Pedestrian cases rarely start with a blank slate. Most clients carry medical histories that include something relevant: an old knee tear from college soccer, a back strain from warehouse work, migraines that ebb and flow, diabetes, or simply the wear and tear of age. When a car strikes a pedestrian, those histories do not vanish. They become part of the case, and how they are handled often determines whether an insurer pays fairly or looks for ways to diminish the claim. A seasoned pedestrian accident lawyer treats pre-existing conditions not as liabilities to hide, but as facts to contextualize, measure, and, when the evidence supports it, connect to new harm or measurable aggravation.
This is the work behind the scenes that most people never see. It starts on day one, sometimes in the first hour, and it influences everything that follows: intake, medical care, the narrative presented to adjusters and, if needed, a jury.
Why pre-existing conditions loom large in pedestrian cases
When a car meets a person, the human body loses. The physics alone explain why latent issues often surface. A body that has already endured injury or degeneration is more vulnerable to forces that a younger or healthier person might tolerate. Insurers understand this, and they often try to flip vulnerability into an argument for paying less. They lean on phrases like “pre-existing,” “degenerative,” or “chronic,” hoping to create doubt about causation and the extent of damages.
The law typically draws two lines that matter. First, a defendant takes a plaintiff as they find them, the eggshell plaintiff rule. If the collision worsens a pre-existing condition, even if only by inches, the defendant can be responsible for the aggravation. Second, the plaintiff still bears the burden to prove what the crash caused or made worse, https://daltonvpzt711.lucialpiazzale.com/when-should-you-settle-vs-going-to-trial-for-your-car-injury-case and by how much. That proof does not come from adjectives, it comes from records, imaging, clinical notes, and careful testimony that separates past from present.
In practice, that means a pedestrian accident attorney is playing a game of measurement. How did the client feel and function before? How do they feel and function now? What changed in imaging, range of motion, work status, daily living, and pain levels? The tighter those comparisons, the harder it is for an insurer to dismiss the aggravation as “just the same old problem.”
Intake that looks backward and forward
A thorough intake is not a five-minute questionnaire. I want a timeline, and I want to hear it in the client’s own words. People remember episodes, jobs, surgeries, the time they stopped running because the ankle kept swelling, the short course of PT that helped until it didn’t. They often downplay symptoms too, especially active people who normalize pain as part of life. It takes patient questioning to pull out details, and those details often become the scaffolding of the case.
I ask about prior injuries head to toe, not just the body part that hurts today. Head injuries, migraines, concussions, learning differences, and mental health history matter if there is a suspected mild traumatic brain injury. Low back pain history matters when a pedestrian is thrown onto a curb. Carpal tunnel or shoulder impingement can be aggravated when someone braces for impact. With each issue I map onset, treatment, resolution or plateau, any gaps in care, and objective studies like X-rays or MRIs.
Then I establish a pre-accident baseline: what they could lift, how long they could stand, whether they used stairs without stopping, what sports or hobbies they enjoyed, what medication they took daily or as needed, and how often. A baseline built from specifics, not broad claims of “I was fine,” stands up better in negotiations and at trial.
The first medical moves after the collision
Medical care after a pedestrian crash often starts in the emergency department. The initial imaging might show “degenerative changes,” which are common and unhelpfully nonspecific. Degeneration can be present for years without symptoms. The task is to separate what is new from what was old.
If the hospital sends the client home with discharge paperwork, an attorney should push for timely follow-ups with primary care and appropriate specialists. The cadence of care matters for both health and credibility. Gaps in treatment create room for insurers to argue that symptoms were mild or unrelated. That does not mean over-treating, it means reasonable care that tracks with the injury pattern.
For a client with a prior back issue, I’ll press for both comparative imaging and careful examination. If there are prior MRIs, they are gold. If not, I’ll look for old X-rays, PT evaluations, or even chiropractic notes. Comparative imaging that shows new disc protrusion, annular tear, or worsened stenosis after the crash can be decisive. When imaging looks similar, objective functional changes can still carry the argument: new radicular symptoms, loss of reflexes, positive straight leg raise, or decreased grip strength.
