What You Need to Know About Medical Records for Injury Claims

How to get the medical records you need for your personal injury claim and protect your medical privacy when dealing with the insurance company.

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, sooner or later you’ll have to provide proof of your injuries.

If you’re handling your own insurance claim, you’ll need to gather your medical bills and records to support your demand for compensation.

Personal injury compensation for car accidents and liability claims outside of workers’ comp are largely based on your total medical bills.

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

Your 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 generally 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 medical 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 your 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 medical 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.

Requesting Your Medical Records

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.

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 claim records and deal with the insurance company.

If you’re handling your claim without a lawyer, 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.

Sample Letter: Request for Medical Records

Date of letter

Your name
Your mailing address
Your phone number

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)
Dates of your treatment

Dear Sir/Madam:

Please accept this letter as my formal request for copies of my medical records as allowed by the Health Insurance Portability and Accountability Act (HIPAA) and Department of Health and Human Services regulations.

I was treated at your facility [fill in date range]. I request printed copies of all health records related to my treatment, including, but not limited to:

  • Admitting charts and notes
  • My medical history
  • Physicians’ and nurses’ notes
  • Medical narratives
  • Diagnosis and prognosis
  • Imaging studies
  • All test results
  • Consultations
  • Referrals
  • Correspondence
  • Itemized billing
  • All other information related in any way to my treatment

I understand there may be a reasonable fee charged for copying and mailing, but not for time spent locating or retrieving my records. Copy charges will be paid promptly upon receipt of your invoice detailing the copy fee and the number of pages copied.

Please mail these records to me at the address listed above. If you are unable to send my records within the 30-day period mandated by HIPAA, please send me a letter explaining the delay and the date my records will be sent.

Please don’t hesitate to contact me with any questions.

Yours truly,

(Your name/signature)

Protecting Your Injury Claim Records

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

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 not unusual for “standard” insurance company forms to authorize the adjuster to get all your medical records going back five or ten years. Someone at the insurance company will go through your past medical records on a fishing expedition to find something they can use to deny or minimize your claim.

You have the right to protect your interests by consulting a personal injury attorney before signing any insurance forms or giving a recorded statement.

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

You right to medical privacy can be limited when it comes to injury claims with your own insurance company or a workers’ compensation 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) at their request. If you refuse, they probably 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, you waived your right to privacy. The insurance company has a right to the medical records from your IME, and they are not obligated to share them with you.

If your injuries are caused by someone else’s negligence, and your claim is with the at-fault party’s insurance company, they can’t require you to go to one of their doctors.

When you’re injured and seek medical care from your doctor, those medical records will not be accessible by the at-fault person’s insurance company without a court order or subpoena, unless you allow it.

Injury Claim Records and Litigation

Severe and potentially permanent injuries are high-dollar insurance claims. Insurance companies are notorious for offering lower settlements to seriously injured claimants who aren’t represented by an attorney.

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 injury attorneys don’t charge for their initial consultation, and represent injury victims on a contingency fee basis, meaning they don’t get paid unless your case settles or you win a court verdict.

There’s too much at stake to try handling a severe injury claim on your own. It costs nothing to find out what an experienced attorney can do for you.

Video: Medical Records and Confidentiality Laws

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