How to Handle Medical Records Requests in a Personal Injury Claim

Protect your medical privacy when dealing with the insurance company. See how to request medical records for your personal injury claim.

Insurance companies rely on medical records to validate injury claims. No matter if you were in a car accident, slip and fall, or filed for workers’ compensation, at some point in the claim process you’ll have to provide proof of your injuries.

Settlement amounts for car accidents and other liability claims are largely based on your total medical bills.

We show you how to get the medical records and bills you need without sacrificing your medical privacy, whether you request records directly or you’re asked to sign the insurance company’s authorization form.

What to Do When Adjusters Want Your Medical Records

If your injuries are caused by someone else’s negligence, your claim is typically handled by the at-fault party’s insurance company. The insurance company will need medical documentation of your injuries before they’ll consider paying your claim.

Your medical records will not be accessible to the at-fault person’s insurance company without a court order or subpoena, unless you allow it.

There’s no hurry. Wait until you know the extent of your injuries before dealing with the adjuster. You have the right to protect your interests by consulting a personal injury attorney before signing any insurance forms or giving a recorded statement.

Never give an insurance adjuster unlimited access to your medical history.

The insurance adjuster may say you have to sign their release form before they can process your claim. The insurance company does need proof of your injuries, but they are not entitled to medical records unrelated to your current injury claim.

It’s common for “standard” insurance company forms to authorize the adjuster to get all your medical records going back five or ten years. This is so someone at the insurance company can go through your past records on a fishing expedition to find something they can use against you.

Adjusters will use whatever information they can dig up to deny your injury claim or minimize your compensation. For example, they might use your records to say your injury was a pre-existing condition and not related to the accident. Or, if you’ve had past treatment for depression, they’ll minimize the pain and suffering portion of your settlement.

HIPAA protects against the unauthorized release of private medical information. If you sign a blanket authorization to release your medical records, you’ve waived your right to medical privacy.

If you choose to sign an authorization form, be sure the release only covers injury-related treatment from the date of the accident. You can also ask the insurance company to send you free copies of any medical records they obtain with your authorization.

Independent Medical Examinations

Your right to medical privacy can be limited when it comes to injury claims with your own insurance company or a workers’ compensation claim.

That doesn’t mean they’re entitled to your medical history prior to the accident. Talk to an attorney if your own insurance company is fighting your injury claim.

Most no-fault and worker’s comp insurance policies have a cooperation clause stating that for them to insure you against injuries, you must submit to an Independent Medical Exam (IME) if they deem it necessary. If you refuse, they may have the right to deny your claim.

Insurance companies normally request an IME when they want to challenge the nature and extent of your injuries or the necessity of ongoing medical treatment. IME doctors work for the insurance company and will not give you medical advice or treatment.

Because you signed the policy with the IME clause, the insurance company has a right to the medical records from your IME, and they are not obligated to share them with you.

Medical Records and Litigation

Severe and potentially permanent injuries are high-dollar insurance claims. Insurance companies often won’t pay fair compensation until a lawsuit is filed and they realize your attorney means business.

The insurance company is allowed to request your medical records without your written permission so long as they have a court order or a subpoena.

Court orders are signed by a judge. In a highly contentious lawsuit, the insurance company lawyer might ask the judge to sign an order seeking specific records or even for an IME. Your attorney will make sure the order isn’t asking for more than strictly necessary.

Your medical provider must share your protected health information if given a court order. However, the provider should only disclose the information specifically described in the order.

Subpoenas are issued by someone other than a judge, such as a court clerk or attorney. In most cases, the insurance company’s attorney will issue a subpoena requesting your injury records.

Before your medical provider can release your records under subpoena, the provider is supposed to verify that you were notified of the subpoena, so you or your attorney can:

  1. Object to the disclosure of your records
  2. Seek a protective order from the court

Most personal injury attorneys offer a free consultation, so it costs nothing to get a case evaluation and some basic legal advice. There’s no need to handle an injury claim on your own. Get help when the adjuster is pressuring you to sign away your right to medical privacy.

How to Request Your Own Medical Records

Rather than authorizing the insurance company or your personal injury lawyer to gather your medical records, you might decide to request them on your own. After you’ve gathered all the relevant records and bills, you can forward copies to the insurance adjuster.

Requesting your records isn’t complicated, but it can take some time. Most hospitals and medical care providers have HIPAA-compliant forms they’ll ask you to fill out before releasing your records. If not, you can use this downloadable Medical Records Request Letter.

Requests for copies of your medical records must be made in writing and by you personally, or by your representative. If you’re represented by an attorney, your attorney will request your injury records and deal with the insurance company.

If you decide to handle your own injury claim, be sure to gather complete billing for all your treatment in addition to your medical and pharmacy records, even if your health insurance paid some or all of your medical costs.

You will have to send a separate records request to each of your medical care providers. Make it easy to keep track of your requests with this Medical Records Request Tracking Log.

Your Medical Privacy Rights Under HIPAA

The federal Health Insurance Portability and Accountability Act (HIPAA) provides protection for personal health information, including your medical and mental health records. HIPAA ensures your right to privacy, limiting who can access and receive your private information. It also protects your right to get copies of your medical records.

Under HIPAA you’re allowed to request medical records for:

  • Yourself
  • Your child, so long as you are the custodial parent or legal guardian
  • Another adult, such as a parent, if you are the person’s legal representative
  • A deceased person, if you are legally appointed to represent their estate

If you’re seeking health information or records other than your own, the medical provider will ask for proof of your legal authority to request the information. For example, you might have a Power of Attorney from your spouse or parent, giving you the right to conduct their affairs.

Information the Doctor May Withhold

While you have a right to access certain medical records, that right can be limited. HIPAA permits medical providers to exercise their discretion to prevent harm.

Doctors don’t have to release records that include:

  • Personal notes intended to be the doctor’s work product, such as personal impressions, messages to other doctors and staff, and notes not directly related to your medical treatment
  • Psychotherapy notes taken by a mental health professional
  • Information you may have told the doctors you never want to be disclosed
  • Information the doctor believes should not be disclosed regarding the treatment of a minor
  • Information the doctor believes may cause substantial harm to you or others
  • Information the doctor believes will unnecessarily result in public panic or riots
  • Information your doctor obtained from other doctors

State Laws for Medical Records

While protecting your right to privacy, HIPAA allows each state to regulate how you can access your medical records. Some of those regulations include:

  • Charging fees for processing and copying your records
  • The time frame your medical provider has to release your records
  • Limiting you to reviewing records in your medical provider’s office
  • How long a medical provider must store your records

Each state also has mandatory reporting laws that supersede your right to privacy. Most states have laws requiring medical care providers to report:

  • Births
  • Deaths
  • Suspected child abuse
  • Dog bites
  • Communicable diseases

While sensitive medical information may be reported to state agencies, personally identifiable information is not usually accessible to the general public.

Personal Injury Medical Records Questions

Charles R. Gueli, Esq. is a personal injury attorney with over 20 years of legal experience. He’s admitted to the NY State Bar, and been named a Super Lawyer for the NY Metro area, an exclusive honor awarded to the top five percent of attorneys. Charles has worked extensively in the areas of auto accidents,... Read More >>