Dealing with Pre-Existing Injuries: Personal Injury Lawyer Strategies

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If you have a back that flares up every few months, a shoulder that never fully recovered from high school sports, or a degenerative condition that shows up on every MRI, you are not alone. Most adults carry some medical history into an accident. Insurance companies know this and often try to turn your prior condition into an escape hatch, arguing that the crash or fall did “nothing new.” Winning with a documented pre-existing injury is not about hiding the past. It is about showing, with clarity, how the incident made things worse, changed your day-to-day life, and created losses the law recognizes.

Having handled hundreds of cases where medical records stretch back years, I can tell you the strategy is equal parts medicine and storytelling. The law provides compensation for aggravations and accelerations of a condition. The proof rests on detail, not soundbites. With careful groundwork, a car accident lawyer or personal injury lawyer can push past the knee-jerk defenses and recover what you need to heal and adapt.

The reality of pre-existing conditions in injury claims

A pre-existing condition is any diagnosed or undiagnosed health issue that existed before the incident at issue. Think degenerative disc disease, prior concussions, old rotator cuff tears, arthritic knees, diabetic neuropathy, chronic migraines. These conditions are common. In MRIs of people over 40 with no symptoms, a surprising percentage show degenerative changes in the spine and joints. Defense adjusters lean on that gap between imaging and symptoms, trying to label your pain as “degenerative” rather than “traumatic.”

The legal standard in most jurisdictions does not require a perfectly healthy plaintiff. The law takes you as it finds you. If a crash turns intermittent back pain into daily pain, or speeds up the timetable for a knee replacement by five years, those are harms the defendant must address. The challenge is translating that principle into evidence the insurer accepts or that a jury finds credible. That starts at the first doctor visit and continues through settlement talks.

The first 30 days shape the whole case

The earliest steps often matter the most. Timelines, consistency, and detail build the bridge between the accident and the aggravation. I tell clients that the first month sets the tone for everything that follows. If you are reading this soon after a crash, you can still shape the record in a way that helps your claim and your recovery.

Seek prompt medical care, even if symptoms seem familiar. Tell the provider not just that your back hurts, but how the pain is different from your baseline. Before the crash you could sit for two hours, now 25 minutes triggers spasms. Before, you managed on ibuprofen, now you need prescription muscle relaxers that make you drowsy at work. This contrast matters. Doctors do not always ask the right questions. You need to volunteer the comparison so the chart reflects it.

Follow through on testing and referrals. If a primary care physician suggests physical therapy or an orthopedic consult, go. Gaps in care become ammunition for the adjuster. Life gets busy, and insurance authorizations can take time, but unfilled referrals look like improvement when they are really paperwork delays.

Do not minimize prior issues. Full disclosure protects you. When I review a denial, I often see language like, “Claimant denied prior back pain,” followed by records that show prior treatment. That inconsistency undermines credibility across the board. A car accident attorney would rather explain an honest history than patch holes later.

What “aggravation” really means in medical terms

Aggravation can be structural, symptomatic, or functional. Structural changes are visible on imaging, such as a new annular tear in a disc, a fresh set of bone marrow edema on MRI, or a worsened meniscal tear. Symptomatic aggravation means increased pain intensity, new pain patterns, or frequency changes, even if imaging looks similar. Functional aggravation shows up in what you cannot do now that you could do before, from lifting your toddler to running your delivery route.

Pain is subjective, but it still needs objective anchors. Range-of-motion measurements, strength testing, straight-leg raise results, reflex changes, gait analysis, and comparative pain diagrams lend credibility. In neck and back cases, serial exams showing evolving muscle guarding, tenderness, and decreased tolerance for certain movements can matter just as much as the scan.

One common trap: insurers claim that degenerative disc disease explains everything. Degeneration progresses slowly. Trauma creates abrupt changes. A doctor who can point to “before and after” markers, such as an MRI from last year and a new scan with different findings, makes causation clearer. Even without prior imaging, a careful narrative of daily function before and after can persuade. A personal injury lawyer spends time helping clients articulate that change so the record reflects it.

The “eggshell plaintiff” and “take the victim as they are”

Courts generally apply the eggshell plaintiff rule. If the defendant’s negligence injures someone with a fragile condition, the defendant remains responsible for the full extent of the workers compensation lawyer injury, even if a healthier person would have fared better. Insurance carriers rarely fight the rule itself; they argue its application. They say, in effect, your outcome would have been the same regardless of the crash because your knee was already headed toward replacement, your shoulder was already torn, or your migraine history explains your current headaches.

