If you already had a bad back, an old knee injury, or a health condition before your car accident, you may be worried that it will be used against you. Many people in that position assume the insurer will simply say their problems are nothing to do with the accident, and that having a prior condition means they cannot claim. It is a common fear, and insurers do raise pre existing conditions often, but the assumption behind it is usually wrong.
The law does not require you to have been in perfect health before your accident. What matters is what the accident did to you. If a crash caused a new injury, or made an existing condition worse, that is something you can claim for, and a pre existing condition is far more often a point to be addressed with evidence than a reason your claim fails.
This guide explains how a pre existing condition interacts with a CTP claim, why insurers raise it, and what actually decides the question. Please treat it as general information rather than advice about your own claim, and you should seek legal advice about your particular situation before making decisions about it.
Can you still make a CTP claim with a pre existing condition?
Yes. Having a condition you already had does not shut you out of the CTP scheme, which operates under the Motor Accident Injuries Act 2017 (NSW), regulated by the State Insurance Regulatory Authority, known as SIRA. The scheme compensates injury caused by a motor accident, and that includes not only brand new injuries but also the aggravation or worsening of something that was already there.
The key idea is that you are entitled to be compensated for the effect the accident had on you, not for the pre existing condition itself. If your accident took a condition that was stable, or not troubling you, and made it symptomatic or materially worse, that aggravation is an injury the scheme recognises. You do not have to show your body was perfect before the crash. You have to show what the crash changed.
Aggravation: what the accident did is what you claim
This distinction, between the condition you already had and the effect of the accident, is the heart of the whole issue.
Take someone with some existing wear in their spine that never caused them trouble, who is then injured in a collision and develops persistent back pain and limited movement. The wear was there before, but the pain and the limitation are the product of the accident. That aggravation is what the claim is about. The same applies to psychological conditions, old injuries and chronic illnesses. The question is always the difference the accident made.
This is why the way your injury is described matters so much. A claim framed as simply a continuation of an old problem invites the insurer to say the accident did nothing. A claim that clearly identifies what changed after the accident is on much stronger ground.
Why insurers raise pre existing conditions
Understanding how insurers use a pre existing condition tells you where to focus. It generally comes up in one of a few ways, and each is answered differently.
| The insurer may argue | What actually matters |
|---|---|
| Your symptoms are from your existing condition, not the accident | Whether the accident caused or aggravated your injury |
| Your scan shows pre existing changes | Whether you were functioning before the accident and are not now |
| Part of your impairment is unrelated to the accident | The impairment the accident actually caused, once any unrelated part is separated out |
| You would have had these problems anyway | The real difference the accident made to your condition and your capacity |
The common thread is an attempt to attribute your current situation to the past rather than the accident. Sometimes that is fair, and part of a problem genuinely does pre date the crash. Often it is not, and the argument does not survive a proper look at the evidence.
The key question: what did the accident cause?
Everything comes down to causation, which simply means what the accident actually caused. The accident does not have to be the only cause of your condition for you to have a claim. If it caused or materially contributed to your injury, or to the worsening of an existing one, that contribution is compensable.
The most powerful evidence on this question is usually the contrast between your life before and after the accident. If you were working, active and managing without difficulty beforehand, and you are not now, that difference speaks directly to what the accident did, whatever a scan might show about underlying wear. A scan finding of pre existing change is not the same as a finding that the change was what stopped you. Plenty of people have such findings and full function until something tips them over.
How a pre existing condition affects impairment and damages
A pre existing condition can affect two particular parts of a claim, and it helps to know how.
The first is the assessment of your whole person impairment, the percentage used for the pain and suffering threshold. When your impairment is assessed, the aim is to measure the impairment caused by the accident, which means any impairment genuinely attributable to a pre existing condition can be separated out. That apportionment can matter, because the pain and suffering threshold requires impairment greater than 10 per cent, so how much of your impairment is credited to the accident can be decisive. We explain that threshold in our guide on pain and suffering compensation, and the assessment itself in our guide on CTP medical assessments.
The second is a common law damages claim, and here a long standing legal principle works in the injured person’s favour. The law takes a person as it finds them, which means that if you were more vulnerable to injury because of a pre existing condition, the driver at fault is still responsible for the harm caused by aggravating it. Being more susceptible to injury does not reduce another person’s responsibility for causing it. Damages are still measured by the effect of the accident, but a pre existing vulnerability is not a defence to having caused real harm.
The evidence that answers a pre existing condition argument
Because these disputes turn on evidence, the response is built from evidence rather than assertion. The material that tends to make the difference includes a clear picture of your health and function before the accident, such as records showing you were working, active and not troubled by the condition, and evidence of the change since. A report from your treating doctor that directly addresses causation, explaining what the accident caused or aggravated as distinct from the pre existing condition, is particularly valuable, far more so than one that simply lists your diagnoses. Imaging and clinical findings, and a consistent treatment history, help complete the picture.
The aim of all of this is to isolate what the accident did, and to show it clearly, so that the insurer cannot fold your accident injury back into your history and dismiss it.
Should you disclose a pre existing condition?
Yes. It is important to be upfront about any relevant pre existing condition. Trying to hide it does far more harm than good, because when it emerges later, and it usually does, through your medical records, it damages your credibility and hands the insurer an argument. Disclosing a pre existing condition does not defeat your claim, because the claim is about what the accident did, not about whether you were previously in perfect health. Honesty, combined with clear evidence of the effect of the accident, is a far stronger position than concealment.
How Stephen Young Lawyers can help
A pre existing condition is one of the most common reasons a CTP claim is contested, and one of the most manageable with the right approach. The difficulty is that separating the effect of the accident from an underlying condition is genuinely technical work, turning on causation, on the way impairment is assessed, and on the quality of the medical evidence.
An experienced personal injury lawyer identifies exactly what the accident caused or aggravated, gathers the evidence of your pre accident function and the change since, briefs your treating doctors so their reports address causation directly, and challenges an insurer that wrongly attributes your injury to your history. Where impairment is apportioned or a damages claim is in issue, this is exactly the kind of situation where careful handling changes the outcome.
For more, see our guides on threshold and non threshold injuries, on pain and suffering compensation and the 10 per cent threshold, and on CTP medical assessments. You can read about your broader options on our motor vehicle accident claims page. As an Accredited Specialist personal injury firm based in Sydney CBD, with a multilingual team and a No Win No Fee approach for eligible matters, we can review your situation and tell you where you stand.
No lawyer can promise you a particular outcome, and every claim turns on its own medical evidence. What can be said is that a pre existing condition rarely ends a claim on its own, and that the law has never required you to have been uninjured before your accident to be compensated for what it did to you.
Speak with an experienced motor accident lawyer today
If a CTP insurer has suggested your injury is really down to a condition you already had, anywhere in New South Wales, do not assume that is the end of your claim. It is worth having the question looked at properly.
Contact Stephen Young Lawyers today for a free, no obligation consultation. Call us or get in touch through our website to speak with an experienced personal injury lawyer about your injury and your options.