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May 12, 2023

Can Auto Insurance Companies Deny Claims for Pre-Existing Conditions?

by Evan Breaux | Auto Accidents | 0 comments

In this important article, we tackle the tough and unfortunate topic of pre-existing conditions claims denial in Louisiana. Sadly, it is true that auto insurance companies may try to deny your claim for compensation if they discover pre-existing conditions. Here’s what you can do to fight back.

Filing a car accident claim in New Orleans or across Louisiana is already a daunting task to most people. It may be the last thing you want to do after experiencing a car accident. However, filing a claim is necessary if you want to be fully compensated for all past and future damages. Filing a car accident claim with pre-existing conditions can be even more anxiety-inducing.

Auto insurance companies will do everything in their power to avoid paying car accident victims a full and fair amount of compensation—including asking prying questions about your health and your pre-existing condition.

The insurance company is only responsible for paying the cost of damages that occurred due to the car accident, so they will see a pre-existing condition as an opportunity to argue that your physical injuries already existed and should therefore not be reimbursed. Still, this is simply one tactic that insurance companies try to use, and does not mean you can’t expect to be fully covered for your injuries.

What are Pre-Existing Conditions?

Pre-existing conditions are any health problem, injury, illness, or diagnoses you had before the auto accident. A non-exhaustive list of common pre-existing conditions may include:

  • Osteoarthritis 
  • Depression 
  • Anxiety 
  • Panic disorder
  • Post-traumatic stress disorder (PTSD)
  • Traumatic brain injury
  • Degenerative disc disorders
  • Prior surgeries
  • Neck or back issues

It’s common for an insurance company to refute a person’s claim for physical or emotional pain and suffering. If you claim an injury to a part of your body that you have already suffered injury to, that will make your case more complex.

Louisiana Auto Insurance Company Policies on Pre-Existing Conditions

Under Louisiana law, when an injury causes aggravation to a pre-existing condition, the victim is still entitled to recover for the full extent of the damage. A rule called the ”eggshell skull doctrine” states that a defendant is to take the victim as you found them. In other words, the injured party cannot be punished for their own frailty. 

For example, a senior citizen may have osteoarthritis or osteoporosis. A former high school football player or cheerleader may have experienced concussions in the past. These pre-existing conditions can be made worse in the event of a car accident, and the victims might be more injured in a car crash than the average American citizen.

The “eggshell skull doctrine” ensures that just because these individuals are more susceptible to worse injuries from the impact of the crash than other individuals, they should not be penalized for this. In other words, pre-existing conditions cannot be used to deny reimbursement for damages. Despite pre-existing conditions or vulnerabilities such as old age, according to this law, all victims are on the same level playing field and weaker individuals cannot be punished for their vulnerabilities.

FAQ:

How long does it take to file a claim for a car accident that caused my condition to worsen?

A claim could take anywhere from months to years to settle. The timing always depends on the specific circumstances of the accident, such as the degree to which liability is shared or easily determined, and the extent of the past and future suffering. If it is clear that the other driver is 100% at fault and if your injuries are relatively minor, a claim will take less time to finalize.

A claim that involves pre-existing conditions that you are trying to prove were aggravated or worsened by the car accident is more complex and could take many months or perhaps even years to settle. Furthermore, working with a personal injury attorney will ensure a smoother process and more reimbursement, but may prolong the claim, especially if you end up going to court.

But don’t forget, due to the statute of limitations in Louisiana, you must file your claim within one year of the accident.

What damages can I get if my pre-existing conditions are aggravated?

A common question we see at Breaux Law Firm is, “What if a car accident aggravated my current condition?” It certainly may be likely that a car accident can aggravate a pre-existing condition, such as an old back injury or military-induced PTSD. Perhaps your previous injury or health problem was not debilitating, but was something manageable that did not interfere with your day-to-day activities.

If your recent car accident has transformed something that was minor into something that is now causing you terrible, chronic pain, or is inhibiting your ability to work or to enjoy life, then these are physical and emotional damages arising from the accident, and your claim should address them as such.

What should I do after a car accident if I have a preexisting condition?

The most important step to take if you have pre-existing conditions is to contact a personal injury attorney and a doctor. These professionals will be able to document your symptoms and injuries in the correct manner, to establish which conditions are pre-existing, which conditions arose from the accident, and which conditions were aggravated by the crash.

Do I have to disclose a pre-existing condition?

You are not required to disclose your pre-existing conditions. However, if you are in litigation, and the other side asks you questions in the discovery process, you will need to answer honestly. Disclosing your full medical history and records, and even having your doctor testify on your behalf if your claim goes to court, will only help prove your case.

Once your case is in litigation, withholding information or lying such as a pre-existing condition could be damaging to your claim. Personal injury claims are based on medical records as well as the plaintiff’s word that they are hurt. In other words, one lie—even a small one—can shatter your credibility.

The insurance adjuster or investigator working for the insurance company may take severe measures to learn about your pre-existing conditions or to discredit your injuries, such as reviewing your entire medical history, talking with people in your community, analyzing your social media presence, or even following you. While this may sound extreme, it’s all the more reason to work with a personal injury attorney, who can help you build a strong and forthright claim.

My claim was denied due to pre-existing conditions. What do I do now?

You do have legal recourse for denied car accident claims with pre-existing conditions. For example, you may choose to file a lawsuit and take your case to court. In this situation, you will want to make sure you have legal representation. A personal injury attorney will be able to, first of all, help you submit a solid claim with sufficient evidence of your pre-existing condition and your injuries suffered as a result of the accident. This will decrease the likelihood that your claim will be denied or that you’ll have to go to court.

In the event that your claim is denied and you decide to take legal recourse, your personal injury attorney—like the experienced team at Breaux Law Firm—will guide you through the process and fight on your behalf.

Contact Breaux Law Firm to Discuss Your Complex Claim

Having a pre-existing condition is very common in the U.S. However, it’s important to understand the impact of pre-existing conditions on car accident claims. When looking for ways to pay a car accident victim less, auto insurance companies and insurance adjusters will do everything in their power to deny or lessen a claim for reimbursement. As a result of this unfortunate truth, pre-existing conditions make an auto injury claim more complex.

For example, you will need to gather official documentation from your medical providers. You will also want to present all the necessary information without holding back—but at the same time, you’ll need to be specific in your language, especially when speaking with an insurance adjuster. For all of these reasons, the best option for those who have been in a car accident in New Orleans, Louisiana, and who have pre-existing conditions, is to work with Breaux Law Firm.

As an experienced team of personal injury attorneys, we understand the ins and outs of settlement options for car accident claims with pre-existing conditions. We also know the auto insurance industry in New Orleans, including all the tactics they use to discredit and refute claims or liability. 
For personalized attention and care, reach out to our family-owned and -operated team of personal injury attorneys at Breaux Law Firm. We’re ready to fight for you as if we were fighting for one of our own family members. Call now for your free consultation: (504) 882-0554.