When you’re injured in an accident in San Antonio, dealing with insurance companies can quickly become one of the most frustrating aspects of your recovery process. Insurance adjusters often employ a common tactic to minimize your compensation: blaming your injuries on pre-existing conditions. This strategy, known as the “pre-existing condition defense,” can significantly impact your ability to receive fair compensation for your injuries.
At Ryan Orsatti Law, we understand the complexities of personal injury cases involving pre-existing conditions and are committed to helping San Antonio residents navigate these challenging situations.
Understanding the Pre-Existing Condition Defense in Texas
Insurance companies operate with one primary goal: to protect their bottom line by paying as little as possible for claims. When you file an injury claim after an accident in San Antonio, the defendant’s insurance company will thoroughly investigate your medical history, searching for any previous injuries or health conditions they can use to deny or reduce your claim.
Under Texas law, defendants are generally required to “take the plaintiff as they find them,” a legal principle known as the “eggshell plaintiff rule.” This means that if an accident aggravates or worsens a pre-existing condition, the at-fault party may still be liable for the resulting damages. However, they’re only responsible for the worsening or aggravation—not for treating the original condition itself.
The Texas Supreme Court has consistently upheld this principle, as demonstrated in cases like Coates v. Whittington, where the court recognized that defendants must compensate plaintiffs for aggravation of pre-existing conditions.
Common Pre-Existing Conditions Used Against San Antonio Injury Victims
In San Antonio, insurance companies frequently target specific pre-existing conditions to minimize liability:
1. Back and Spine Injuries
Back pain is extremely common, with the National Institute of Neurological Disorders and Stroke reporting that about 80% of adults experience back pain at some point in their lives. If you’ve ever reported back pain to a medical provider before your accident, insurance companies may attempt to attribute your current pain entirely to your pre-existing condition rather than the recent accident.
2. Degenerative Disc Disease
Many San Antonio residents over 40 have some degree of degenerative disc disease, a natural part of aging. Insurance adjusters often point to these degenerative changes shown on MRIs or X-rays as the “real cause” of your pain, even when you were asymptomatic before the accident.
3. Arthritis and Joint Problems
Pre-existing arthritis, particularly in the knees, hips, or shoulders, is frequently cited by insurance companies as the true source of your post-accident pain and limitations.
4. Previous Similar Injuries
If you’ve previously injured the same body part that was harmed in your current accident, insurance companies will likely argue that your current symptoms are merely a continuation of the old injury rather than a new one.
5. Mental Health Conditions
For claims involving emotional distress, anxiety, or PTSD following an accident, insurers may point to previous mental health treatment as evidence that your psychological symptoms preceded the accident.
The Eggshell Plaintiff Rule: Your Protection Under Texas Law
Texas personal injury law provides important protections for accident victims with pre-existing conditions through the eggshell plaintiff rule. This doctrine states that a negligent party takes their victim as they find them, including any physical vulnerabilities or pre-existing conditions.
The 14th Court of Appeals in Houston reinforced this principle in Big Town Nursing Home, Inc. v. Newman, stating that a defendant cannot escape liability simply because the plaintiff had a pre-existing condition that made them more vulnerable to injury.
In practical terms, this means that if you had a dormant back problem that was asymptomatic before your San Antonio car accident, but the accident triggered severe pain, the responsible party may be liable for all resulting damages—even if someone without your pre-existing condition might have suffered less severe injuries.
Strategies for Overcoming Pre-Existing Condition Defenses in San Antonio
At Ryan Orsatti Law, we employ several proven strategies to counter insurance companies’ attempts to use your pre-existing conditions against you:
1. Establishing Clear Documentation of Your Pre-Accident Condition
Medical records demonstrating your functional capacity before the accident are crucial. This may include:
- Records showing you were asymptomatic or had minimal symptoms before the accident
- Documentation of your regular activities and work capacity prior to the injury
- Physical therapy or treatment records showing stable condition management
2. Utilizing Expert Medical Testimony
Specialized medical professionals can distinguish between pre-existing conditions and new injuries. In San Antonio, physicians from respected institutions like UT Health San Antonio can provide credible testimony regarding:
- Whether the accident caused a new injury or aggravated an existing one
- The specific mechanisms of how the accident impacted your condition
- The expected recovery time for accident-related symptoms versus baseline symptoms
3. Applying the “Before and After” Method
This approach focuses on demonstrating the clear contrast between your quality of life and functional abilities before and after the accident:
- Employment records showing consistent work history before the accident
- Testimony from friends, family, and coworkers about your activity levels
- Evidence of physical activities you regularly engaged in before being injured
- Medical records comparing your treatment needs before and after the incident
4. Understanding Relevant Texas Case Law
Several Texas court decisions have established important precedents for cases involving pre-existing conditions:
- In Coates v. Whittington, the Texas Supreme Court confirmed that plaintiffs can recover damages for aggravation of pre-existing conditions.
- The court in Kerr v. Lyford emphasized that the defendant must take the plaintiff as they find them, regardless of unusual susceptibility to injury.
