The insurance company called with troubling news: “We’ve reviewed your medical records and discovered you have a pre-existing back condition. Unfortunately, we can’t pay for injuries related to pre-existing conditions. Your claim is denied.”
Your heart sank. You knew you had an old back problem from years ago. You’d learned to live with it. But this accident made everything worse. Now the insurance company is using your past condition as a reason to deny your claim entirely. You’re scared and confused. Does having a pre-existing condition really disqualify you from recovering? Is the insurance company right?
No. At the Law Offices of Steven Gacovino P.C., we’ve successfully recovered compensation for hundreds of clients with pre-existing conditions in Suffolk County. A pre-existing condition does not disqualify you from recovery. In fact, New York law specifically protects people with pre-existing conditions. The at-fault driver takes you as they find you—with all your medical history included.
New York's "Eggshell Plaintiff" Rule
New York follows what’s called the eggshell plaintiff rule. This means that a defendant is liable for all injuries they cause, even if the plaintiff is more fragile than average. If you have a pre-existing condition that makes you more vulnerable to injury, the defendant is still fully liable.
The classic example is the eggshell plaintiff—a person with extremely fragile bones. If a defendant commits a minor accident that would cause a normal person minor injury, but causes an eggshell plaintiff severe injury because of their fragility, the defendant is liable for the severe injury.
The same applies to your pre-existing condition. If you have a weak back and a car accident aggravates that back, the defendant is liable for the aggravation even though a person without a pre-existing back condition might have recovered fully in weeks.
This rule exists because it’s unfair to allow defendants to escape liability simply because their victims have health vulnerabilities. The defendant’s negligence is the cause of the injury. They should be responsible for the full consequences, even if those consequences are worse because of pre-existing conditions.
What "Aggravation" Means in Personal Injury Law
You can’t claim that a pre-existing condition was caused by the accident if it actually existed before. But you can claim that the accident aggravated or worsened the pre-existing condition. This aggravation is fully compensable.
If you had a chronic back condition that caused occasional mild pain before the accident, and the accident caused significant back pain requiring surgery, you have an aggravation claim. The defendant didn’t create your condition, but they did worsen it.
Aggravation claims must be supported by medical evidence. You need medical records showing the condition before the accident and medical records showing the worsened condition after the accident. Your doctor must testify that the accident caused the aggravation.
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Pre-existing Condition Examples and Recovery
Let’s look at realistic examples from Suffolk County cases:
You had arthritis in your knee before your accident. The accident caused a fall on that knee, worsening the arthritis significantly. You now need physical therapy and pain management. The defendant is liable for the aggravation. You recover for the worsened condition, medical treatment for the aggravation, pain and suffering from the aggravation, and potential future medical costs for managing the aggravated condition.
You had chronic migraines before your accident. A car accident caused a head injury that triggered much more frequent migraines. You now have migraines daily instead of weekly. The defendant is liable for the aggravation. You recover for worsened migraines, medication costs, lost wages from increased missed work days, pain and suffering from the increased frequency, and potentially permanent changes to your migraine pattern if the accident permanently worsened your condition.
You had a herniated disc that was manageable before your accident. A truck accident caused a serious back injury requiring surgery. The surgery was needed because of the accident, even though you had a pre-existing disc condition. The defendant is fully liable for all medical costs and damages related to the injury and surgery. Your pre-existing condition doesn’t reduce your recovery.
You had asthma before your accident. An accident at a chemical facility exposed you to fumes that triggered severe asthma attacks. Your asthma is now much worse. The defendant is liable for the aggravation of your asthma condition. You recover for worsened asthma, increased medication costs, emergency room visits, lost work, and pain and suffering from the aggravation.
Note: These ranges are estimates. Actual recovery depends on how severely the accident worsened the condition and the amount of medical treatment required.
How Insurance Companies Weaponize Pre-existing Conditions
Insurance companies don’t want to pay for aggravation of pre-existing conditions, so they use several tactics to avoid responsibility:
They claim the aggravation isn’t real, that you’re just reporting the same symptoms that existed before. This is why medical documentation is critical. Medical records showing the condition before and after the accident defeat this argument.
They argue that the pre-existing condition, not the accident, is causing your current problems. If you had arthritis before, they claim the arthritis is getting worse naturally, not because of the accident. Medical testimony from your doctor that the accident caused acute aggravation defeats this argument.
They argue that your medical treatment is unrelated to the accident and thus your fault, not theirs. They’ll say you’re treating a chronic condition that would have progressed anyway. Your doctor’s testimony about causation defeats this argument.
They try to reduce your damages significantly based on the pre-existing condition. They’ll argue that because you had a condition before, the accident’s impact was minimal. This ignores the eggshell plaintiff rule and is legally incorrect.
