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Can Insurance Companies Deny Claims for Pre-Existing Conditions?

Events resulting in injuries because of someone else’s wrongdoing can be extremely stressful without the fear of a claim being denied because of a pre-existing condition. While it doesn’t seem fair that an insurance company will deny a claim for a pre-existing condition, they are for-profit companies with one goal: to make money.

It is not uncommon that an insurance company will use someone’s pre-existing condition to avoid compensating an injured party. However, an initial denial of coverage does not mean all is lost.

What Is a Pre-Existing Condition?

A pre-existing condition is a mental or physical ailment someone had before they were involved in the incident causing the personal injury claim or lawsuit. Below are some common pre-existing conditions that insurance companies will try and use to avoid liability.

  • Back or neck problems
  • Joint problems
  • Respiratory conditions
  • Anxiety, depression, or other psychological conditions

While an insurance company will try to use a pre-existing condition to deny an insurance claim, they are not allowed to deny a claim simply because there was a pre-existing condition. However, they can deny a claim if no injury resulted from the insured’s negligence and the claim merely seeks to compensate for an injury sustained earlier.

When a Pre-Existing Condition Is Not Related to the Claim

If your pre-existing condition is not related to the injuries being claimed, the insurance company cannot deny your claim because of the pre-existing condition. The following is evidence that can be used to help make your case:

  • Medical records: Medical records for the injury being claimed can be used to show the history of the injury. A medical record will show the claimed injury’s diagnosis, treatment, and recovery progress. Your medical records should have doctors’ notes concerning what caused the injury and whether it was linked to a pre-existing condition.
  • Medical history: You may be reluctant to share your medical history with an insurance company, but it tells the story of your health, including the pre-existing condition. Your medical history will show when you were treated for your pre-existing condition, what treatments you received, the recovery process, and indicate whether the pre-existing condition was asymptomatic at the time of the new accident. For example, if you hurt your neck ten years prior and received treatment but were no longer receiving treatment because the injury had fully healed, your medical history will show that.
  • Medical professional statements: You can also request a statement from the treating medical professional or professionals concerning the injury being claimed. In the statement, the medical professional would provide their opinions and observations concerning the injury and whether it was linked to a pre-existing condition.

What to Do if an Insurance Company Denies Your Claim Because of a Pre-Existing Condition

If an insurance company has denied your claim, you do not have to accept the denial. Instead, you can choose to fight the insurance company’s decision by proving that the injury is not a result of the pre-existing condition. If you are unsuccessful in changing the insurance company’s mind, you can file a personal injury lawsuit against the insurance company and the at-fault driver.

It is important to note that Georgia is a modified comparative negligence state. This means that if you are found to be over 49 percent responsible for an accident, you likely will not be eligible for compensation from another party, even if their negligence contributed to the incident.

What Happens if My Pre-Existing Condition Has Worsened Because of an Accident?

While you cannot recover compensation for a pre-existing condition, you deserve compensation if the accident aggravated your pre-existing condition. Georgia follows what is widely known as the “eggshell plaintiff rule,” which allows individuals to pursue compensation for aggravated injuries because of someone else’s negligence.

Under the eggshell plaintiff rule, a claimant can usually recover compensation for their injuries if they can show that:

  • Their pre-existing condition was stable when the incident occurred, and
  • Before the accident, there was no indication that the stability of your pre-existing condition would change.

Insurance companies are generally required to take a claimant as they are, meaning if someone’s pre-existing condition would have remained the same if they were not involved in the accident, the injured party may be eligible to receive compensation.

Contact an Experienced Attorney for a Free Consultation

If you have been injured in Augusta because of another person’s negligence, you deserve to be represented by a skilled and knowledgeable legal team who will fight for your best interests. The Augusta personal injury attorneys of Chris Hudson Law Group are here to help you get the compensation you deserve after an accident that wasn’t your fault.

Contact us online or call us today at (706) 690-4613 for a free, confidential consultation and to learn more about your legal options.

Last Updated : January 11, 2023