My Pre-Existing Condition Was Injured in an Accident. Can I Still Get Compensation in Pennsylvania?

August 9, 2025

A pre-existing condition does not prevent you from recovering money in a personal injury claim in Pennsylvania or New Jersey. The law holds a negligent party responsible for worsening or aggravating a prior injury. This means if someone else’s carelessness took a manageable condition and made it debilitating, they are responsible for that new harm.

Insurance companies, however, will use your medical history to reduce or deny your claim. They might argue the accident didn’t cause a new injury, but that you are simply trying to get compensation for an old one. While specific data on pre-existing condition denials is hard to isolate, studies show that denials of in-network claims are frequent, with some insurers denying nearly one in five claims. Insurers often use pre-existing conditions as a reason to deny payment, arguing the treatment is for an old issue, not a new injury.

Your story deserves to be heard. Call us for a free consultation to discuss your situation. Call Wapner Newman at (215) 569-0900.

The Insurance Adjuster’s Playbook: How a Pre-Existing Condition Becomes a Weapon

To protect your claim, you first need to understand the insurance company’s incentive, which is to minimize the amount they pay out. A pre-existing condition is one of their most common avenues to do this.

The adjuster’s entire case could be built around this simple narrative: “The pain you feel today is the same pain you had before the accident.” They will work to create doubt about the cause and severity of your current medical problems.

Common Tactics We See:

The “Independent” Medical Examination (IME): The insurer may require you to see a doctor they hired and paid for. This examination is rarely truly independent. The doctor’s report may conclude that your current symptoms are just a continuation of your prior condition, providing the insurer with the ammunition they need to deny or lowball your claim.
Scouring Your Medical History: They will request access to years of your medical records. Their goal is to find any mention of pain, discomfort, or treatment to the same body part.
The Quick, Lowball Offer: You might receive a fast, small settlement offer shortly after the accident. They hope you’ll take the money before you understand the full extent of your aggravated injury and its long-term costs. They know that these cases often become more valuable as the medical evidence develops over time.
Attributing Everything to the Old Injury: If your records show occasional back stiffness, they will claim the debilitating pain you now feel is one and the same. If you had mild, manageable arthritis, they might blame your new, significant mobility limitations entirely on that, ignoring the trauma from the recent accident.

The Law Is Your Shield: Pennsylvania and New Jersey’s “Eggshell Plaintiff” Rule

This is the single most important legal concept for your case. The “Eggshell Plaintiff Rule” (also called the Eggshell Skull Rule) is a long-standing principle that protects injured victims who are more susceptible to injury than a typical person.

What It Means in Simple Terms

A defendant must “take the victim as they find them.” This means the person who caused the harm cannot use the victim’s underlying frailty as a defense to escape responsibility.

Analogy: Imagine one person has a skull as strong as concrete and another has a skull as fragile as an eggshell. If a person negligently drops a small brick on both of their heads, the first person might only get a bump. The second person, however, could suffer a catastrophic injury. The negligent person is responsible for the actual harm they caused to the “eggshell” victim, not the lesser harm they would have caused to a healthier person.

How It Applies in PA and NJ

Pennsylvania: The courts in Pennsylvania have long followed this doctrine. A defendant is liable for the full extent of the harm they cause, even if the victim’s pre-existing condition made the injury much worse than anyone could have foreseen. The person at fault must compensate for all consequences, including medical bills and pain, without a discount because the victim was more fragile.
New Jersey: New Jersey law operates on the same fundamental principle. The person who caused the accident is responsible for all consequences of their negligence, even if your specific injuries were unforeseeably severe because of a prior weakness.

This rule is the legal foundation that allows us to pursue fair compensation, but it must be supported by clear evidence—the focus of the rest of your case.

Drawing the Line: How Do You Prove an Injury Was “Aggravated”?

This is the central challenge of your case. The focus isn’t on the pre-existing condition itself, but on the new harm the accident caused. We work to establish a clear “before and after” picture for the insurance company and, if necessary, a jury.

Types of Worsening Injuries

The specific language used to describe the change in your condition is important, as it can affect the value of your claim.

Aggravation: This means a pre-existing condition has been made permanently worse by the new injury. Your old injury was present and symptomatic (for example, you had chronic but manageable back pain), but the accident made it significantly and permanently more severe.
- Example: Your manageable arthritis now requires invasive injections or a full joint replacement surgery.
Exacerbation: This describes a temporary worsening of a pre-existing condition. Your old injury existed but was dormant or asymptomatic (you weren’t experiencing pain or limitations), and the accident “woke it up,” causing a painful flare-up that eventually subsides, returning you to your pre-accident baseline.
- Example: An old knee injury that hadn’t bothered you in years now causes constant pain and instability after a fall, but with treatment, it is expected to return to its former state.
New Injury from an Old Condition: The accident caused a distinctly new injury that likely wouldn’t have happened, or wouldn’t have been as severe, if not for your pre-existing condition.
- Example: A person with osteoporosis suffers multiple bone fractures in a minor car crash that would have only bruised someone with average bone density.

The Evidence We Use to Connect the Dots

Proving your case is like building a bridge from the accident to your current pain, demonstrating with evidence that one caused the other. At Wapner Newman, we gather the specific materials needed to make that bridge unshakable.