With head injuries, I watch for subtle signs that family and coworkers notice first: personality shifts, irritability, forgetting appointments, difficulty multitasking. Concussions often leave no structural fingerprint on CT or MRI, so the case hinges on careful documentation and sometimes neuropsychological testing. Prior anxiety, depression, or ADHD does not wash out the claim, but it must be acknowledged and accounted for so the defense cannot paint it as the whole story.
Building the narrative without hiding the past
A client with a prior knee surgery can still prove that a crosswalk impact caused a meniscus tear or exacerbated osteoarthritis to the point of needing a total knee replacement earlier than expected. The key is to avoid the temptation to minimize the old problems. Juries punish evasiveness. Adjusters seize on omissions. I prefer to front-load the history, then show the inflection point.
Anecdotes carry weight when they are specific. A retired postal worker might say she used to walk three miles every morning, pain reaching a two out of ten by the end, then the crash turned it into a seven by the first block. A mechanic who managed periodic flare-ups with ibuprofen might suddenly need prescription medication and miss two months of work. Those changes become quantifiable damages: wage loss, medical bills, and loss of enjoyment that a jury can understand.
Quantification sometimes requires creative but honest tools. Pain journals, calendars marked with missed events, text messages to family about sleepless nights, and activity tracker data showing steps and heart rate dips can corroborate. When clients can show a before and after in their own lives, it complements the medical evidence.
The defense playbook and how to answer it
There are patterns to how insurers and defense lawyers handle pre-existing conditions. They blame degeneration. They hire radiologists to call everything “age appropriate.” They search for gaps in care to argue that symptoms are intermittent and mild. They point to prior treatment as evidence that nothing changed. These tactics are predictable, which is helpful, because preparation beats surprise.
A pedestrian accident attorney anticipates these angles and counters them with a few steady moves: obtaining pre- and post-accident records, retaining experts who will actually examine the client, and framing aggravation as a measurable delta rather than a guess. When adjusters say the MRI looks the same, I point to new clinical findings and the change in functional capacity. When they say the plaintiff had neck pain before, I agree and explain that the plaintiff went from monthly tension headaches to daily cervical radiculopathy with numbness in the fingers. Precision is a better weapon than indignation.
An example from practice: a client with chronic low back pain had an MRI two years before being hit while crossing a driveway. The old MRI showed mild L4-L5 bulging without nerve compression. The post-crash MRI showed a focal protrusion contacting the L5 nerve root, consistent with new foot drop. The defense radiologist tried to dismiss it as “progression of degeneration.” Our treating neurosurgeon testified that foot drop does not materialize from mild bulging absent a precipitating event, and that the clinical exam aligned with the imaging. The jury accepted aggravation and funded a decompression surgery.
Eggs, skulls, and real bodies
The eggshell plaintiff rule is often misunderstood. It does not inflate damages beyond what the crash caused. It simply prevents a defendant from escaping responsibility because the plaintiff was susceptible to injury. In pedestrian cases, this rule can matter a lot. A person on blood thinners might have a bleed from a relatively modest impact. A person with osteoporosis may fracture where others would only bruise. The defendant does not get a discount because the victim was fragile.
The flip side is candor. The jury needs to hear that susceptibility existed, and that the medical science supports the link between fragility and outcome. A good plaintiff’s case does not shy away from that reality. It leans into it with evidence and trusted experts who can explain in plain language how bodies respond to trauma.
Causation, aggravation, and apportionment
In many states, juries can apportion damages between pre-existing conditions and crash-related aggravations. That can feel threatening to a plaintiff, but when framed correctly, apportionment often helps anchor the discussion in fairness. If a client had baseline back pain at a two out of ten that limited heavy lifting, and the crash pushed it to a daily six with new radiculopathy, there is a real allocation to be made. Experts can opine that a percentage of the impairment is due to the crash, supported by timeframe, new diagnostics, and clinical findings.
