Can Insurance Companies Deny Claims for Pre-Existing Conditions?
Insurance companies cannot deny claims for pre-existing conditions if their insured caused new injuries or aggravated your pre-existing condition. However, they will try. Insurance companies, like any for-profit business, want to make money. One of the ways insurance companies manage their bottom line is by denying claims when they see any plausible reason for denial. As a result, your insurance claim may be rejected because of your pre-existing condition.
If your claim was denied, don’t lose hope. You have options.
What Is a Pre-Existing Condition?
A pre-existing condition is a medical condition that existed before the incident that resulted in the claim. Examples of common pre-existing conditions include:
- Back injuries
- Respiratory conditions
- Neck injuries
- Knee injuries
- Chronic pain conditions
If you had one of these injuries before the accident and your new injuries aggravated your prior condition, your claim might be denied. However, you do not have to accept this denial. Instead, you can appeal the decision under certain circumstances.
Can I Claim My Pre-Existing Condition?
An insurance company can deny your injury claim if there is no new injury and you are merely claiming compensation for a pre-existing condition. You can only seek compensation if your pre-existing condition is worse because of the accident or if your current claim is unrelated to your pre-existing condition.
What If My Pre-Existing Condition Is Not Related to My Claim?
An insurance company cannot deny your claim simply because you have an unrelated pre-existing condition. Therefore, you can fight if an insurance company wrongfully denies your claim because you have a pre-existing condition.
One way to fight a denial is to submit evidence that your pre-existing condition is unrelated to the injury you’re claiming. For example, if you have knee injuries, and someone else’s negligence resulted in a back injury, you can pursue compensation from the at-fault party’s insurance for your back injury.
To get an insurance company to reverse their denial, you can present evidence that your pre-existing condition is unrelated. This can be done through the following:
- Medical records: Your medical records can be strong evidence in support of your claim. To show your claim was wrongfully denied, you should provide copies of your medical records to the insurance adjuster. Your medical records should include the initial diagnosis and when it occurred.
- Doctor statements: If the medical records aren’t enough or you do not want to provide them. You can ask your doctor for a written statement. The statement should include the initial diagnosis, treatment plan, and recovery progress.
- Medical expert testimony: In some instances, it may be worth hiring an expert witness to review and make a written determination whether a pre-existing condition is related to your claim. However, medical experts are usually reserved for cases that go to trial because they can be expensive.
What If the Accident Aggravated My Pre-Existing Condition?
If you are in an accident, your pre-existing condition may worsen. While you cannot pursue compensation for the pre-existing condition itself, you can seek compensation for the aggravation of a pre-existing condition.
Like many other states, Florida follows the eggshell plaintiff rule. Under this rule, if you can show the following, you may be able to recover compensation from the negligent party for the aggravation of a pre-existing condition.
- Your pre-existing condition was stable when the accident occurred; and
- There was no reason to believe that the pre-existing condition would get worse.
What Compensation Can I Recover If I Have a Pre-Existing Condition?
If it is determined that your claim is valid because your pre-existing condition is unrelated to the claim or the incident aggravated it, you can seek the following compensation:
- Past and future medical expenses
- Lost wages
- The difference between your pre-injury earnings and post-injury earnings
- Pain and suffering
How Can Schuler, Weisser, Zoeller, Overbeck & Baxter P.A. Help?
At Schuler, Weisser, Zoeller, Overbeck & Baxter P.A., we have experience handling personal injury cases where the victim has a pre-existing condition. Using that experience, we can help you by:
- Gathering evidence and investigating your claim
- Appealing a wrongful denial of coverage
- Handling all communications with the insurance company and other parties
- Negotiating with the insurance adjuster on your behalf
- Representing you in court
- Providing support and guidance through a complex and challenging situation
Handling an injury claim alone can be challenging, especially if you have a pre-existing condition. Insurance adjusters are experienced negotiators who are likely trying to save their company money, making it challenging to change their minds on whether your injury is new.
The Florida personal injury attorneys of Schuler, Weisser, Zoeller, Overbeck & Baxter P.A. are skilled negotiators who can present evidence to support your claim and help you pursue fair compensation. To discuss your options during a free and confidential consultation, call us at 561.689.8180.