- Houston Lighting & Power Co. v. Reed established that when a dormant condition is activated by an injury, the defendant may be liable for all resulting damages.
The Difference Between Aggravation and New Injuries in Texas Law
Texas courts distinguish between two scenarios when dealing with pre-existing conditions:
Aggravation of Pre-Existing Conditions
When an accident worsens a condition that was already causing symptoms, you may recover damages for the difference between your pre-accident state and your post-accident condition. The Texas Pattern Jury Charges provide specific instructions for juries evaluating these claims, directing them to compensate only for the aggravation, not the pre-existing condition itself.
Triggering a Dormant Condition
If you had a condition that was asymptomatic (dormant) before the accident but began causing problems afterward, Texas law generally allows recovery for all resulting damages since you weren’t experiencing symptoms before the incident.
Documenting Your San Antonio Injury Case When Pre-Existing Conditions Are Involved
Proper documentation is essential when countering pre-existing condition defenses:
1. Seek Immediate Medical Attention
After an accident in San Antonio, seek medical care promptly, even if you think your symptoms might be related to a pre-existing condition. Explain to your healthcare provider:
- Your complete injury history
- How your current symptoms differ from any previous problems
- When these new or worsened symptoms began relative to the accident
2. Be Honest About Your Medical History
Never conceal prior conditions or treatments from your healthcare providers or attorney. Insurance companies will likely discover this information during their investigation, and dishonesty can severely damage your credibility.
3. Maintain a Symptom Journal
Document how your symptoms have changed since the accident:
- Pain levels before and after the incident
- New limitations on activities
- Changes in medication needs
- Additional treatments required
4. Follow All Treatment Recommendations
Adhere strictly to your healthcare provider’s recommendations to demonstrate that you’re taking your recovery seriously and to create a clear record of your post-accident medical needs.
How the Insurance Claims Process Works with Pre-Existing Conditions in San Antonio
Understanding how insurance companies handle claims involving pre-existing conditions can help you prepare for the challenges ahead:
1. Medical Record Reviews
Insurance companies will request authorization to access your medical records, often going back 5-10 years. They employ medical record reviewers specifically trained to identify any prior complaints that could be linked to your current injury.
2. Independent Medical Examinations (IMEs)
The insurer may require you to undergo an examination by a doctor of their choosing. These “independent” examiners are often selected because they reliably produce reports favorable to insurance companies, frequently concluding that your symptoms are due to pre-existing conditions rather than the accident.
3. Surveillance and Social Media Monitoring
Insurance companies in Texas frequently employ investigators to observe claimants with pre-existing conditions, hoping to capture evidence of activities that contradict claimed limitations. They also routinely monitor social media accounts for inconsistencies.
The Role of an Experienced San Antonio Personal Injury Attorney
Having skilled legal representation is particularly crucial when dealing with pre-existing condition defenses. At Ryan Orsatti Law, we:
- Anticipate insurance company tactics and prepare counterstrategies
- Work with respected medical experts to establish causation
- Ensure proper documentation of all aggravated or newly symptomatic conditions
- Handle all communication with insurance adjusters to prevent damaging statements
- Present compelling evidence distinguishing between pre-existing and new injuries
Texas Statute of Limitations Considerations
If you have a pre-existing condition that was aggravated by an accident, be aware that Texas imposes a two-year statute of limitations for personal injury claims under Texas Civil Practice and Remedies Code § 16.003. This means you must file your lawsuit within two years of the accident date, regardless of whether your symptoms initially seemed related to your pre-existing condition.
Maximizing Your Recovery: Settlement Negotiations vs. Trial
Cases involving pre-existing conditions often require strategic decisions about whether to settle or proceed to trial:
Settlement Negotiations
Most personal injury cases in San Antonio resolve through settlement negotiations. When pre-existing conditions are involved, effective negotiation typically requires:
- Clear medical evidence distinguishing new injuries from pre-existing conditions
- Documentation demonstrating the accident’s impact on your quality of life
- Expert opinions supporting your claims of aggravation
Trial Considerations
If the insurance company refuses to offer fair compensation, trial may be necessary. At Ryan Orsatti Law, we prepare every case as if it will go to trial, developing compelling evidence that helps jurors understand:
- The real-world impact of your aggravated condition
- How the accident changed your life compared to your pre-accident state
- Why you deserve compensation despite having a pre-existing condition
Conclusion: Don’t Let Insurance Companies Deny You Fair Compensation
Insurance companies in San Antonio routinely use pre-existing conditions as a reason to deny or minimize legitimate injury claims. However, with proper legal representation, medical documentation, and an understanding of your rights under Texas law, you can overcome these tactics and secure the compensation you deserve.
At Ryan Orsatti Law, we have extensive experience helping San Antonio residents with pre-existing conditions obtain fair compensation after accidents. If you’re facing challenges with an insurance company blaming your injuries on pre-existing conditions, contact us today for a free consultation to discuss your case and explore your legal options.
This blog is for informational purposes only and does not constitute legal advice. Every case is unique, and the information provided here may not apply to your specific situation. To understand how the law applies to your circumstances, consult with a qualified San Antonio personal injury attorney.
