What Is Considered a Pre-Existing Condition?

If you already had a medical condition or old injury prior to seeking coverage for a new injury, prepare for a more difficult claims process. You have what is known as a pre-existing condition in personal injury law – something that can make it harder to recover compensation from a defendant. The more you know about pre-existing conditions, the better your odds are of obtaining a fair award.

Legal Definition of a Pre-Existing Condition

In personal injury law, a pre-existing condition is any health complaint or ailment that existed in the claimant before the accident and injury in question. Any condition or injury the claimant already had at the time of the cause of action will qualify as a pre-existing condition for legal purposes. Pre-existing conditions can refer to physical injuries and ailments, as well as genetic conditions and mental health disorders.

  • Broken bones
  • Head and brain injuries
  • Back injuries
  • Degenerative disk disease
  • Hypertension
  • Arthritis
  • Diabetes
  • Depression or anxiety

Dozens of different ailments and diagnoses a plaintiff had before an accident can constitute pre-existing conditions. However, these conditions and injuries more commonly impact personal injury claims than others in Missouri.

How Do Pre-Existing Conditions Impact Personal Injury Claims?

Pre-existing conditions are relevant to personal injury claims because a defendant will only be liable, or financially responsible, for the damages he or she caused. A defendant will not be responsible for paying the bills for a condition the victim had prior to the accident. A defendant will, however, be liable for the extent by which a pre-existing condition exacerbated accident-related injuries. This rule is called the Eggshell Skull Doctrine.

The Eggshell Skull Doctrine holds that a defendant must take an injured victim as he or she is at the time of an accident, even if this is a state that is more susceptible to injuries due to a pre-existing condition. The existence of a health defect, ailment or injury prior to the accident will not relieve the defendant of his or her financial obligation toward the victim. The defendant will still be liable for the actual injuries suffered.

For example, if a woman had a rare condition that made her skull as thin as an eggshell, this would not preclude her from financial recovery if it contributed to her suffering a brain injury in a car accident. It will not be relevant to the case if another person who did not have her condition would not have suffered the brain injury; the defendant must take the plaintiff as she was at the time of the accident.

The Eggshell Skull Doctrine also works to hold a defendant liable for the degree by which the accident worsened a plaintiff’s pre-existing condition. If the accident exacerbated an old injury or ailment, the defendant would have to pay for the plaintiff’s additional medical bills and pain and suffering. Any losses from the accident, even those related to a pre-existing condition, will be the defendant’s responsibility.

How to Handle Your Claim

If you had a pre-existing condition prior to the accident, proceed cautiously with your claim. The insurance company will want to use your pre-existing condition against you to deny liability. With this in mind, be careful what you say to the insurance claims adjuster hired to analyze your claim.

  • Do not admit any degree of fault for the accident or injury.
  • Do not give the adjuster a recorded statement from you about the accident.
  • Limit the amount of detail you give to the adjuster; only answer the questions asked.
  • Gather medical records proving the accident exacerbated a pre-existing condition or vice versa.
  • Do not sign a Medical Authorization Release Form.
  • Contact a personal injury attorney for assistance negotiating your claim.

If an insurance company in Kansas City tries to deny your claim based on a pre-existing condition, use an attorney to fight back. An attorney can help you demand maximum compensation for your losses in spite of a pre-existing condition. The defendant will still be liable for the damages he or she caused.


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