The success of your personal injury claim depends on how much reliable documentation you can provide about your injuries and other losses. Your medical records are crucial to the outcome of your personal injury claim. The insurance company will rely heavily on your medical records when evaluating your claim and making a settlement offer.
It is important to understand that your medical records will be closely scrutinized by the claims adjuster and other insurance company representatives. Without a solid proof of your injuries and associated costs for your settlement demand, you will have no foundation upon which to negotiate a favorable settlement.
While you are being treated for your injuries after an accident, you should ask for medical records from every treating physician and medical care provider. Even if you included up-to-date medical records in your demand letter, you may be asked by a claims adjuster to provide additional medical records. In addition, you might be asked to undergo what is known as an “independent medical examination.”
This page will offer some basic information on dealing with these types of requests from insurance companies. It may not apply to you, and is not a substitute for consulting with an experienced personal injury lawyer. Only a licensed attorney in your area can give you legal advice about your situation.
It is important to note that the insurance adjuster may ask you to sign a release so that he or she can get your medical records directly. This release may be overly broad in scope and duration, giving the insurance adjuster the opportunity to fish and explore your entire life’s medical history. The release should specifically identify the medical provider, the medical conditions of issue, and the time period of records sought, otherwise the insurance adjuster can use the Release to get any of your medical records, even those that are not related to your injuries. It is almost never advisable to do this.
Privacy Laws Applicable to Medical Records
You should know that certain state and federal laws govern how you and other parties can access your medical records. If you have questions about how these laws apply to you, contact a qualified personal injury attorney right away.
The Health Insurance Portability and Accountability Act of 1996 (commonly referred to as “HIPAA”) provides protection for your personal health information. HIPAA guarantees certain privacy protections with respect to your PHI, and limits who can access and receive your private medical information. It also guarantees you the right to obtain copies of your medical records.
In addition to protecting your right to privacy, HIPAA establishes a framework for states to regulate how you can access your medical records. These regulations may include:
- Fees for processing and copying your medical records;
- The amount of time medical providers have to respond to requests for records;
- How and where you can review your medical records (for example, only in your doctor’s office); and
- Other reasonable restrictions on access to your medical records.
Each state has different regulations regarding access to medical records. To learn more about the medical records laws in your state, visit: State Medical Records Laws
One of the most important provisions of HIPAA protects individuals against the unauthorized release of private medical information. You should know that you will no longer be protected from this provision if you sign a “Release of Information” form. When you file a personal injury claim with an insurance company, the insurance company will require you to sign a release.
You should make sure that the release only applies to your current injuries that you sustained in your accident. You should never give an insurance company access to your entire medical history. The insurance company may try to use information about past medical issues to avoid making a fair settlement offer.
To learn more about HIPAA, visit: Understanding Health Information Privacy
Limitations on Access to Medical Records
Your rights to access medical records may be limited. HIPAA permits doctors to withhold certain information from their patients, including:
- Personal notes made by your doctor about your visit intended to be his or her work product. This might include your doctor’s personal impressions, messages to other doctors or medical staff in his or her office, and notes that are not directly related to your medical treatment.
- Information that you told your doctor not to disclose.
- Information regarding the treatment of a minor that your doctor believes should not be disclosed.
- Information your doctor believes may cause substantial harm to you or others.
- Information your doctor believes may cause unnecessary harm to the public.
- Information your doctor obtained from your other doctors. You may have to request this information directly from your other doctors.
Requesting a Copy of Your Medical Records
Do not be intimidated by the laws governing private health information. Requesting a copy of your medical records is usually quite simple. Most health care providers, including doctors’ offices and hospitals, have forms available specifically for this purpose. If not, you can use the sample letter below to make your requests. You should substitute your own information where applicable.
Most care providers require that requests for medical records be made in writing and by you personally. If you are represented by an attorney, your attorney can request your medical records on your behalf. If you are physically or mentally incapacitated, a valid power of attorney may be sufficient to allow another person to request your medical records.