Key Evidence We Will Assemble:

Your Complete Medical Records (Before and After): This is the foundation. We need your medical records from before the accident to establish a clear baseline of your health. If your prior records show you had mild, manageable back pain treated with occasional physical therapy, and your post-accident records show MRIs with new disc herniations and a referral to a spinal surgeon, that creates a powerful and undeniable timeline.
Testimony from Your Treating Physicians: The doctors who see you regularly and have managed your care over time are often the most credible witnesses. We will work with them to properly document how your condition, symptoms, treatment plan, and physical limitations have changed since the day of the accident.
Opinions from Medical Experts: In many cases, especially those involving significant or complex injuries, we retain independent medical specialists. These physicians can review your entire medical history and provide a formal, expert opinion that distinguishes the pre-existing condition from the accident-caused aggravation. This testimony is essential for explaining the medical complexities to a jury.
Your Own Testimony (and That of Friends and Family): You are the most important witness to your own suffering. The story of how your life has changed is itself a powerful form of evidence.
- Example: “Before the accident, I could play golf twice a month if I stretched properly. Now, I can’t even lift the grocery bags out of the car. My wife has to do all the yard work, something I used to enjoy.”
Diagnostic Imaging: There is no substitute for objective, visual proof. Comparing an old X-ray or MRI to a new one taken after the accident can provide clear evidence of a worsened condition, such as advanced degenerative changes or a new herniation, which is very difficult for an insurance company to dispute.

How Is Compensation Calculated for an Aggravated Injury?

You cannot be compensated for the pain and limitations you had before the accident. You can only be compensated for the worsening of your condition caused by someone else’s negligence.

The value of your claim is based on the difference between your life before the accident and your life now. It is the monetary value of the new pain, the new limitations, and the new costs you face because your condition was aggravated.

Damages We Pursue:

Economic Damages (The Tangible Costs): These are the verifiable financial losses you have incurred.

Medical bills for treatment of the new or worsened condition.
Future medical care, such as ongoing physical therapy, future surgeries, or long-term pain management.
Lost wages from being unable to work during your recovery.
Loss of future earning capacity if the aggravated injury permanently prevents you from returning to your previous job or working at the same capacity.

Non-Economic Damages (The Human Costs): These damages compensate you for the intangible, personal losses.

Pain and Suffering: Compensation for the increased physical pain you now endure.
Emotional Distress: For the new anxiety, stress, and mental anguish caused by the worsened injury and its impact on your life.
Loss of Enjoyment of Life: This addresses how the aggravated injury has taken away your ability to enjoy hobbies, family activities, and the simple pleasures of daily life. This is where the “before and after” stories from you and your loved ones become so important.

Potential Hurdles: Comparative Negligence in PA & NJ

Insurance companies may also try to limit what they pay by arguing you were partially at fault for the accident itself. This legal doctrine is known as “comparative negligence,” and both Pennsylvania and New Jersey have similar rules.

How It Works in Pennsylvania:

Pennsylvania uses a “51% modified” rule, outlined in 42 Pa. C.S.A. § 7102. You can recover damages as long as your percentage of fault is 50% or less. If a jury finds you were 51% or more at fault for the accident, you are barred from recovering any compensation. If you are found 20% at fault, your final financial award is reduced by 20%.

How It Works in New Jersey:

New Jersey has a very similar “51% modified” rule under N.J.S.A. 2A:15-5.1. Your financial recovery is reduced by your percentage of fault, and you cannot recover any damages if your fault is determined to be greater than the defendant’s (i.e., 51% or more).

This is a separate issue from your pre-existing condition, but it is a common defense tactic used in conjunction with it. An insurer might try to reduce the value of your claim from multiple angles by arguing both that your injuries already existed and that you were partially to blame for the accident that worsened them.

Frequently Asked Questions

Do I have to tell my lawyer about my pre-existing condition?

Yes, absolutely. You must be completely transparent with us from the very beginning. Hiding a pre-existing condition will only damage your credibility and harm your case. The insurance company’s lawyers will eventually find out about it through medical records and investigations. When we know about it from the start, we can build a proactive strategy around it and control the narrative, rather than being forced to react to the defense’s claims.

What if my pre-existing condition is not in my medical records?

This could be both a challenge and an advantage. If there is no official record of treatment for a condition, it may be harder for the defense to prove it existed before the accident. However, you must still be truthful under oath if asked. We’ll work to establish your baseline health through your own testimony and that of friends, family, or coworkers who can speak to your physical abilities and activity levels before the accident.

Can the insurance company get my entire medical history?

Legally, they are only entitled to records that are relevant to the injuries being claimed in the accident. However, “relevant” can be a very broad term, and insurers will often send a blanket authorization form hoping to gain access to your entire life’s medical history. We will carefully review these requests and fight to limit them to only what is legally necessary, protecting your privacy while complying with legal obligations.

Will my case have to go to trial because of my pre-existing condition?

It increases the possibility. Because these cases are more medically complex and insurers tend to dispute them more vigorously, they are more likely to end up in litigation. However, many of these cases still settle before a trial becomes necessary. A settlement often happens once we have built a strong case with clear medical evidence and expert support that makes it clear to the insurer that they are likely to lose in court. We prepare every case as if it will go to trial, which puts you in the strongest possible position to negotiate a fair settlement.

My health insurance paid for my treatment. Do I have to pay them back from my settlement?

In many cases, yes. This is a legal concept called subrogation. If your health plan is provided by your employer, it is likely governed by a federal law called ERISA, which often gives the plan a right to be reimbursed from your settlement for the medical bills it paid. This is a complex area of law, but our firm handles these negotiations as part of your case. We work to reduce the amount you have to pay back, maximizing the money that ultimately goes into your pocket.

Your Story Is More Than Your Medical History

Your past health does not define your right to justice now. An accident caused by someone else’s carelessness rewrote your future, and that is what matters. The challenge is making an insurance company, or a jury, see the clear line between the “before” and the “after.”

Let us take on the work of building your case, gathering the proof, and fighting the insurance company’s tactics so you can focus on your recovery.

Call Wapner Newman today to talk about what happened. We are here to listen. Contact us at (215) 569-0900.