When the Insurance Company Uses Pre-existing Conditions to Minimize Your Claim

When the Insurance Company Uses Pre-existing Conditions to Minimize Your Claim

Some insurance companies use pre-existing medical conditions as an opportunity to save money on claim payments. Pre-existing illnesses can reduce payments for policyholders’ medical expenses by as much as 50 percent.

Pre-Existing Medical Conditions

Most insurance companies place significant emphasis on pre-existing medical conditions. They always ask a variety of questions regarding prior medical history and illnesses. Some companies even ask policyholders to give a recorded statement about pre-existing conditions to create a way to deny or minimize injury claims. If an injury claim is filed, pre-existing medical conditions can result in reduced or denied payments for medical expenses. Insurance companies may argue that injury symptoms are related to prior illnesses or injuries rather than current injury conditions.

A bad faith insurance attorney often sees cases where medical expenses are denied or reduced by as much as 50 percent due to arguments used by insurance companies about pre-existing conditions. While pre-existing medical conditions often complicate insurance claims, they do not always prevent payments for medical bills.

Recovering Damages for Injuries

When an accident occurs, pre-existing medical conditions can have a big impact on the outcome of an injury claim. If a person has previously reported symptoms or has been diagnosed with a medical condition that causes pain, that pain can be blamed on the previous condition rather than the current injury. In such cases, the physician’s medical records and statements will be extremely important to the outcome of the claim. If there are records that show the pain and other symptoms increased after the accident, the likelihood of recovering damages is much greater. Many insurance companies clearly define pre-existing conditions for illnesses like diabetes, asthma, arthritis, and cancer, but don’t define conditions that involve personal injuries, so claims may be more difficult to prove.

Under the Affordable Care Act, health insurance companies can no longer refuse health care coverage, limit benefits, or charge higher rates for pre-existing medical conditions on policies that went into effect on or after January 1, 2014. However, the pre-existing coverage rule does not apply to “grandfathered” individual health insurance policies that were purchased before March 23, 2010.