At some point in your personal injury claim, you’ll have to request copies of your medical records. They are the foundation of your claim. Your medical records are the most important evidence you can get to back up your demand for settlement.
Insurance companies rely heavily on your records and other documentation. Before deciding what amount to offer for settlement, the insurance adjuster will first scrutinize the nature and extent of your medical treatment. Without solid documentation of your injuries and treatment, you’ll have no foundation upon which to negotiate a settlement.
Privacy and HIPAA
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) provides protection for personal health information (PHI). HIPAA ensures your right to privacy, limiting who can access and receive your private information. It also ensures your right to obtain copies of your medical records.
While protecting your right to privacy, HIPAA has empowered 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 your records in your medical provider’s office
- Other reasonable restrictions
To check your state’s regulations for copying and releasing medical records, visit statelaws.findlaw.com. There you can find each state’s requirements, and get helpful information about how to request your medical records.
HIPAA protects against the unauthorized release of private medical information. If you sign a Release of Information, however, you are no longer protected. Most insurance companies require you to sign a release when you file a claim. Be sure the release only covers your current injuries. You never want to give the insurance company access to your entire medical history.
First-party Claims and IMEs
First-party insurance claims have different rules than third party claims. Most no-fault and worker’s comp insurance policies contain a clause that says in order for them to insure you against injuries, you must submit to an Independent Medical Exam (IME) at their request.
Insurance companies normally request IMEs when they want to challenge the nature and extent of your injuries, or the medical treatment you say you require. Because you signed the policy with the IME clause, you waived your right to privacy. Therefore, your IME results are readily available to your insurance company.
You have little choice if your no-fault or worker’s comp insurance company has you submit to an IME. If you refuse, they probably have the right to deny your claim.
Is it really “independent”?
An IME is used to obtain what the insurance company considers an objective medical opinion. Unfortunately, doctors working for insurance companies have a conflict of interest. They’re paid to render “independent” medical opinions, but an insurance company won’t continue to employ a doctor who gives too many opinions against the company’s interests.
Moreover, the results of an IME can legally be kept from you. In most cases where IMEs are performed, the insurance company reserves the right to deny the claimant access. If this happens in your claim, those records may be “discoverable” by your attorney after filing a lawsuit. Requesting certain records is sometimes only possible through litigation.
Third-party Claims and Release of Records
Third-party claims are those filed against an at-fault driver and defended by his insurance company. They exist in the absence of no-fault insurance, and normally do not require an IME. When you’re injured and seek medical care from your doctor, those medical records will not be accessible by the at-fault driver’s insurance company unless you allow it.
Alternately, the at-fault driver’s medical records will not be accessible by you. The driver’s insurance company has a limited right to keep those records from you.
When the at-fault driver’s insurance company refuses to make their insured’s medical records available, you may only be able to access them if you file a lawsuit. When a lawsuit is filed, your attorney can access those records with a subpoena.
Limitations on Accessing Records
While you may have a right to access your medical records, that right can be limited. HIPAA permits doctors to withhold certain information, which can include the following:
- The doctor’s personal notes intended to be his work product. These include his personal impressions, messages to other doctors and medical staff, and notes considered not directly related to your medical treatment.
- 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 who may have treated you previously or concurrently. You have to request that information directly from those other doctors.
Requesting Medical Records by Written Notice
Requesting your records is not complicated. Most hospitals and clinics have their own forms specifically for this purpose. If not, we’ve included below a sample letter you can use to make the request. Be sure to substitute your own information where applicable.
In almost all cases, requests for copies of your medical records must be made in writing and by you personally. There are some exceptions to this requirement, including if you’re physically or mentally unable. In that case, a Power of Attorney authorization signed by you may be sufficient. If you’re represented by an attorney, she can do it on your behalf.
When gathering your claim documentation, it’s essential to request the full extent of your records from all your healthcare providers. This includes every type of record related to your injuries, their treatment, and costs.
Template of a written request for medical records:
Date of letter
Your mailing address
Your phone number
Name of medical provider
Mailing address of medical provider
Your date of birth
Your Social Security number
Your patient ID number (if applicable)
Dates of your treatment
Please accept this letter as my formal written request for the release to me of copies of my complete medical records. I make this request pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and Department of Health and Human Services regulations. The regulations contained therein designate the process of requesting medical records. My intention is to fully comply with those regulations.
The medical records I am requesting represent the dates of my treatment beginning on (date you started treatment) and ending on (date you ended treatment). They should include, but not be limited to:
- Admitting charts and notes
- My medical history
- Physicians’ and nurses’ notes
- Medical narratives
- Diagnosis and prognosis
- All test results
- All other information related in any way to my treatment
I understand there may be a reasonable fee required for the assembly, copying, and mailing of these records. If you tell me the cost I will be happy to pay it either now or when you complete the process.
Please mail these records to me at the address listed above. I understand and appreciate you may need some time to assemble this information. I am confident you will have the records ready within the 30-day period allowed by HIPAA.
If you have any questions, or if any of the above is unclear, please do not hesitate to contact me.
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Visitor Questions on Requesting Medical Records
Do I have to let the insurance company access my medical history? I fell in major chain retail store in July 2011, I filled out a claim form the day of the accident. Approximately 30 days later an insurance representative called and stated that the store wasn’t going to deny my claim. I said I’d been seen by a physical therapist and used my own insurance, but... Read More >>