount of damages you should receive.

Using the above example, your damages might include:

  • the cost of prescription medication
  • chiropractor medical costs
  • lost income from missed work, and
  • pain and suffering.

Pre-Existing Injuries and "Pain and Suffering"

Perhaps the biggest hurdle comes when trying to determine your more subjective and intangible damages, such as "pain and suffering." It's hard enough to calculate these losses when there is no pre-existing injury. But when the earlier injury is aggravated by the accident, the task becomes even more challenging.

Whatever calculations you come up with, you can be confident the person responsible for your injuries will believe your final figure is excessive. Get tips on negotiating a personal injury settlement.

What Is the "Eggshell Plaintiff" Rule?

Imagine you have severe osteoporosis. Then one day while grocery shopping, you slip and fall in a puddle of water in one of the aisles. The fall was minor, but due to your osteoporosis, you break your hip. You must go through multiple surgeries and months of physical therapy. If the store is liable for your fall, should they have to pay for all of your injuries? The answer is almost always "yes", because of the "eggshell plaintiff" rule.

This rule says that a liable party is responsible for all of the injuries the plaintiff receives, regardless of the plaintiff's condition before the accident. In other words, the defendant must fully compensate a plaintiff for all injuries, even if a pre-existing condition makes the plaintiff more susceptible to an injury or makes any injury much worse, and even if the defendant could not have reasonably foreseen the severity or extent of the resulting injuries.

Learn more about intervening causes and foreseeability in personal injury cases.

A Pre-Existing Injury Isn't Always a Negative

Despite the extra complications that can arise, a pre-existing injury can sometimes make getting compensation easier, in the sense that a clear picture of the plaintiff's condition before the accident can make it easier to identify and measure the impact of the harm caused by the accident.

Looking back at the prior construction worker example of lower back pain and the car accident, let's add the fact that the claimant is 60 years old. Following the accident, one of the defendant's arguments is that because of the claimant's age and the natural degeneration of the discs in his spine, the herniated disc likely existed before the accident.

But luckily, because of the claimant's work injury and ongoing treatment, MRI images show the condition of his back just a few weeks before the car accident, and there is no indication of herniation. Now, it's far easier to counter the defendant's arguments thanks to these pre-accident medical records.

Getting Help When Your Claim Might Involve a Pre-Existing Injury or Condition

As we've discussed here, a pre-existing injury or medical condition probably won't doom your personal injury claim, but there's no getting around the fact that it will complicate things. Once the other side's insurance company (or their attorney) starts poking holes in your claim based on your pre-accident health picture, it's crucial to have an experienced attorney on your side.

This is the point at which it becomes crucial to properly interpret your medical history alongside your medical records from your recent injury, and present your best argument as to the extent of the at-fault party's financial liability. An experienced injury lawyer will have the expertise to frame your case in the best light, and might enlist a medical expert or two to help.

Learn more about finding and hiring the right personal injury lawyer. You can also use the features on this page to connect with an injury lawyer in your area.

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