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How Do Pre-Existing Medical Conditions Affect a Personal Injury Claim?

G. Aldrich Law  Oct. 5, 2023

Accidents can happen just about anywhere. Just leaving your home to go shopping, you might be rear-ended by another vehicle and end up in the emergency room. Assume you’re not rear-ended, and you make it to your favorite retailer. While walking down the aisle, you slip and fall backwards on a wet surface that has not been cordoned off. You suffer neck and spine injuries. 

In both of these cases, the other driver and the store owner/operator likely would have insurance on which you can make a claim to receive compensation for your medical expenses, any lost wages, and even for pain and suffering. You could also file a personal injury lawsuit against the insurer or the at-fault party, for instance, the driver or owner/operator. 

When the insurance claims adjuster reviews your claim, however, if he discovers that you already suffered from back problems, he might assert that the pain you’re suffering actually is the result of a pre-existing condition and, therefore, you’re not entitled to the compensation you’re asking for. The adjuster then offers an extremely low-ball settlement, or perhaps none at all. What do you do? 

Whenever you’re injured because of someone else’s negligence—or even an intentional act—you should immediately seek out the advice and help of an experienced personal injury attorney. Discuss your pre-existing medical condition with your attorney, and let him or her take it from there. 

If you’ve been injured in or around Lakeport or Woodland Hills, California, contact us at G. Aldrich Law. We are experienced in all aspects of personal injury claims and lawsuits and are knowledgeable in all relevant laws and regulations governing them. G. Aldrich Law also proudly serves clients in Lake County, Los Angeles County, Colusa County, Riverside County, as well as in surrounding Northern and Southern California counties. 

What Are Pre-Existing Medical Conditions?

A pre-existing medical condition is any injury or physical condition that existed prior to the accident or incident in which you suffered your current injuries. Examples include: 

  • birth defects or congenital abnormalities 

  • medical conditions that surface only in a time of stress, such as asthma 

  • injuries you suffered in a previous unrelated accident 

  • injuries, however incurred, that have not yet properly healed or are in the process of healing 

When you submit an injury claim, you are required to reveal any pre-existing conditions. The claims adjuster, or the judge and jury in a lawsuit, will then have to factor in whether your current injuries are the result of your pre-existing medical condition. You and your attorney will need to show that your injuries were caused entirely by the accident for which a claim is being made or a lawsuit is being filed. 

With someone who slips and falls and ends up with neck and back injuries, let’s assume that this person suffered from what is known as brittle bone disease. The insurance company’s claims adjuster, or the defendant’s defense lawyer in a lawsuit, can argue that their disease caused their injuries rather than the store owner’s negligence in not cleaning up or marking off the wet surface. 

Fortunately, there is legal precedent you can rely on in pressing your claim or lawsuit, which is known as the “eggshell skull rule.” 

“Eggshell Plaintiff”

The eggshell skull rule holds that a defendant’s liability won’t be reduced just because the plaintiff is more susceptible to injury than others. The rule was established way back in 1891 in Wisconsin and is now accepted in all 50 states. 

The case involved two young boys who got in an argument in a classroom, and one boy eventually kicked the other in the shin. Normally, this would not have done much in the way of injury, but the victim had a tibia infection. The kick aggravated the infection, and the victim never recovered full use of his leg.  

The Supreme Court of Wisconsin held the kicker liable, even though he knew nothing of the victim’s tibia infection. Thus was born the eggshell skull rule.  

However, another rule called the “crumbling skull” holds that, though a defendant is responsible for any injuries they cause through negligence or intentional actions, they are not responsible for any debilitating effects already present from a pre-existing condition.  

In our wet-floor example, the defendant would have to pay for medical and related expenses for the any new back and neck injuries, but would not have to pay for any treatment for the plaintiff’s pre-existing brittle bone disease. 

Comparative Negligence in California

The Golden State recognizes the legal principle known as pure comparative negligence. This means that each party in an accident can be assessed a percentage of the fault. Say our slip-and-fall victim was so busy reading text messages on his cellphone that he failed to see the wet surface. Was he 50 percent at fault?  

Comparative negligence states that an injured victim can be held partially liable depending on the circumstances, affecting the settlement amount. Whatever figure is arrived at, say 25 percent, that portion will be withheld from any settlement or court award. For example, if you claim $50,000 and are assigned 25 percent of the fault, you would be eligible to receive only $37,500 (which is 75% of the original 50k). 

Skilled Legal Guidance: G. Aldrich Law 

Making a personal injury claim is not a DIY project. The claims adjuster assigned to you will use all the arguments above to whittle down or deny your claim, and on your own you probably will become an unsuspecting victim of the tricks and tactics they use. You need an attorney to advocate for you throughout the whole process. 

Reach out to us at G. Aldrich Law, and let us deal with the insurance adjusters. If necessary, we can also file a personal injury lawsuit to press for the just compensation due you. We are experienced and dedicated to you and your well-being. While yhou recover, we’ll work on all the insurance legal aspects needed to settle your claim.