When you make a request for medical records to support your personal injury claim, you must request the full extent of your medical records from every healthcare provider you have seen in the course of your medical treatment. You should obtain every record related to your injuries, your medical treatment, and the cost of your medical treatment.
Sample letter for requesting medical records:
Your mailing address
Your phone number
Your email address
Name of medical provider
Mailing address of medical provider
ATTN: Medical Records Department
RE: Your full name
Your date of birth
Your social security number
Your patient ID number (if applicable)
The date(s) of your treatment
The reason for your treatment
To whom it may concern:
I am making a formal request for the release to me of copies of my complete medical records in your possession. This request is being made pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and applicable Department of Health and Human Services (HHS) regulations. These regulations designate the process of requesting my medical records, and my intention is to fully comply with them.
I am requesting any and all medical records associated with my treatment beginning on [DATE YOUR TREATMENT BEGAN] to [DATE YOUR TREATMENT ENDED or PRESENT]. They should include, but not be limited to:
- Admitting charts and notes about my admission;
- My medical history;
- Notes from treating physicians and nurses;
- Medical narratives;
- Diagnoses and prognoses;
- Any test results and reasons for tests ordered;
- Notes about consultations and/or referrals; and
- All other information related in any way to my treatment.
I understand that you may charge a reasonable fee for the assembly, copying, and mailing of these medical records. I can pay the cost now or when you complete the process of releasing my medical records to me.
Please mail the requested records to me at the address listed above. While I understand that you may require some time to assemble and release my medical records, I expect that you will have them ready within the 30-day period allowed by HIPAA.
If you have any questions, or if the information contained in this letter is unclear in any way, please do not hesitate to contact me.
[YOUR NAME, PRINTED]
If you have any questions about requesting your medical records, or a medical care provider has denied your request for medical records, contact an experienced personal injury lawyer right away.
When a Claims Adjuster Requests an Independent Medical Examination
Sometimes, you and the claims adjuster may disagree about the severity of your injuries. These disagreements usually arise when a personal injury claimant seeks compensation for long-term or permanent injuries that the adjuster does not believe are as serious as the claimant suggests. If you and the claims adjuster cannot reach an agreement about the severity of your injuries during settlement negotiations, the claims adjuster may ask whether you are willing to be examined by a doctor selected by the insurance company, who can provide a second medical opinion about your injuries.
These medical examinations are referred to as “independent medical examinations” by insurance company representatives. Also known as an IME, these types of examinations are anything but independent. The insurance company chooses the doctor who will conduct the investigation, and pays the doctor for his or her services. Many of the doctors who are chosen by insurance companies to conduct IMEs have longstanding relationships with the insurance company and almost never find anything seriously wrong with the insurance claimant.
As you can imagine, submitting to an independent medical examination is usually a bad idea. The good news is that you can typically refuse to submit to an IME, unless you are making a claim with your own automobile insurance policy. Many automobile insurance policies require insureds to undergo these types of examinations. If a claims adjuster asks you if you are willing to submit to an IME, politely decline the request.
It is important to understand that the results of an independent medical examination can be legally kept from you. If you submit to an IME, the insurance company usually reserves the right to deny you access to records pertaining to the examination. If this happens to you, a personal injury lawyer may be able to conduct discovery into these records, but only after filing a personal injury lawsuit.
Bad Faith Insurance Tactics
If you believe that an insurance company is making unnecessary, burdensome, or invasive requests for medical records or information, contact an experienced lawyer right away. The insurance company may be engaged in bad faith insurance tactics, which may give you the right to sue the insurance company. To learn more about bad faith insurance practices, visit: How to Identify/Respond to Bad Faith
Seeking Help from a Personal Injury Lawyer
If you have questions or concerns about obtaining copies of your medical records, a personal injury lawyer can help you understand your rights.
Disclaimer: Information provided on this site is NOT formal legal advice. It is generic legal information. Under no circumstances should the information on this site be relied upon when deciding the proper course of a legal action. Always get a formal case evaluation from a licensed attorney if you think you might have a personal injury lawsuit.