Vocational experts can add dimension here. If the client was able to work full time in a physically demanding job before, and now cannot stand more than 20 minutes or lift more than 10 pounds, the economic impact is not theoretical. If the client had already shifted to lighter work before the collision, that too matters. Apportionment done honestly avoids the trap of asking a jury to award for old problems, which undermines credibility.
The missing records problem
People move, clinics close, and records vanish. That does not end the analysis, but it changes the approach. When prior imaging cannot be recovered, I rely more heavily on testimony from the client and those around them, and on objective testing after the crash. Functional capacity evaluations can quantify lifting, reaching, and endurance. Balance testing and vestibular assessments can confirm concussion-related deficits. Advanced imaging like diffusion tensor imaging has limited legal acceptance in some jurisdictions, so I use it cautiously, favoring mainstream studies and clinical correlation.
I also look for collateral documentation. Insurance explanation of benefits, pharmacy records showing long-term prescriptions, or employer wellness physicals sometimes fill gaps. Digital breadcrumbs can be surprisingly useful. Fitness app histories and sports league participation records show activity levels pre-accident. These are not substitutes for medical records, but they are credible pieces that strengthen the mosaic.
The treating physician’s voice
Jurors trust treating providers more than retained experts, but treaters do not naturally document for litigation. They chart for care. Encouraging clear, neutral, and thorough notes helps everyone. I never ask a doctor to change an opinion, only to be specific where generalities can be misread. If a PCP writes “neck pain - chronic,” I might ask whether the pain increased after the collision and by how much, or whether radicular symptoms were new. When a surgeon explains why surgery became necessary post-crash despite prior conservative care, that narrative has force.
Sometimes I request a narrative report that walks through history, exam, imaging, diagnosis, treatment, and prognosis with apportionment where appropriate. A two-page factual letter from a well-respected orthopedist has more persuasive power than a 40-page boilerplate IME. The goal is clarity, not volume.
Settlement dynamics when the past is crowded
Pre-existing conditions affect value in both directions. They create arguments for the defense, but they also increase the plausibility of serious harm from what might look like a moderate impact. Adjusters know juries are skeptical of low-speed collisions causing major injuries for otherwise healthy adults. In pedestrian cases, the physics neutralize some of that skepticism. Even a slow car can impart enough force to topple a person awkwardly onto asphalt or a curb. If a client’s medical history shows a vulnerable spot that was asymptomatic or well-managed before and unleashed after, the damages picture can command a higher number than the defense expects.
Negotiations rarely move on rhetoric. They move when the file is trial-ready: comparative imaging lined up, prior records distilled into a baseline, treating providers prepared to testify with specificity, and damages tied to concrete life changes. When that foundation exists, insurers recognize risk. If they do not, presenting this kind of case to a jury is less about selling sympathy and more about walking through an orderly set of facts that make sense.
When the client waited to get care
Delays happen for real reasons. People hope pain will fade. They cannot afford copays. They are caregivers for children or parents and put themselves last. Defense lawyers will still argue that a gap in treatment breaks the causal chain. The best answer is documentation. If a client self-treated with ice and over-the-counter meds, say so. If they called a clinic and could not be seen for three weeks, get the phone logs or appointment emails. If work demands prevented daytime appointments, show the employer schedule. Context converts a “gap” into a reasonable human story.
I also remind clients that honesty about delay beats a contorted explanation. Juries forgive the human impulse to wait and see, especially when the symptoms worsen or persist in a way that makes the eventual care sensible.
Pre-accident waivers and releases
Sometimes there are releases from prior settlements, like a previous car crash years earlier. Those documents must be read closely to see what they encompass. A release for a specific incident and specific body parts usually does not bar a new claim for a new aggravation. But if an old case settled with a global release that includes unknown claims, the defense will argue that the plaintiff waived future issues. Courts vary in how they interpret such releases. The safest course is to obtain the full file and, if needed, consult coverage counsel to map out the risk.
