Jane Dotson
It is customary for insurance adjusters to request medical records following an injury claim. While this is a typical step in the process, it is important to understand your rights and the implications of sharing your medical history. Insurance adjusters will often ask for medical records to verify the injuries you have suffered and ensure that they are related to the accident in question. However, they may also use this opportunity to search for any pre-existing conditions or previous injuries that could potentially reduce the value of your claim. As such, it is generally recommended to consult with an attorney before agreeing to release your medical records. This allows you to control the scope of the information disclosed and protect your privacy.
| Characteristics | Values |
|---|---|
| Customary for insurance adjusters to request medical records | Yes, it is customary for insurance adjusters to request medical records, especially in injury claims, to verify injuries and medical treatment. |
| Reason for request | To verify the injury is related to the accident, understand the costs, and predict future medical issues. |
| Additional reasons | To look for pre-existing injuries or conditions that could be used to deny or downplay the claim. |
| Permission to access records | It is up to the individual to decide if the request is reasonable and relevant to the claim. |
| Recommendations | Consult with an attorney before providing access to medical records, especially for significant injuries. |
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What You'll Learn
Reasons for the request
It is customary for insurance adjusters to request medical records, but it is important to remember that you are not obligated to provide unrestricted access to your medical history. The insurance adjuster's primary goal is to verify the injuries you have claimed and review any associated costs. They may also want to determine if there are any pre-existing injuries or conditions that could impact your current claim. Here are some detailed reasons for their request:
Verifying Injuries and Treatment
Insurance companies need to confirm that the injuries you are claiming are indeed related to the accident in question. They may request medical records to understand the extent of your injuries, the specific treatments you have received, and any future medical complications or expenses you may encounter. This information helps them assess the validity and cost of your claim.
Pre-existing Conditions and Injuries
Insurance adjusters are particularly interested in identifying any pre-existing injuries or medical conditions that could be used to dispute your claim. For example, if you claim emotional distress after a car accident, the insurance company may scrutinize your medical records for any history of mental health issues that could be used to argue that your emotional distress existed prior to the accident. While federal law prohibits health insurance companies from denying coverage for pre-existing conditions, this does not apply to auto insurance companies.
Independent Medical Examinations (IMEs)
In some cases, insurance adjusters may request that you undergo an IME (Independent Medical Examination), where a physician designated by the insurance company examines you. While these examinations are presented as independent, the doctors are chosen and paid by the insurance company, creating a potential conflict of interest. The insurance company may use the IME report, along with your medical records, to challenge the severity or cause of your injuries.
Cost Assessment and Negotiation
Insurance companies are for-profit businesses, and their goal is to minimize the amount paid out on claims. By reviewing your medical records, they can assess the potential future costs associated with your injury and develop strategies to negotiate lower settlements. They may also use the information to identify any discrepancies or inconsistencies in your claim that could weaken your position during negotiations.
Remember, while it is customary for insurance adjusters to request medical records, you have the right to protect your privacy and personal information. Consult with an attorney who can guide you through the process and ensure that only relevant medical records are disclosed while safeguarding your rights and best interests.
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Protecting your privacy
While it is customary for insurance adjusters to request medical records, it is not customary for them to receive them without challenge. You are not legally obligated to turn over medical records to the insurance company after an accident, but you must provide documentation of your injury before a policy claim is paid out.
- Never give insurance adjusters access to your medical history. Limit the scope to only providers who treated your accident-related injuries.
- Before releasing any records, review them and remove records that fall outside the scope of the claim.
- Never sign an agreement authorizing an adjuster to directly obtain any of your medical records, and never give the adjuster verbal permission to obtain them.
- Always obtain records yourself.
- If there are costs associated with gathering your medical records, you may request that the insurance company pay for them.
- If the request for additional medical records seems overbroad, politely inform the adjuster that you don't believe the records are relevant to your claim.
- Remind the adjuster that if you end up filing a personal injury lawsuit in court, your lawyer and the insurance company's attorney will be able to argue over this issue.
- Consult an attorney before releasing medical records to an insurance company. An experienced personal injury attorney can provide valuable legal guidance, helping you navigate complex forms and requests while avoiding unnecessary disclosures.
- An attorney can also speak directly to the insurance adjuster and advise you on your best interests, such as limiting the scope of the records shared and ensuring your privacy.
