The last thing you want to hear an insurance company say is that your injury isn’t covered because they think it was there before the accident. The question of “preexisting injuries” can be complicated in some cases, but it isn’t always as detrimental to your case as you might think.
Insurance companies will only cover injuries and effects that were caused in the accident before them. If you had an injury before that, they cannot cover it – but they can cover any worsening of the injury. The fact that an insurance company said your injury is preexisting doesn’t make that true; we can take the issue to court if needed to get you coverage.
For a free review of your injury case, call The Queenan Law Firm’s Dallas personal injury attorneys at (817) 476-1797.
Does Insurance Cover Preexisting Conditions?
When our Texas personal injury lawyers talk about preexisting conditions and injuries, we are talking about injuries and health conditions that were already there before your accident. Insurance companies like car insurance, homeowners insurance, and business liability insurance have no obligation to pay for these, so they often try to say every injury was preexisting.
When other people talk about preexisting conditions and insurance, they are talking about health insurance. Under the Affordable Care Act, health insurance companies cannot deny your coverage because of a preexisting condition.
Does a Preexisting Injury Hurt My Case?
The fact that you have another injury does not necessarily hurt your case.
Coverage
If you had an injury before the accident, then suffered more injuries in the accident, you won’t be covered for the first injury. However, the insurance company still needs to cover the new injuries their policyholder caused you.
They cannot get out of covering an injury that happened in this accident just because you have other injuries from previous accidents or health problems.
Worsened Condition
If you already had an injury, but this new accident made it worse, they also need to pay for the extent to which the accident made it worse.
An easy example is a broken bone. Imagine you had a broken arm that was already 2 out of 6 weeks into healing, and you rebroke it in a car accident. Now it’s going to take more medical appointments and another 6 weeks to heal.
Your prior break would have taken 4 more weeks to heal anyway, so they might not have to cover that – but they do have to cover the 2 additional weeks tacked on at the end.
Vulnerability to Accidents
Sometimes preexisting injuries or conditions make you more vulnerable to an accident. This doesn’t stop the defendant from being responsible; in fact, they have to still pay for your injuries even if a “normal” or “healthy” person would not have been injured.
For example, if an office building’s wet lobby floor didn’t cause others to slip, but you slipped because you walk with a cane, they would still be liable even though you were more vulnerable to injury. In fact, this might even show an Americans with Disabilities Act (ADA) violation.
Vulnerability to Injury
The defendant also has to pay for all injuries you do suffer, even if they would have been unlikely for a “normal” person. For example, if two victims faced the same accident, but one had brittle bones, their injuries would be far worse than those of the other person with stronger bones. The defendant still has to pay for the injuries their victim actually suffered.
How Do You Prove a Preexisting Injury?
It is important to understand the evidence and proof needed for a preexisting injury.
The Burden of Proof
It isn’t on the insurance company to prove that the injury was preexisting. Instead, it’s actually your burden to prove that your injury came from this accident. If it wasn’t caused by this accident, the insurance company can deny you – as can the courts.
The burden of proof in an injury case in Texas is the “preponderance of the evidence standard,” meaning the insurance company/jury sides with whichever claim is more likely. You do not need to prove it “beyond a reasonable doubt” – close to 99% certainty – just to around 51% certainty.
Evidence Needed
Medical records are going to be the best proof of your health before and after an accident. If you have recent medical records that do not show the injury already existed before the accident, the jury can infer that it only happened after the accident.
Your medical records can also show how fresh the injury was, making it unlikely it happened any earlier.
Testimony about your condition before the accident can also show the injury was new. For example, if you were seen walking just fine to get into your car, then you had a broken leg after the crash, it’s very likely from this crash.
FAQs for Preexisting Injuries in Personal Injury Claims in Texas
How Do I Sue Insurance for Denying My Claim?
If you were denied coverage by your own insurance – such as medpay coverage – then you can appeal through their internal processes. If they still refuse to pay, but the injury should be covered, we can bring the case as a breach of contract claim, since the insurance policy is a contract. We can even potentially bring it as an “insurance bad faith” case if they never intended to pay in the first place.
If another party’s insurance – such as auto insurance or homeowners insurance – is denying the claim, then we can still appeal through their processes. However, we can also just take the defendant to court, and the insurance company can defend them there before a judge and jury.
Can You Sue With a Preexisting Injury?
If you already had an injury or health condition, you can’t get damages for that in a new accident case. However, if you are still within the statute of limitations from that original accident (2 years for most cases), we may be able to go back and sue whoever caused your prior injury, too.
How Are Worsened Conditions Assessed?
You will likely need a doctor to go over your injuries to break down what injuries are old and what injuries are new. Then, your doctors and your lawyers can go through what harms (medical care, time away from work, lost ability) were already in place, versus what harms are new from the new injury.
Call Our Texas Personal Injury Lawyers Today
For your free case review, call The Queenan Law Firm’s Austin personal injury attorneys at (817) 476-1797.