They request extensive medical records hoping to find reasons to minimize the aggravation. While you should provide records, don’t let extensive investigation change your claim’s validity.
How Your Lawyer Proves Aggravation
Proving aggravation requires strong documentation and medical testimony:
Medical records from before the accident showing the pre-existing condition’s status. Get records from your primary care doctor or specialist who treated the condition. These establish your baseline condition.
Medical records after the accident documenting the worsening. Emergency room records, hospital records, specialist records, and imaging studies all show what happened after the accident.
Your doctor’s testimony about causation. Your medical provider must testify that the accident caused acute aggravation of your pre-existing condition. This is the linchpin of your case.
Medical experts who can explain the mechanism of aggravation. Sometimes a physician who didn’t treat you but who understands the condition can testify about how the accident would aggravate it.
Your own testimony about the difference between the condition before and after. You lived with the pre-existing condition. You can testify about how much worse it is now compared to before the accident.
Documentation of increased treatment after the accident. More doctor visits, more medication, more therapy—all documented in medical records—show the aggravation.
Treatment costs after the accident. Medical bills and prescription receipts show the financial impact of the aggravation.
Pre-existing Conditions Don't Reduce Your Rights
Never accept an insurance company argument that a pre-existing condition disqualifies you from recovery or significantly reduces your claim. The law doesn’t work that way. The defendant is liable for the full consequences of their negligence, even if you have vulnerabilities that made the consequences worse.
Some insurance companies will offer settlement amounts based on what they claim a person without your pre-existing condition would have recovered. This is wrong. You’re entitled to compensation for what actually happened to you, not what would have happened to a hypothetical healthy person.
Interested in Learning More?
For comprehensive information about all damages you can recover, read our guide on what damages you can recover in a personal injury lawsuit.
To understand how comparative negligence might affect your claim, read our guide on New York’s comparative negligence law.
For information about evaluating whether settlement offers are fair, read our guide on how to evaluate insurance settlement offers.
External Resource: The American Medical Association provides patient information about documenting medical conditions and aggravation at https://www.ama-assn.org/
Don't Accept Pre-existing Condition Denials
Having a pre-existing condition doesn’t disqualify you from recovery. The law recognizes that people have medical histories, and defendants must take you as they find you. If the accident aggravated your condition, you have every right to recover.
The Law Offices of Steven Gacovino P.C. has successfully recovered compensation for countless clients with pre-existing conditions throughout Suffolk County. We know how to document aggravation, we know how to respond to insurance company tactics, and we know how to present compelling cases showing why your recovery isn’t reduced because of the pre-existing condition.
Call 844-692-1200 today for a free consultation about your accident and pre-existing condition. Tell us what conditions you had before the accident and how the accident changed them. We’ll assess your claim and explain your rights. We work on a contingency fee basis—you don’t pay unless we win.
Frequently Asked Questions
1. If I had a pre-existing condition and the accident made it worse, do I have to prove the accident was the main cause?
Not the only cause, but you must prove the accident was a substantial factor in causing the aggravation. Your doctor must testify that the accident aggravated the condition. It’s acceptable that the pre-existing condition was already present—you just need to prove the accident made it significantly worse.
2. How do I prove my pre-existing condition is worse now?
Medical records are the primary proof. Records from before the accident showing the condition’s status, compared with records after the accident showing worsened symptoms, prove aggravation. Your doctor’s testimony that the accident caused the worsening is also critical.
3. Will having a pre-existing condition reduce my pain and suffering damages?
Not under New York law. You recover for the full pain and suffering caused by the accident aggravation, not reduced amounts. Your recovery might be different than someone without the pre-existing condition, but not reduced because of the condition itself.
4. What if the insurance company says my medical records show the condition was already worsening before the accident?
Sometimes conditions naturally worsen over time. This doesn’t prevent recovery for accident-caused aggravation. If your doctor testifies that the accident caused acute worsening beyond the natural progression, you recover for the aggravation. This is why your doctor’s testimony is so important.
5. Can I recover for a pre-existing condition that had nothing to do with the accident?
Generally no. You can only recover for damages caused by the accident. If you have a completely unrelated pre-existing condition, that’s not the defendant’s responsibility. However, if the accident caused you to need treatment for the pre-existing condition (like triggering migraine episodes), you can recover for those treatment costs and the pain caused.
Interested in More Related Links?
What Damages Can I Recover in a Personal Injury Lawsuit?
How Do I Know If I Should Accept the Insurance Company’s Settlement Offer?
An Overview of New York’s Comparative Negligence Law
Personal Injury Settlement Calculator for Suffolk County
How Long Does a Personal Injury Case Take in New York?