How Do Co-Morbidities Impact Your Client’s Personal Injury Case?

One of the primary elements in proving damages in a personal injury case is establishing a direct causal link between the breach of duty (neglect action) and the resulting harm. Clients with co-morbidities (the presence of pre-existing medical conditions) or previous injuries can complicate a personal injury case. It makes it more difficult to prove that the accident caused the injuries and, therefore, difficult to determine the extent of the damages.

At Bridge Point Legal Nurse Consulting, our registered nurses have extensive experience and knowledge in identifying these obstacles and are prepared to help the legal team overcome them by:

1- Assessing which damages are directly attributable to the injury.

2- Evaluate how pre-existing conditions interplay with the new injury affect the client’s prognosis and future medical needs.

3- Determine the extent to which the accident exacerbated the client’s pre-existing conditions or caused new complications.

4- Assist in developing strategies to mitigate arguments by demonstrating the precise impact on the client’s health.

5- Assist the legal team in evaluating how the client’s condition impacts the case’s value by factoring in the client’s pre-existing medical conditions.

Case Study: Defense Case

A 59-year-old female was involved in a significant motor vehicle accident and sustained an L2-3-disc herniation that required multiple lumbar epidural steroid injections and an anterior lumbar interbody fusion (ALIF).

The average recovery time after an ALIF can vary from three to twelve months, depending on the bone healing and the patient’s activities. After eight months of follow-up care (physical therapy and medication), the client continued to have persistent neck pain and neck mobility issues.

The neurosurgeon determined that the client would ultimately need revision surgery due to a failed fusion of the lumbar bones.

Our legal nurse consultants reviewed the medical records and determined that the client was a heavy smoker and had a history of uncontrolled diabetes. Smoking affects bone health by decreasing bone density and causing the bones to become brittle and weak. Diabetes is a chronic metabolic disease with high blood glucose levels. High blood sugar levels cause alterations in the bone remodeling cycle and lead to bone fragility.

It can be argued that the client’s extensive pre-existing conditions contributed to the need for revisionary surgery. Our legal nurse consultant provided the legal team with medical record evidence, which included diagnosis, blood work, causation statements, and hyperlinks within the medical chronology for efficiency. Not only did it help the retaining attorney understand hidden aspects of the case, but it helped ensure that there were no surprises from opposing counsel.

Bridge Point Legal Nurse Consulting offers collaborative expertise and valuable insights into co-morbidities’ effects on personal injury cases.


Al-Bashaireh AM, Haddad LG, Weaver M, Chengguo X, Kelly DL, Yoon S. The Effect of Tobacco Smoking on Bone Mass: An Overview of Pathophysiologic Mechanisms. J Osteoporos. 2018 Dec 2;2018:1206235. doi: 10.1155/2018/1206235. PMID: 30631414; PMCID: PMC6304634.

Charalampidis A, Hejrati N, Ramakonar H, Kalsi PS, Massicotte EM, Fehlings MG. Clinical outcomes and revision rates following four-level anterior cervical discectomy and fusion. Sci Rep. 2022 Mar 29;12(1):5339. doi: 10.1038/s41598-022-09389-1. PMID: 35351960; PMCID: PMC8964822.

Moseley KF. Type 2 diabetes and bone fractures. Curr Opin Endocrinol Diabetes Obes. 2012 Apr;19(2):128-35. doi: 10.1097/MED.0b013e328350a6e1. PMID: 22262002; PMCID: PMC4753802.

Verla T, Xu DS, Davis MJ, Reece EM, Kelly M, Nunez M, Winocour SJ, Ropper AE. Failure in Cervical Spinal Fusion and Current Management Modalities. Semin Plast Surg. 2021 Feb;35(1):10-13. doi: 10.1055/s-0041-1722853. Epub 2021 May 10. PMID: 33994872; PMCID: PMC8110352.

Valerie Creel

Valerie Creel

Valerie Creel is the owner of Bridge Point Legal Nurse Consulting. Valerie has been an RN since 2013 and has extensive experience with Critical Care, having been in ICU for the entirety of her Nursing career. Valerie has worked with Trauma, Neuro, and Medical ICU patients including providing care through the Covid-19 pandemic. In addition to her nursing experience, she worked providing prehospital care in the 911 system of San Mateo County from 2007-2014. She had the opportunity to work with complex trauma and multi-casualty incidents including the Asiana Airline Crash at SFO in 2013. Valerie holds her board certification in Critical Care and earned her Bachelors Degree from Grand Canyon University. She has been working in the legal nursing field since 2021 and has completed her coursework to specialize in Strangulation. She will also complete her Forensic Nurse Certification by the beginning of 2023. In her spare time, she loves spending time with her family and two young daughters and husband. She also enjoys being outdoors, fitness, and cooking.