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How Can a Pre-Existing Condition Affect an Injury Claim?

Insurance companies will try anything to reduce their liability and diminish a client’s payout during a personal injury claim. One of the most common tactics used is alleging that the victim’s injury is pre-existing. If you have a pre-existing condition, this does not bar you from financial recovery. You may need help from a personal injury lawyer in Atlanta, however, to achieve a fair settlement.

What Is the “Eggshell Skull” Rule?

The eggshell skull rule is a legal doctrine that applies to cases where a plaintiff has an unforeseeable and uncommon reaction to a defendant’s negligence. In other words, the plaintiff has a pre-existing condition that makes him or her predisposed to serious injuries. The eggshell skull rule states that a defendant must take a plaintiff as he or she finds him, even if this is with pre-existing injuries or conditions.

This rule gets its name from a common example taught in law school. In the example, a plaintiff has a rare condition where his skull is as thin as an eggshell. In an accident, the plaintiff suffers a catastrophic brain injury where a normal plaintiff would have only suffered a minor injury. In this scenario, the eggshell skull rule states that the defendant is still liable for the full extent of the victim’s injuries, even if they exceed the injuries that another plaintiff reasonably would have suffered.

Can I Recover Compensation With a Pre-Existing Condition?

Yes, you can recover compensation if you have a pre-existing condition. A pre-existing condition alone is not grounds for an insurance company to deny your claim. However, an insurer can deny your claim if you are seeking benefits for an injury or condition that you had prior to the accident in question. This is the argument the insurance company will most likely use to try to avoid paying you if it finds a pre-existing condition in your medical records.

By law, an insurance company must take a claimant as he or she is at the time of an accident, even if a pre-existing condition made the injuries worse (or vice versa – the accident exacerbated a pre-existing injury). If an insurance company tries to deny your claim based on a pre-existing condition, you may have to prove how the accident injured or affected you. This may take evidence such as detailed medical records, a written statement from your doctor and testimony from a qualified medical expert.

What If I Was Unaware of My Pre-Existing Condition?

If you have a pre-existing condition, it is imperative to disclose this during your insurance claim. If you intentionally conceal your condition, the insurance company can use your material misrepresentation as a reason to deny or reduce your benefits. You could even face criminal charges for insurance fraud. If you were unaware of your pre-existing condition, however, you may be able to prove that the omission was unintentional using your medical records and testimony from your doctor.

Examples of Pre-Existing Conditions

A pre-existing condition can refer to virtually any physical or emotional injury, illness or condition a victim had prior to an accident. Many different types of pre-existing conditions can impact a personal injury claim in Georgia. However, they tend to be chronic or long-term conditions most often. Common examples include:

  • Anxiety or depression
  • Arthritis
  • Asthma
  • Back and spine injuries
  • Cancer
  • Degenerative disk disease
  • Diabetes
  • Epilepsy
  • Fibromyalgia
  • Hernias
  • High blood pressure
  • Joint and ligament injuries
  • Knee and elbow injuries
  • Lupus
  • Mental health conditions, such as PTSD
  • Previously healed bone fractures
  • Sleep apnea

If an insurance company tries to use your pre-existing condition or injury against you during a personal injury lawsuit, contact an attorney for assistance. A pre-existing condition alone does not make you ineligible for financial compensation. You may need help gathering evidence to support your claim.

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