The Insurance Industries Fallacy of ‘Pre-existing Conditions’


What is a pre-existing condition? This is strictly an insurance term that was created to characterize a particular health condition a person applying for insurance may have. The vast majority of people have pre-existing conditions. They may range from migraine headaches or chronic back pain, to cancer. The insurance industry is using pre-existing conditions as a pretext to deny coverage when someone applies for insurance. We hear politicians using pre-existing conditions as a political talking point, in particular with regard to the affordable care act. As many as 130 million adults under age 65 in the U.S. have pre-existing conditions that could result in their not being able to get insurance coverage in the private market, according to the Department of Health and Human Services. Before the Affordable Care Act became law, insurance companies routinely declined health insurance coverage to people who had ongoing medical conditions or recent illnesses. Even when insurers offered policies to those with health problems, they often excluded those illnesses. And insurance companies could cancel coverage for people who became ill once the policy year ended. The ACA made all those practices illegal. By withdrawing from defending the law in court, the Trump administration is saying it no longer supports those consumer protections, which are popular with voters.


What most people don’t know is that the insurance industry has decided to use pre-existing conditions to deny coverage for injuries received as a result of other peoples negligence.

When a person is involved in an auto accident, or slip and fall, as a result of the negligence of another person or business, the first course of action for any lawyer is to pursue recovery from the insurance coverage of the person or business responsible for the injury.

The insurance industry now attempts to blame any and all injuries a person incurs on some type of pre-existing condition that person may have had, even if that condition was ten or more years prior. The standard response from insurance carriers when a claim is made for injuries, rather than attempting to pay the claim, is to demand that the injured person provide the name, address, and phone number of every medical provider they have ever seen in the past ten years, and to sign a medical release form so that the insurance carrier can obtain all the persons prior medical records.

When any injury shows up, regardless of how remote, the insurance carrier cries “pre-existing condition” and either denies the claim or low balls the offer to settle. In many cases, the injured party has made a full recovery from the prior injury and has had no symptoms for years and years, until the new accident happens. Despite full recovery and years of being symptom free, the insurance carrier cries “pre-existing condition” and denies the claim or offers so little that the claim is effectively denied.

This is why injured persons need the help of a lawyer more now than ever if they are injured as a result of the negligence of others.

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