- HIPAA may protect you against the unauthorized release of your information, but signing an agreement will invalidate that protection.
- If you are asked to undergo an "independent medical examination" (IME), do not agree before discussing your situation with a car accident attorney.
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Consulting an attorney
Understanding Your Rights
Attorneys can help you understand your rights regarding medical record disclosure. They can advise you on the relevant laws and regulations, such as the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which protects the privacy of your medical records. Attorneys can also explain the limitations of insurance adjusters' rights to request your medical records and the potential consequences of unauthorised disclosure.
Evaluating the Request
An attorney can assist in evaluating the insurance adjuster's request for medical records. They can review the scope and relevance of the requested records and determine if the request is reasonable and proportional to the claim. Attorneys are skilled in identifying red flags and can help protect you from overly broad or intrusive requests.
Negotiating and Limiting Disclosure
If you decide to provide medical records, an attorney can help negotiate the terms and limit the scope of disclosure. They can advise on the specific records relevant to your claim and guide you in redacting or removing unnecessary or sensitive information. By doing so, you can maintain your privacy while still fulfilling your obligations.
Alternative Sources of Information
Attorneys may suggest alternative sources of information that can support your claim. For example, they can help you obtain records directly from opposing counsel as evidentiary exhibits or through court orders or subpoenas. This ensures that your personal medical records remain protected while still providing the necessary evidence for your case.
Representing Your Interests
Preparing for Litigation
In some cases, disputes over medical record requests may lead to litigation. An attorney can advise you on your legal options and represent you in court if necessary. They can also assist in gathering and organising medical records as evidence, ensuring compliance with legal procedures and protecting your rights throughout the process.
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Pre-existing injuries
While it is customary for insurance adjusters to request medical records, it is important to remember that you are not obligated to provide them with unrestricted access to your medical history. The insurance company will want to review your medical records to determine if there are any pre-existing injuries or conditions that could impact your claim. They may argue that a pre-existing injury is the true cause of the medical care you needed or that it exacerbated the injury, allowing them to deny your claim or minimise their responsibility.
It is crucial to carefully review and redact any records before releasing them to the insurance adjuster. Remove any information that is not directly related to the injuries you suffered in the accident. You have the right to protect your privacy and request that the adjuster provides specific reasons for their requests. If you are not satisfied with their justification, you can decline their request.
Additionally, be cautious about signing any authorisation forms or giving verbal permission for the insurance adjuster to directly obtain your medical records. Instead, obtain and review the records yourself before providing them with only the relevant documents pertaining to your claim. This ensures that your private medical history remains protected.
In some cases, the insurance adjuster may request an independent medical examination (IME) to assess your injuries further. Remember that you have the right to consult with an attorney or seek legal advice if you are unsure about the scope of the adjuster's requests or feel that they are invading your privacy.
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Independent medical examinations (IME)
An IME may be conducted at the request of an employer or an insurance carrier to obtain an independent opinion of an individual's clinical status. This is particularly relevant in workers' compensation insurance, auto insurance, and self-insured employers, who have a legal right to request an IME. The insurance company will want to know if the injury is related to the accident, the costs of the procedure, and what type of future medical issues may arise.
The process of an IME is straightforward. The insurer selects a physician through a third-party vendor and pays them for the examination. The physician will then review the patient's treatment records before the examination. The examination itself usually lasts about an hour and consists of an interview and a physical examination. Following this, the physician will prepare a report that addresses the insurer's questions. The report will determine the patient's functionality and whether they are prevented from performing their job duties.
It is important to note that while IMEs are deemed independent, they may not always be truly objective. The insurance company may use the IME to claim that the patient's injuries are unrelated to the accident or not as severe as claimed. Therefore, it is crucial to understand the details of the IME and how it works.
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Frequently asked questions
Yes, it is customary for insurance adjusters to request medical records. They will want to know if you have any pre-existing injuries or conditions that could affect your claim.
No. You should never give an insurance adjuster access to your full medical history. Only provide records that are directly related to your claim.
You should consult with an attorney before agreeing to release any medical records. You may also request that the insurance company covers the cost of obtaining these records.
An insurance adjuster will review your medical records to confirm that you have suffered the injuries you've claimed. They may also look for previous injuries or accidents that could be used to explain your current injuries or as ammunition against your claim.
