If you are impacted by pre-existing illnesses and health conditions prior to your motor vehicle accident, it’s crucial to understand how these conditions might affect your insurance claim. Here’s a detailed exploration of the implications:
Case Study: An Ontario Woman’s Struggle
An Ontario woman was severely injured in a motor vehicle accident. The impact of the accident was devastating, leading to severe and increasing pain in her neck. Despite undergoing two spinal decompression surgeries, her condition did not improve. Tragically, she became an incomplete quadriplegic a few years later, significantly altering the course of her life.
The Challenges Faced
The woman faced immense physical pain and suffering due to the accident. Her life was dramatically changed, and she required constant medical attention and support. However, her struggles were compounded when she discovered that her insurance company refused to make any benefits payments. This refusal added financial stress to her already overwhelming situation.
Pre-existing Conditions and Insurance Claims
The woman had a pre-existing degenerative spinal condition, which made her more susceptible to spinal injuries. The insurance company argued that her injuries were inevitable due to this pre-existing condition, even if the motor vehicle accident had not occurred. They invoked the “crumbling skull theory,” which posits that a defendant is not liable for the debilitating effects of a pre-existing condition that the plaintiff would have experienced regardless of the accident.
The “Crumbling Skull Theory” and Its Limitations
The “crumbling skull theory” is often used by insurance companies to minimize their liability. According to this theory, if a plaintiff’s condition was bound to deteriorate over time, the defendant (or in this case, the insurance company) is not responsible for that natural progression. The insurer argued that the woman’s eventual quadriplegia was a result of her degenerative condition, not the accident, thereby attempting to avoid paying benefits.
Legal Victory for Claimants
Fortunately for claimants, the Ontario Court of Appeal (ONCA) ruled that the “crumbling skull theory” does not apply to insurance benefits claims under the Statutory Accident Benefits Schedule (SABS), a regulation under the Insurance Act. This ruling was a significant victory for individuals with pre-existing conditions, ensuring they can still be entitled to insurance benefits even if they had underlying health issues before the accident.
The Importance of Legal Representation
In light of such challenges, it is crucial to retain experienced personal injury lawyers who are well-versed in insurance law and understand your rights. Insurers will often attempt to leverage pre-existing conditions to deny or reduce claims. A knowledgeable lawyer can effectively counter these arguments, ensuring that you receive the benefits to which you are entitled.
If you have a pre-existing illness or condition and are involved in a motor vehicle accident, do not be discouraged by potential resistance from your insurance company. Legal precedents protect your right to benefits, and with the right legal support, you can navigate the complexities of your claim successfully. It’s essential to seek professional legal advice to ensure your rights are protected and to secure the compensation you deserve.