The legal strategy is to separate the hypothetical from the actual. What did your life look like the month before the crash? What did your work evaluations say? How often did you see your doctor? Compare that to the months after. If your prior knee arthritis let you hike five miles on weekends and now you cannot walk a grocery aisle without a cart, that is a measurable change. If chronic migraines were monthly and post-crash they are weekly with new nausea or light sensitivity, that is measurable too. The rule fits those facts cleanly.

Records, records, and more records

A strong aggravation claim rests on complete documentation. That includes prior records, not just post-accident care. Asking clients to retrieve five years of records can feel intrusive, but it often saves the case. Here is the typical set that proves essential:

  • Pre-incident primary care notes covering baseline symptoms, meds, and activity levels.
  • Any prior imaging and specialist reports related to the same body region.
  • Pharmacy history showing pain medication usage patterns.
  • Work or athletic physicals that demonstrate function.
  • Post-incident urgent care, ER, and follow-up notes with consistent symptom reporting.

We rarely need a decade of history unless there were surgeries or complex conditions. Five years captures enough context without drowning in noise. When prior imaging exists, we send both the films and the radiology reports to an expert for side-by-side comparison. Radiology addendums that explicitly call out new findings carry weight in negotiations.

The narrative layer: pairing facts with lived experience

Numbers and scans do not, by themselves, move an adjuster. The narrative layer connects why those numbers matter. I once represented a chef with a pre-existing lumbar disc herniation that had been quiet for years. A low-speed rear-end crash turned his manageable condition into radiating pain that made standing over the line impossible after two hours. His MRI looked similar, and the carrier called it degenerative. We gathered time-stamped schedule logs, pre-crash text messages trading shifts, and photos from the kitchen showing him lifting stock pots without a back brace. Post-crash, he kept an activity diary showing breaks, icing routines, and missed prep tasks. The doctor wrote a letter comparing symptom sets in specific, non-technical terms. That bundle told a story the carrier could not wave away with a single word like “degenerative.” The case settled for a number that paid for work retraining and an ergonomic setup.

The diary piece is often overlooked. A few sentences each day about pain patterns, medications taken, side effects, missed events, or modified chores add texture. It is not dramatization. It is a contemporaneous record that refreshes memory and helps your attorney and your doctor draw accurate lines between the accident and the life that followed.

Crossroads in treatment: when the plan changes the case

Some treatment decisions carry outsized legal consequences. Injections, surgery, and long-term medications create clear markers that the post-incident condition is different from baseline. That does not mean everyone should rush to invasive care. Medical decisions should serve health first. Still, recognize that failing conservative care and moving up the ladder, documented step by step, both helps your body and supports causation.

Pain management agreements, opioid prescriptions, or work restrictions in the chart also change the case value. They tell a fact finder that daily life now sits behind narrower guardrails. Adjusters tend to downgrade cases where the patient refuses reasonable options without medical reason. Conversely, they pay attention when a person tries physical therapy, home exercise programs, and activity modification before taking the next step. Persistence reduces the insurer’s favorite argument, that you are just seeking a payday.

The “independent” medical exam and how to handle it

If your case involves significant money or complicated history, the defense will likely request an independent medical exam, often called an IME. These exams are not truly independent. They are defense evaluations. Preparation matters. Bring a concise list of current symptoms, aggravating activities, and what helps. Answer honestly, but do not minimize. Describe baseline and change, not just pain scores. If a maneuver hurts, say so and ask that it be noted. After the exam, write down what was asked and tested while it is fresh. Some jurisdictions allow a companion or recording. Your personal injury lawyer will advise depending on local rules.

Expect the IME report to emphasize degeneration, return you to “baseline,” or suggest that any worsening was temporary. It may cherry-pick records or downplay exam findings. A treating physician’s detailed rebuttal often proves decisive. We provide the treater with the IME and ask for a point-by-point response that ties specific records and exams to their opinions. Precision beats volume. A two-page letter that cites dates and findings is better than a generic statement of disagreement.

