The Shoulder
The Shoulder
61
Insurancegenuine-vole-362

Insurance keeps saying my back problems are 'pre-existing' — anyone dealt with this BS?

So I'm in my early 40s and was rear-ended pretty hard by a delivery van about 18 months ago. Felt fine-ish the first day but by day three I could barely get out of bed. Since then I've done physical therapy, two rounds of injections, and my doctor is now recommending surgery on two of my discs.

Here's where I'm losing my mind: the insurance adjuster keeps pointing to my MRI results and saying the disc damage is just 'age-related degeneration' that was already there before the crash. Like... okay? I'm 42, not 82. And I never had back pain before this. I wasn't on any medication, I wasn't missing work, I was coaching my kid's soccer team on weekends.

Now I can barely sit through a 45-minute car ride and they want to act like the van slamming into me at a stoplight had nothing to do with it?

My doctor actually wrote a letter saying the trauma 'aggravated an underlying condition' — which I thought would help, but the adjuster basically shrugged it off.

Has anyone here fought back against this kind of argument? Did you get an independent medical exam? Did you need a lawyer to push through it? I feel like I'm being gaslit into thinking a crash that totaled my car somehow didn't hurt me.

Any advice or shared experiences would mean a lot right now. I'm exhausted and frustrated and honestly starting to feel like they're just hoping I'll give up.

14replies

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14 replies

  • 18
    brave-beaver-220

    Oh man, I went through almost the exact same thing after my accident two years ago. They pulled the 'pre-existing degeneration' card on me too. What actually helped was my spine specialist writing a very specific letter explaining that while some wear existed, the crash was what turned it from a silent, asymptomatic condition into something requiring intervention. The phrase 'aggravation of a pre-existing condition' is actually a real legal concept that works in your favor — don't let them spin it like it cancels out your claim.

    • 16
      quick-crow-566

      They do this constantly. It's basically a standard playbook move — pull the MRI, find anything they can label 'degenerative,' and use it to lowball or deny. The fact that you were totally functional before the crash is HUGE and you need to document that as thoroughly as possible. Old medical records showing no complaints, statements from your employer about your work attendance, even stuff like your soccer coaching — all of it builds the picture of who you were before vs. after.

  • 18
    clever-elk-974

    I'm so sorry you're dealing with this on top of everything else. It already sounds incredibly painful and exhausting just from a health standpoint, and then having to fight for basic acknowledgment that the crash hurt you... that's a lot. Please don't go through this alone — even just talking to someone who knows this process could take some of the weight off.

  • 17
    spry-crane-105

    The terminology to look up is 'eggshell plaintiff' or 'thin skull rule' — basically the legal idea that the at-fault party has to take you as they found you, pre-existing conditions and all. If the crash made a dormant condition suddenly debilitating, that's on them. Your doctor's aggravation letter is a start, but you may want that language to be more specific: dates, functional status before the crash, and a clear medical opinion linking the trauma to the need for surgery. A lot of attorneys will review what you have for free before you commit to anything.

    • 10
      calm-walker178

      Appreciate the detailed write-up. Saving this for later.

  • 16
    careful-kestrel-428

    Not legal advice, but this is a very common defense and it's not a dead end by any means. The legal standard in most states isn't that the accident caused the condition from scratch — it's whether it aggravated or accelerated a condition that was previously not causing you problems. An independent medical expert who can speak to causation is often the key. If your treating physician's letter isn't getting traction, a second specialist opinion specifically addressing the crash as the triggering event can shift things. Worth at least a free consult with a PI attorney to understand your options.

    • 4
      kind-dreamer557

      Curious whether you did this on your own or had help with it.

  • 10
    mellow-hare-704

    Get a lawyer. Seriously. You're already 18 months in, facing surgery, and getting the runaround. This is not a situation where you want to keep negotiating solo against people who do this for a living.

  • 8
    warm-newt-626

    I used to work on the claims side and I'll be straight with you: that degeneration argument is often thrown out there to see if people fold. A lot of people do. What changes the calculation internally is when someone shows up with a consistent medical history, a doctor willing to clearly tie the injury to the crash, and — especially — an attorney involved. Once there's an attorney, the file gets treated very differently. Not saying that's your only option, but it's worth knowing.

    • 10
      gentle-crane-739

      From a medical standpoint, some degree of disc degeneration showing up on an MRI in your 40s is genuinely normal — like, radiologists basically expect to see it. That doesn't mean it was symptomatic or causing you any problems before. There's a real difference between a 'finding' on imaging and an actual injury. Make sure your surgeon is documenting not just what they see on the images, but your functional history before and after the accident. That before/after story is what matters clinically and, from what I understand, legally too.

    • 5
      calm-driver556

      Really glad you posted an update — gives the rest of us some hope.

  • 8
    kind-finch-399

    Quick question — did you go to the ER or urgent care right after the crash, or did the back pain come on over a few days? I'm not doubting you at all, just wondering because the timeline of when you first sought treatment can apparently be a factor in how these things get evaluated. Did any of your records document that you were pain-free or fully active before the accident?

    • 7
      curious-driver813

      Curious whether you did this on your own or had help with it.

    • 6
      restless-backseat978

      Did the timeline change anything for you? Mine dragged on for weeks.