An adjuster for a major insurance company (think of the lizard) sent me a letter about injuries in a case we are trying to settle. He said that my client was not entitled to a settlement because he had previous back treatment. This startled me because of his obvious misunderstanding of the law concerning accident cases.
There is a major difference between accident insurance coverage and health insurance coverage. One of the concepts which comes up in both types of insurance is “pre-existing conditions.” This is fancy language regarding medical conditions which existed before the policy went into effect. A health insurance company is entitled in most cases to “exempt” or “exclude” having to pay for any bills due solely to treatment of conditions which it excluded in its policy,
On the other hand, an accident insurance policy cannot exclude having to pay for treatment of an injured body part even if the affected body part was previously injured or in bad shape due to wear and tear, old age or a congenital defect. Any injury to the body has to be paid for by an accident policy even if the injured or diseased body part had a “pre-existing” condition.. For example, a 50 year old who is rear ended probably has something called “DDD” meaning degenerative disc disease. As we grow older, the bones and discs in our back undergo changes due to the aging process. They are more vulnerable to injury by accident. Bottom line: any injury which is caused by another person must be compensated for by the accident insurance company. If the injury was caused by an auto accident, and permanently aggravates or worsens the pre-existing condition, then the at fault driver owes you for your lifetime of pain and suffering, in addition to lost income, and medical bills.