We hear a lot of discussion today about how under "Obamacare" health insurance companies can't deny you coverage on the basis of a pre-existing condition. But what about car insurance companies -- can they reject your claim for damages sustained in a car accident when your injuries are totally or partially related to a pre-existing condition? In most cases, the answer is "yes."
Pre-Existing Injuries and the Requirement of "Proximate Cause"
The longstanding personal injury liability concept of negligence -- which almost always governs car accident cases -- requires an injured person to prove four things: 1) duty, 2) breach of duty, 3) proximate cause, and 4) damages. Once you have established that the person responsible for the accident breached a duty owed to you (e.g., the duty to obey the traffic laws), you must then prove that you have suffered damages that were "proximately caused" by the responsible person's negligence.
The concept of "proximate cause" is central to negligence law, and it means the cause which, in a natural and uninterrupted sequence, produces the injury, and without which the injury would not have occurred. "Proximate cause" does not need to be the sole cause, but it will not be found if there is an efficient intervening cause. Let's look at a few examples to see how "proximate cause" works.
First, let's say you are in a car accident in which you suffer a broken leg and a dislocated shoulder. The broken leg was caused by the driver who rammed you from behind at 40 miles per hour, and the dislocated shoulder was caused by the negligence of a good samaritan who tried to remove your seatbelt and get you out of the car before it caught on fire. While it is clear that the responsible driver's negligence proximately caused your broken leg, it is far less clear that his or her negligence proximately caused your dislocated shoulder, because in the latter case another person's subsequent actions led directly to the injury. So, while you could clearly recover damages for your broken leg from the at-fault driver, you probably could not recover damages for your dislocated shoulder.
Next, assume your injuries from this same accident consist of lacerations to your face and a fractured skull with resulting closed head injury that causes post-traumatic stress disorder ("PTSD"), a condition from which you have suffered for years before the accident. The responsible driver's negligence was clearly the proximate cause of your facial lacerations, and you will be entitled to recover damages for these injuries. The same is true for your fractured skull, and your damages that result from this injury (medical bills, pain and suffering, lost earnings, etc.) will be recoverable. However, with respect to the closed head injury, you will be denied recovery to the extent that this injury is not materially different from, or more severe than, your pre-existing PTSD.
Finally, assume that your injuries from this same accident consist only of a very sore and stiff neck with radiating pain down your arm and into your hand. At the time of the accident, you already had a herniated disc in your neck that was causing these exact symptoms. Unless you can prove through expert medical testimony and evidence that the crash made these symptoms worse, you will be denied recovery because no new injury was "proximately caused" by the driver's negligence.
In sum, truly pre-existing injuries are not compensable in auto accident cases, although aggravation or worsening of those injuries may be compensable if proof of "proximate cause" can be established. But, as you can see, pre-existing injury cases can become quite difficult to prove, and often require a thorough analysis of the injured person's medical history to determine exactly what has been "proximately caused" by the latest accident, and what problems already existed.
Learn more about The Role of Insurance in a Car Accident Case.