Making sense of causation in multi-factor cases

Life rarely presents clean lines. Consider a delivery driver with known knee osteoarthritis who gets rear-ended, then keeps working through swelling and pain because she needs the paycheck. Six months later she falls at work when the knee gives way. Now there are three factors: degeneration, a crash, and a fall. The defense will blame the last event or the arthritis. Untangling this requires medical insight and a timeline. Did the crash cause inflammation that destabilized the knee, making the fall more likely? Were there new findings on imaging after the crash but before the fall? Did function decline in that window? We often bring in a biomechanical or orthopedic expert to explain how trauma can accelerate cartilage wear or alter gait, loading other joints. Jurors understand chain reactions when presented clearly.

Causation also gets complicated when psychological symptoms or sleep disturbances follow an incident. Someone with a history of anxiety may develop post-crash hypervigilance, headaches, and insomnia that amplify pain perception. Documenting mental health history and showing the post-incident change, including counseling records, can prevent the carrier from dismissing these symptoms as “just stress.” Pain is a biopsychosocial experience. Lawyers who embrace that model, rather than shy away from it, do better with pre-existing conditions.

Settling fairly when the baseline was not normal

Valuation is more art than math in aggravation cases. Two people with the same diagnosis and treatment can end up with different outcomes based on baseline function, occupation, and resilience. An accountant with wrist tendinopathy may work around pain with dictation tools. A hairstylist with the same tendinopathy might have to cut hours by half. That difference matters.

When I negotiate, I frame damages around three concentric circles:

  • Hard economics: medical bills tied to the aggravation, lost wages, future care estimated by a treating physician or life care planner.
  • Functional loss: reduced capacity at work and at home, supported by employer statements, duty modifications, and activity diaries.
  • Human loss: pain, loss of hobbies and roles, missed family events, and the way chronic pain changes mood and connection, corroborated by family or friends.

The defense will try to pay only the first circle. Your job, with your attorney, is to bring the other two into focus without inflating anything. Specificity helps. “I can no longer bowl with my league of 12 years” does more than “I can’t do hobbies.” “I had to put a bench in the shower and my spouse helps wash my hair twice a week” lands harder than “I need help with daily tasks.”

When the insurer blames “normal aging”

Adjusters lean on the phrase “age-related changes” like a magic incantation. Normal aging does not mean normal pain. Many people with degenerative findings live without daily symptoms. A traumatic event can convert a silent condition into a symptomatic one. That conversion is compensable if you can prove the before and after. A measured reply, backed by records, beats indignation. Your car accident attorney might share published data showing that asymptomatic degeneration is common, then pivot to your unique story: the prescribed medications, the work restrictions, the therapy notes. You are not a statistic. You are a person whose life changed on a date that appears on a police report.

Surveillance, social media, and credibility traps

If your case involves a large claim, assume surveillance. A three-minute clip of you carrying groceries does not tell the story of the hour you spent icing afterward. But it will show up at mediation if the insurer thinks it helps. Live consistently. If your doctor restricts lifting to 10 pounds, follow it. If you post on social media, avoid activity bragging or humor that undercuts your claim. Juries and adjusters equate consistency with truth. That does not mean you must live like a patient every minute. It means you should avoid moments that make you look like a different person than the one in your records.

Role of the lawyer: conductor, translator, and shield

A skilled car accident lawyer serves as conductor of a complex orchestra. We coordinate medical opinions, collect records, schedule experts, and time settlement demands to coincide with clear medical milestones. We translate medical jargon into plain language, and your lived experience into damages categories the law recognizes. We also act as a shield, deflecting tactics that aim to wear you down.

In aggravation cases, we spend more time with treating providers than usual. We request narrative reports that compare baseline to post-accident status. We ask for impairment ratings when appropriate, and we prepare providers for deposition questions about degeneration. We often obtain short statements from employers or coworkers describing changes they observed. The goal is cohesion. When the story in the medical file, the work file, and your day-to-day lines up, adjusters lose their leverage.

Common defense playbooks, and how to counter them

Most carriers recycle a handful of arguments. Anticipating them shortens the fight.

  • The MRI looks the same as before, so nothing changed. Response: show symptom escalation, failed conservative therapy, new functional limits, and any exam differences such as new neurological signs. Include comparative radiology commentary if available.
  • Gaps in treatment mean you got better. Response: explain insurance delays, work or caregiving obligations, or periods where you tried home programs, and show consistent medication refills or over-the-counter purchases as proof you were still managing symptoms.
  • Prior injury explains everything. Response: separate the timeline and highlight inflection points like new medications, injections, or restrictions. If the prior condition was episodic, emphasize the shift to persistent symptoms.
  • Secondary gain or malingering. Response: provide objective anchors, credible third-party observations, normal psychological testing where applicable, and evidence of continued work efforts or missed opportunities that cut against that theory.

