Setareh Law
August 11, 2025
Insurance companies typically examine medical records spanning three to five years when investigating pre-existing conditions during personal injury claims, though they may request records dating back even further for serious injuries or high-value cases. The specific timeframe depends on the nature of your current injuries, the severity of your claim, and the insurance company’s assessment of potential pre-existing condition impacts on your damages.
At Setareh Law, we understand how insurance companies use pre-existing conditions to minimize claim values and have extensive experience protecting our clients from unfair tactics designed to reduce compensation. Our attorneys know how to present medical evidence effectively and ensure that pre-existing conditions don’t prevent you from receiving fair compensation for injuries caused by someone else’s negligence.
Standard Medical Record Review Periods
Most insurance companies request medical records covering the three to five years preceding your accident when evaluating personal injury claims. This timeframe allows adjusters to identify any pre-existing conditions that might relate to your current injuries and assess how much of your damages stem from the accident versus prior medical issues.
For certain types of injuries, insurance companies may seek records extending back seven to ten years or even longer. Spinal injuries, traumatic brain injuries, and other conditions with potential long-term progression often trigger more extensive medical record requests due to their complex nature and potential for pre-existing complications.
Factors Influencing Record Review Scope
The severity and value of your claim directly impact how far back insurance companies will investigate your medical history. High-value cases involving catastrophic injuries or significant damages typically prompt more thorough medical record reviews extending further into your past than minor injury claims.
The type of injury you sustained also influences the scope of medical record requests. Back injuries, neck injuries, and joint problems often have longer review periods because these conditions commonly develop gradually over time and may have pre-existing components that complicate damage assessments.
How Insurance Companies Use Pre-existing Conditions
Insurance adjusters use pre-existing condition information to argue that your current symptoms and limitations existed before the accident and, therefore, shouldn’t be compensated as part of your claim. They may attempt to attribute ongoing pain, reduced mobility, or treatment needs to prior medical issues rather than accident-related injuries.
However, California law protects injury victims through the “eggshell skull” doctrine, which holds that defendants must take victims as they find them. This means that even if you had pre-existing conditions, the responsible party remains liable for any aggravation or worsening of those conditions caused by their negligence.
Common Insurance Company Tactics
Insurance companies often request extensive medical records, hoping to find any prior complaints or treatments related to the area of your body injured in the accident. They may highlight routine medical visits, minor complaints, or even preventive care as evidence of pre-existing problems that reduce their liability.
Adjusters frequently mischaracterize normal age-related changes or minor prior issues as significant pre-existing conditions that should reduce your compensation. They may also argue that you would have eventually required the same medical treatment regardless of the accident, attempting to minimize their responsibility for your current medical expenses.
Protecting Your Rights with Pre-existing Conditions
Having pre-existing conditions doesn’t disqualify you from receiving compensation for accident-related injuries, but it does require careful legal strategy to ensure fair treatment. Understanding how to present your medical history and distinguish between pre-existing issues and new injuries is crucial for successful claims.
Working with experienced personal injury attorneys helps protect your rights when insurance companies attempt to use pre-existing conditions against you. Attorneys can obtain expert medical testimony explaining how the accident aggravated or worsened your pre-existing conditions and caused new injuries requiring additional treatment.
Medical Expert Testimony
Medical experts play a crucial role in cases involving pre-existing conditions by explaining the differences between your condition before and after the accident. These professionals can testify about how trauma can aggravate pre-existing conditions and cause symptoms or limitations that wouldn’t have occurred without the accident.
Orthopedic surgeons, neurologists, and other specialists can provide a detailed analysis of your medical records and current condition to demonstrate how the accident impacted your health beyond any pre-existing issues. This testimony becomes essential for securing fair compensation when insurance companies challenge your claims.
Documentation Strategies
Proper documentation of your medical condition before and after the accident helps distinguish between pre-existing issues and new injuries. Maintaining detailed records of your symptoms, limitations, and treatment needs following the accident creates a clear timeline that supports your compensation claims.
Key documentation includes:
- Medical records from your primary care physician showing your condition before the accident
- Emergency room records and initial treatment documentation immediately after the accident
- Imaging studies comparing pre-accident and post-accident conditions when available
- Treatment notes documenting new symptoms or worsening of existing conditions
- Expert medical opinions explaining the accident’s impact on pre-existing conditions
- Daily activity logs showing how your function changed after the accident
This documentation helps establish a clear connection between the accident and your current medical needs, regardless of any pre-existing conditions.
Legal Protections for Injury Victims
California law provides strong protections for injury victims with pre-existing conditions through established legal doctrines that prevent insurance companies from unfairly reducing compensation. The “eggshell skull” rule ensures that responsible parties remain liable for all consequences of their negligence, even when victims have heightened vulnerability due to pre-existing conditions.
Courts recognize that many people live with minor aches, pains, or underlying health conditions that don’t significantly impact their daily lives until aggravated by trauma. Insurance companies cannot use the mere existence of prior medical treatment to deny compensation for legitimate accident-related injuries and complications.
Contact Setareh Law for Your Personal Injury Case
Pre-existing conditions don’t prevent you from receiving fair compensation for accident-related injuries, but they do require experienced legal representation to protect your rights. Insurance companies will thoroughly investigate your medical history to minimize their financial responsibility.
Our experienced personal injury attorneys at Setareh Law know how to handle complex cases involving pre-existing conditions and have successfully secured significant compensation for clients with prior medical issues. We work with medical experts to clearly demonstrate how accidents aggravated existing conditions and caused new injuries requiring compensation. For a free consultation about your personal injury case, contact us at (310) 659-1826 or through our contact form.
