Legal Question in Personal Injury in Texas
Pre-existing conditions
My wife had an asymptomatic brain tumor. She was rear ended in an automobile accident. She sustained head trauma. She was taken to a hospital, which only x-rayed her neck and back, even though the ambulance report stated that she had a history of cerebral aneurysm. The first five weeks after the accident, she had to be taken repeatedly to a doctor for severe headaches and vomiting. The medical expenses (for MIA's,MRA's,Spineal Taps, etc.) was over $15,000. She also lost a job opportunity. Anyway, the insured womans' insurance refused to pay for these bills or lost wages, because of this "pre-existing condition". They said if a person without an anuerysm had taken this head trauma, the damage wouldn't had been that great. My question is: Is this a legal argument? Can they do this? They only want to pay for the emergency room treatment, and not the pain, suffering, and medical bills incurred after that day.
2 Answers from Attorneys
Thin skull doctrine
There is a wonderful little theory in tort law called the thin skull doctrine, it is on first year tort exam, bar exams andthe multistate. Basically, it holds that a tortfeasor takes his victimas he finds them. Id she has a "thin skull" or a condition out of the they are liable.On a practicle matter, retain counsel, this is not something you will be settle on your own. In addition, you may well have other sources ofcoverage that you are unaware of. Please email me or give me a call ifyou would like to discuss this matter, get a referal or just to mull over.
thin skull rule / causation
Generally one takes his victim as he finds them. If the damage to you was more extensive because your bones break more easily than a normal person's or if you bleed more when injured due to a genetic disorder, I am still charged with responsibility for the damage. There are two issues to contemplate, at least off the top of my head.
First, causation. Were the medical expenses caused by the accident or were they independently caused by the tumor. In other words, are you asking the person who stepped on your foot to treat you for the flu? Second, if the insurance company has no grounds to argue the causation argument, are they acting in bad faith in an attempt to cheat you, knowing that you are not a lawyer and that you might be hoodwinked? If so, there may be other things you can do as well. It is clear to me that you are in way over your head. Keeping people in the industry honest is in part a matter of fear and this should be handled delicately. If they are really wanting to cheat you on purpose, a good lawyer can have them in a bad position before they even know you have a lawyer. You know, they might not even know what they are doing, but you expect that a clear cut rule would be known. It is probably a causation question to the insurance company, but what do you think? I think you need a lawyer.
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