When to bring in experts

Not every case needs experts beyond treating physicians. But when the record is thin, imaging is ambiguous, or the defense digs in, experts help. Radiologists can author comparative reads that explain why a small change matters. Orthopedists or neurologists can clarify causation and future care. Biomechanical engineers can connect crash forces to injury patterns in disputed liability cases. Vocational experts translate restrictions into lost earning capacity, especially for trade and manual labor jobs. Life care planners turn medical recommendations into cost projections, which anchor settlement ranges.

The key is proportionality. Do not spend $20,000 on experts for a case that cannot justify it. An experienced personal injury lawyer will map the cost-benefit and timing. Sometimes one well-chosen expert letter early in the process prevents a year of denial tactics.

Practical steps for clients to strengthen an aggravation claim

A few habits make a measurable difference and do not require legal training or special access.

  • Keep a simple symptom and activity journal for at least 90 days. Note pain levels, triggers, meds, missed activities, and sleep.
  • Save receipts for over-the-counter items, braces, or ergonomic tools you did not need before the incident.
  • Ask your doctor to record functional limits in the chart using specifics, such as standing tolerance or lifting limits, not just general pain descriptors.
  • If you work, request written light-duty or accommodation notes and keep copies of modified schedules.
  • If you have prior imaging, get the actual images on disc, not just the report, and give them to your lawyer.

These small steps add up. They create a mosaic that feels real because it is real.

Special scenarios worth flagging

Two situations deserve special attention. First, undiagnosed pre-existing conditions. Many people learn they have degenerative changes or congenital issues only after a crash leads to imaging. The defense may argue you had the same problem before without symptoms, so the crash did nothing. The correct frame is that the condition existed but was asymptomatic, and trauma made it symptomatic. The law generally recognizes this as an aggravation, assuming evidence supports it.

Second, aggravation of mental health conditions. Anxiety, PTSD, and depression can flare after a collision, especially when chronic pain sets in. People sometimes hide this out of pride or fear of stigma. Document it instead. Seeing a therapist or psychiatrist creates a record that supports both pain management and damages. Defense counsel will try to separate mental health from physical injury. Do not let those strands unravel. They interact in daily life, and juries understand that.

Settlement timing and the arc of recovery

Do not rush to settlement before reaching a reasonable point of stability or a defined plan for next steps. If an orthopedic surgeon recommends trying two rounds of injections before considering arthroscopy, there is no sense guessing future costs until those conservative steps play out. On the other hand, waiting forever is not wise either. Most cases reach a practical point where your course is clear: you are as good as you are going to get, or you have a road map for surgery and rehab with cost estimates.

Your attorney will often issue a demand package at that moment, including a narrative letter, medical summaries, bills, wage documentation, and any expert opinions. With pre-existing injuries, include a dedicated “baseline versus now” section with quotes from records rather than vague assertions. The stronger that section, the less oxygen for the degenerative defense.

When a lawsuit becomes necessary

Many cases settle with diligent preparation. Some require filing suit. Litigation can surface the truth that adjusters prefer to ignore. Depositions of treating physicians allow us to lock in opinions on aggravation and causation. Defense IMEs get scrutinized, and inconsistencies come to light. Discovery produces surveillance, social media posts, and internal claim notes. Sometimes the act of building the case for trial reveals enough that a fair settlement follows.

Not every client wants to risk trial, and not every case should go. A measured conversation about risk, cost, and likely outcomes helps. The presence of a pre-existing condition does not sink a case, but it can tighten the margins. A candid car accident attorney will tell you when a number is fair given those margins, and when to push.

Final thoughts for people with a medical history

Your medical history is not a liability if you use it properly. It is the baseline against which any aggravation is measured. Hiding it invites disaster. Owning it, with careful documentation and honest comparisons, gives your lawyer tools that jurors trust. The defense will keep repeating the word “degenerative” as if it ends the discussion. It does not. It begins the discussion about how a specific crash, on a specific date, took a manageable condition and turned it into something else.

If you find yourself facing that fight, get help early. A seasoned personal injury lawyer knows how to shape the record, coach you on medical communication, gather the right experts, and keep you away from credibility traps. The goal is not to rewrite your past, but to make sure the law sees the present for what it is and what it costs you now and in the years ahead.

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