{"id":100147,"date":"2026-07-13T08:43:30","date_gmt":"2026-07-13T06:43:30","guid":{"rendered":"https:\/\/ru.law\/?p=100147"},"modified":"2026-07-10T09:20:19","modified_gmt":"2026-07-10T07:20:19","slug":"bandscheibenvorfall-unfallversicherung-kausalitaet","status":"publish","type":"post","link":"https:\/\/ru.law\/en\/bandscheibenvorfall-unfallversicherung-kausalitaet\/","title":{"rendered":"Intervertebral disc, shoulder, knee \u2013 the dispute over causality after the accident"},"content":{"rendered":"

Why the accident insurance company argues that these injuries are due to pre-existing conditions and how you can prove the connection to the accident.<\/strong><\/h2>\n\n\n\n

Is your accident insurance refusing to pay out because a herniated disc, shoulder, or knee injury is allegedly due to pre-existing conditions or wear and tear? Insurers frequently dispute the connection to the accident in precisely these types of injuries. Crucially, the correct proof of causality and complete documentation are essential. Rogert & Ulbrich will review the denial and enforce your claims against the insurer.<\/p>\n\n\n\n

Why the insurer argues with pre-existing damage in cases of herniated disc, shoulder and knee<\/strong><\/h2>\n\n\n\n

Intervertebral discs, shoulders, and knees are body parts that are subject to natural wear and tear over the course of a lifetime. Insurers exploit this fact. They attribute injuries not to accidents, but to age-related or degenerative changes, and reject disability benefits. Disputes over causality are therefore among the most frequent reasons for a claim. Rejection of benefits by the insurer<\/a>.<\/p>\n\n\n\n

From his previous work on the insurance company side, lawyer Dario Kovac is familiar with these patterns of argumentation. Often, an expert opinion describing degenerative changes is sufficient for the insurer to downplay the accident as the cause. Whether this argument holds water depends on the medical findings and the documentation of the accident.<\/p>\n\n\n\n

Anyone who can establish a clear and early connection to the accident undermines this strategy. Therefore, every finding and every timely examination is crucial.<\/p>\n\n\n\n

Is the insurer citing pre-existing damage or wear and tear? Have the findings checked to see if they actually support this claim before you accept the rejection.<\/p>\n\n\n\n

Exclusion of disc herniation and the predominant cause<\/strong><\/h2>\n\n\n\n

Many accident insurance policies contain a special clause regarding herniated discs. According to this clause, damage to the intervertebral discs is generally excluded from coverage. Coverage only applies if an accident is the predominant cause of the damage.<\/p>\n\n\n\n

This regulation is strict. It works differently than a simple deduction: If the accident is not the predominant cause, the benefit for the herniated disc is completely forfeited. It is therefore not enough that the accident made some contribution. It must be the decisive cause, which becomes the central point of contention, especially in cases of pre-existing conditions.<\/p>\n\n\n\n

Whether and how this clause is worded in your contract depends solely on your insurance terms and conditions. The wording determines the requirements the proof must meet.<\/p>\n\n\n\n

Is the insurer citing the exclusion for herniated discs? Have it checked whether the accident was not in fact the predominant cause.<\/p>\n\n\n\n

Causality in shoulder and knee: trauma or degeneration?<\/strong><\/h2>\n\n\n\n

Shoulder and knee injuries usually don't have a specific exclusion clause like those for herniated discs. The debate here revolves around whether the injury was caused by the accident or whether pre-existing wear and tear is the determining factor. Typical examples include rotator cuff tears in the shoulder or meniscus and cruciate ligament damage in the knee.<\/p>\n\n\n\n

Two points are crucial for proving a traumatic injury. First, the mechanism of the accident: the event must have been capable of causing the specific injury. Second, the imaging findings: fresh signs of injury, such as hemorrhages or associated bone fractures, suggest a traumatic injury, while purely degenerative findings tend to argue against an accident.<\/p>\n\n\n\n

A careful distinction between traumatic and degenerative findings is therefore at the heart of every discussion. It often determines the entire claim.<\/p>\n\n\n\n

Does your insurer consider your shoulder or knee injury to be purely due to wear and tear? Have the accident mechanism and findings professionally assessed.<\/p>\n\n\n\n

Participation or exclusion \u2013 two different mechanisms<\/strong><\/h2>\n\n\n\n

Pre-existing damage can manifest itself in two very different ways, which are often confused:<\/p>\n\n\n\n