The role of surveillance and social media
Cases with pre-existing conditions are magnets for surveillance. Insurers hope to catch a client doing something they claimed they could not do. The footage rarely tells a complete story, but it can damage credibility if testimony is absolute. I advise clients to be accurate and measured. If they can sometimes carry groceries for a few minutes, they should say so. If they pay for it later with pain or numbness, that belongs in the description. Absolutes invite ambush. Nuance is harder to impeach.
Social media tells a similar story. Photos and posts that project normalcy can conflict with claims of disability, even if they reflect one good day among many bad ones. Tight privacy settings help, but the safest approach is to avoid posting about activities, symptoms, or the case while the claim is pending. Defense subpoenas for social content are common, and courts often allow discovery of relevant materials.
Working with a pedestrian accident attorney early
The earlier a pedestrian accident attorney gets involved, the better the record will be. Aligning care, collecting prior records before they disappear, and setting the tone with insurers can prevent missteps that are hard to fix later. An experienced pedestrian accident lawyer has lived through the patterns and knows which details matter more than others, when to escalate to specialists, and how to speak the language of adjusters and jurors without overselling.
For clients, the best step is openness. Share the full history, even the parts that feel embarrassing or minor. A problem seen early is a problem managed. Surprises in litigation are rarely good for plaintiffs.
A brief roadmap for clients with pre-existing conditions
- Tell your attorney about every relevant prior injury or condition, no matter how old it seems. Seek timely medical evaluation after the crash and follow reasonable treatment plans. Gather pre-accident records and any objective indicators of your prior function. Be precise in describing changes since the collision, avoiding absolutes. Assume insurance may conduct surveillance and act accordingly.
Edge cases that demand special handling
Some cases sit on the fringes of typical patterns and demand extra care. A client with a long history of fibromyalgia or chronic fatigue may report a dramatic symptom flare after a crash. Objective tests are limited, so the case leans heavily on treating providers and functional descriptions. Another client with a prior fusion might suffer adjacent segment disease after an impact. Distinguishing natural progression from trauma-induced acceleration requires a spine surgeon willing to engage the literature and the facts.
There are also cases where the accident reveals, rather than causes, a condition. A pedestrian struck in a crosswalk gets imaging that discovers a previously unknown tumor or congenital abnormality. Ethically, that information must be shared with the client and, where relevant, with the defense. The claim then narrows to what the trauma did, not what the scan discovered. Credibility again becomes the anchor.
Trial presentation when history is complicated
At trial, the structure matters. I like to start with the plaintiff’s baseline through the words of friends, family, and coworkers. They put flesh on the bones of the medical record. Then I move to the event, the immediate aftermath, and the arc of care. Only after jurors understand who the plaintiff was and what the crash did do I walk them back to the prior history, openly and without defensiveness. That sequence avoids the impression that we are hiding the ball and frames prior conditions as ordinary human background.
Experts follow, each with a defined role: a treating physician to explain diagnosis and causation, perhaps a radiologist who can compare images side by side, a physical medicine specialist for function, and a vocational economist for losses. The aim is clarity. If a juror can explain the case in a few sentences at dinner, we have done our job.
The bottom line
Pre-existing conditions are not a trap for the unwary so much as a test of discipline. A pedestrian accident attorney who respects the medical nuance, insists on specificity, and embraces the client’s real history can turn a defense talking point into a compelling, well-supported claim. The work is meticulous. It asks for patience and straight talk from clients and providers alike. Done well, it honors the law’s core requirement: prove what changed, and why the change matters.
The measure of success is not whether the file looks clean. It rarely will. The measure is whether the story the evidence tells feels true to ordinary people who know that bodies carry old scars, and that new harm still counts.