Pre-existing Condition

Injured driver may have back pain secondary to muscle spasm needing conservative treatment prior to auto accident. Pain is a symptom. Injured driver had symptom of pain in lower back secondary to back muscle spasm. Patient may have been treated with medication, physical therapy or trigger point injection. Following auto accident, driver may continue with back pain of increased intensity and change of character of pain. Change in character of pain is presented by patient’s history which is subjective. Pain was dull intermittent prior to accident and after accident it is continuous and stabbing. MRI and CAT scan of patient with back pain may show disk bulge or herniation with facet joint hypertrophy. Patient may or may not have gone through any investigation prior to accident. Now after auto accident, cause of pain is not just a spasm of back muscle anymore, it is either disk herniation causing radicular pain because of pinch nerve or pain caused by facet joint hypertrophy. But, insurance companies will use symptom such as back pain, which was presented prior to auto accident as a pre-existing condition.

Patient will be advised by adjuster of insurance company to go through Independent Medical Evaluation (IME).   Independent Medical Evaluation physician after examination will conclude back pain was pre-existing condition. IME physician often ignores differential diagnosis of back pain before and after auto accident. In this case back pain is not pre-existing since prior to accident, pre-existing muscle spasm was causing back pain and after accident back pain was caused by disk herniation or facet joint injury.

Car Accident- Pre-existing Condition Dispute Claim by Insurance Companies

Some pre-existing conditions like disk herniation are well documented and investigated prior to accident. After accident there may not be any change seen in MRI, but patient may insist his pain has increased in intensity and duration. In this case diagnosis of pre-existing condition is not back pain but disk herniation. Since MRI does not show any changes in disk herniation, insurance companies may dispute the claim of disk herniation causing back pain following auto accident.

In short, the pre-existing conditions are often disputed. Legal hassle at times postpones the required treatment. Delaying treatment may further deteriorate condition and prognosis is not favorable.

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:January 30, 2019

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