I tattooed a simple line-work flower on a client’s chest, technique perfect, depth controlled. Six months later, she came back with a lawyer and a massive, raised keloid scar that distorted the entire piece and itch like crazy. She sued me for “disfigurement” and requested $25,000 for plastic surgery to excise the scar tissue. I pulled her intake form, hoping she checked the “History of Keloids” box—she hadn’t.
Key Takeaways
- The “Susceptibility” Defense: You are generally not liable for a client’s genetic predisposition to scarring if you did your job correctly and screened them.
- The Intake Form is Your Shield: If your waiver asks “Do you keloid?” and they say “No,” you have a strong defense against negligence claims. If you didn’t ask, you might be liable for failing to screen.
- Technique vs. Genetics: Insurance adjusters look for “blowouts” (artist error) vs. “proliferation” (genetics). Photos of the fresh tattoo are critical to prove the ink wasn’t blown out initially.
- Settlements Happen: Even if it’s genetics, insurers often settle for the cost of the laser/cortisone injections (
2k−2k−5k) just to close the file.
The “Why” (The Trap): The “Bodily Susceptibility” Factor
In a Bodily Injury claim, the plaintiff must prove you were negligent.
If the injury (keloid) is a result of their own biology, you weren’t negligent—unless you knew (or should have known) they were high-risk and tattooed them anyway.
The trap is the Failure to Warn. If your waiver doesn’t explicitly list “Keloid Scarring” as a risk, the client’s lawyer will argue: “My client didn’t know this could happen, and the professional didn’t warn her.” That failure to warn is the negligence that triggers the payout.
The Investigation: “I Called Them”
I asked claims specialists how they handle keloid cases.
1. The Specialty Adjuster (PPIB)
- The Process: They immediately asked for the signed consent form.
- The Verdict: Because my mock form had a specific checkbox for “Keloid/Hypertrophic Scarring,” they said they would deny the claim and defend me. The client assumed the risk.
2. The General Liability Adjuster
- The Process: They looked at the photos.
- The Verdict: They struggled to tell the difference between a scarred blowout and a keloid. They suggested settling for “Nuisance Value” ($3,000) to avoid a court battle where a jury might sympathize with the disfigured client.
3. The Medical Expert
- The Insight: In 2026, dermatology AI can scan a photo and determine if the scarring pattern matches “mechanical trauma” (your fault) or “biological response” (their fault). Insurers are starting to use this tech.
Comparison Table: Defense Strength
| Documentation | Defense Strength | Likely Outcome |
| Waiver with Keloid Checkbox | High | Claim Denied (You win) |
| Generic Waiver | Medium | Low Settlement |
| No Waiver | Zero | Full Payout (You lose) |
| Fresh Photo (Clean work) | High | Proves genetics, not error |
Step-by-Step Action Plan
- Audit Your Waiver: Open your digital waiver right now. Does it have a specific “Yes/No” question for “History of Keloid Scarring”? If not, add it.
- The Chest/Shoulder Warning: These are high-risk areas. If a client wants a chest piece, verbally ask: “How do you heal from cuts? Do you get raised scars?” Note their answer in the client notes.
- Use High-Res Photos: Take a macro photo of the finished work. If the lines are crisp and not blown out, a keloid forming 3 months later is almost certainly genetic.
- Refuse High-Risk Clients: If they say yes to keloids, refuse the tattoo. “I cannot ethically tattoo you knowing the risk of disfigurement.” If you proceed, you are assuming the liability.
FAQ
Q: Can I tattoo over a keloid?
A: High risk. If it reactivates the keloid and it grows, you are liable for “aggravating a pre-existing condition.”
Q: Does it matter if they have dark skin?
A: Biologically, darker skin types are more prone to keloids. Legally, you must screen everyone equally. Profiling isn’t a defense; asking the medical history question is.
[IMAGE: Comparison diagram: “Blowout” (Ink spread under skin) vs. “Keloid” (Raised tissue over the line).]