How Do Insurance Companies Know About Pre-Existing Conditions?

If you've been hurt in an accident and file a claim, you might be surprised when the insurance company denies you coverage due to "pre-existing conditions." This is especially true if you didn't tell the insurance company about any past injuries, or if your old injury had nothing to do with the accident. 

We'll Start with an Example

Let's use the example of Jack and Samantha. Samantha had shoulder surgery years ago, but the problem was fixed and she hasn't had issues for years. One day, Samantha's driving her car when Jack rear-ends her, causing another shoulder injury. Samantha makes a claim against Jack's insurance (he caused the accident so he's responsible for paying for her damages and injuries). 

Somehow, Jack's insurance company finds out about Samantha's previous shoulder surgery and suddenly devalues her claim. They want to give her only a small fraction of what she needs to pay for her medical bills incurred from the accident. Their reasoning? "Your shoulder was already hurt before this. The accident didn't cause the injury." 

Samantha knows the two injuries are unrelated, but how can she prove this to the insurance company? And how did they even find out about her old shoulder injury in the first place?

Did You Sign a Medical Release? 

At my firm, this is one of the most common mistakes I see accident victims make - they authorize the insurance company to access past medical records. Sometimes, people do it without even realizing it. 

Insurers are very good at making you feel like they have your best interests at heart. They might ask you to sign a "blanket release" without really explaining the implications. They'll tell you they need to know about the injuries you sustained in the accident and how you were treated in order to reimburse you, so when they ask for a medical release form, it will seem reasonable. 

Insurers then use your permission to snoop through old records to look for anything that they might be able to use against you. If you have a pre-existing condition, they'll try to deny your claim on the grounds that you were already injured and their insured had nothing to do with it. 

Did You Make Mention of Prior Injury on Your Intake Form? 

During the intake process, you'll fill out tedious paperwork and answer lots of questions. It might not even occur to you that the insurance company is digging into your background during this process. Similarly, you might not remember answering a question about previous injuries. Still, it's possible that you tipped the insurance company off on your intake form.  

You don't necessarily have to say anything outright, either - merely hinting at an old injury is enough to get the insurance company going. If the insurance company suddenly knows about a pre-existing condition, you might have accidentally told them yourself. 

What to Do Next

I wrote a helpful article on How Pre-Existing Injuries Affect Your Claim where you can find more information. 

If you're concerned about your privacy rights, you should contact your attorney. 

If you need help in the Dallas-Fort Worth area, call the Anderson Law Firm at 817-294-1900 for a free consultation. 

 

Mark A. Anderson
Board Certified Personal Injury Lawyer in Fort Worth, Texas