When an individual is injured in an accident, the immediate focus should be on recovery and receiving fair compensation for medical expenses, lost wages, and pain and suffering. However, a disturbing trend is emerging in the world of personal injury claims: victims are being penalized for their own medical history.
Instead of receiving fair compensation based on the severity of their injuries, some victims find themselves facing reduced settlements or outright denials due to pre-existing conditions or previous health issues. In this article, we’ll dive into why injury victims are being punished for things they can’t control and how insurance companies are using medical history to their advantage.
The Role of Medical History in Personal Injury Claims
Medical history plays a crucial role in determining the extent of an injury and the treatment required. When a person files a personal injury claim—whether it’s for a car accident, slip and fall, or workplace injury—insurance companies often request the victim’s complete medical history. At first glance, this may seem reasonable. After all, knowing the person’s previous health conditions helps determine the true extent of their injuries.
However, the problem arises when insurance companies use a victim’s medical history against them, even if the pre-existing conditions had no relation to the current injury.
1. The “Eggshell Skull” Rule: Fair or Unfair?
The eggshell skull rule in tort law holds that a defendant is fully liable for the plaintiff’s injury, even if the injury is more severe than it would have been for someone with an average medical history. Essentially, it means that if a victim has a pre-existing condition or vulnerability (e.g., a fragile bone structure or weakened tissue), the defendant is still liable for the full extent of the injury they caused.
While the eggshell skull rule is designed to protect victims, it doesn’t always work in practice. Many insurance companies will argue that the victim’s pre-existing condition exacerbated the injury, and as a result, they may offer reduced compensation or refuse to cover certain medical costs altogether. This can be especially frustrating for victims whose current injuries are unrelated to their medical history.
2. Pre-Existing Conditions and the “Pre-Existing Injury Defense”
In some cases, insurance companies will attempt to use a pre-existing injury defense. This is a tactic where the insurer argues that the victim’s prior medical condition—such as a previous back injury or chronic pain—was the true cause of their current injury, rather than the accident or event in question.
Even if the accident aggravated the pre-existing condition, the insurer might claim that the injury would have happened anyway, or that the accident simply “triggered” the condition. As a result, the victim may find themselves being penalized for a medical history that has no direct relevance to the current injury.
For example, if someone with a prior knee injury gets into a car accident and suffers a worsened knee condition, the insurance company may claim that the injury is merely a continuation of the prior condition, rather than a new injury caused by the crash. This can lead to lower compensation or even a total denial of the claim.
The Impact on Victims: Why It’s a Problem
When insurance companies penalize injury victims for their medical history, the consequences can be severe. Here’s why this issue matters:
3. Reduced Compensation for Legitimate Injuries
One of the most immediate impacts of penalizing victims for pre-existing conditions is that they receive less compensation than they deserve. Even if an accident has worsened a person’s condition, insurance companies may only offer compensation for the “new” injury, not accounting for the fact that the accident has aggravated an underlying medical issue.
This results in victims being left with out-of-pocket expenses for treatment, rehabilitation, and other costs that should be covered by the responsible party. For example, someone who already has a heart condition but suffers a heart attack after a car crash may have their claim reduced or denied, even though the stress from the accident was a direct contributing factor.
4. Unnecessary Delays in the Claims Process
Penalizing victims for their medical history also leads to unnecessary delays in the claims process. Insurance companies may demand extensive documentation, further medical examinations, and expert testimony to evaluate whether the pre-existing condition truly played a role in the injury.
These delays can cause financial strain on victims, particularly if they are unable to work due to their injuries. The longer the process drags on, the more frustrated victims become, and in some cases, they may even accept a lower settlement out of sheer exhaustion.
5. Emotional and Psychological Toll on Victims
On top of the physical and financial challenges, injury victims may also experience an emotional toll when they are penalized for their medical history. Feeling blamed for something beyond their control can create significant stress and anxiety. For those already dealing with the pain of an injury, the added burden of fighting insurance companies for fair treatment can exacerbate the trauma.
In some cases, the idea that the injury victim “brought this upon themselves” due to a previous condition can lead to feelings of shame and helplessness, making it even harder to navigate the claims process with confidence.
How Insurance Companies Use Medical History to Their Advantage
Insurance companies are not only aware of the vulnerabilities of injury victims, they actively use them to reduce their payouts. Here are a few ways they leverage medical history to undermine claims:
6. Requesting Unnecessary Medical Records
Insurance companies often ask for comprehensive medical records, including details about conditions that are irrelevant to the current injury. This request is sometimes designed to dig into a victim’s health history and find ways to undermine the current injury claim. By focusing on past conditions, the insurance company can cast doubt on the legitimacy of the injury or the extent of the damages.
7. Using Biased Medical Experts
Insurance companies frequently rely on their own medical experts to evaluate the victim’s condition. These doctors are hired by the insurer and are typically biased in favor of reducing payouts. They may minimize the impact of the injury, claim that it’s due to a pre-existing condition, or argue that the victim’s injury isn’t as severe as claimed.
8. The “Aggravation” Argument
In cases where a pre-existing condition is aggravated by an accident, insurance companies may argue that the aggravation is minimal or not covered under the policy. In some situations, they may claim that the injury is not the result of the accident but rather the result of the victim’s prior health issues. This is especially common in cases of neck or back injuries, where the victim may have had previous pain that was exacerbated by the accident.
What Can Victims Do to Protect Themselves?
If you’re an injury victim being penalized for your medical history, there are steps you can take to protect your rights:
9. Consult a Personal Injury Lawyer
A skilled personal injury lawyer can help ensure that your rights are protected and that your case is properly evaluated. Your lawyer can work with medical experts to demonstrate how your injury was caused or worsened by the accident, even if you have a pre-existing condition.
10. Keep Detailed Medical Records
It’s essential to maintain comprehensive records of your injuries and treatment, as well as any changes in your condition. Having a detailed medical history helps to show the progression of your injury and its relationship to the accident, making it harder for insurance companies to minimize your claim.
11. Don’t Settle Too Quickly
Insurance companies often offer settlements early in the process, hoping that you will accept a low offer without fully understanding the long-term implications. Consult with a personal injury attorney before accepting any settlement to ensure you’re getting the compensation you deserve.
Don’t Let Insurance Companies Take Advantage of You
Being penalized for your own medical history is one of the most frustrating aspects of personal injury claims. Insurance companies may use your pre-existing conditions against you, leaving you with reduced compensation or no compensation at all. But with the right legal representation and a thorough understanding of your rights, you can fight back and ensure that you receive fair compensation for your injuries, regardless of your medical history.
Remember, you are not responsible for what happened to you. If an accident has exacerbated a pre-existing condition, you are still entitled to seek compensation for the damage caused by the accident. Don’t let insurers take advantage of you—seek legal counsel and fight for the justice you deserve.