Many people who are injured in a car accident caused by another driver make a claim against the at-fault driver’s auto insurer, looking for compensation. The claim will detail the extent of the injuries received from the accident and what the consequences of those injuries mean in the life of the person injured.
An insurance company, never wanting to pay out any more than absolutely necessary, will want to see medical evidence to back up the statements made in the claim. The insurance company has the right to review any medical records that are relevant to the injuries being claimed. The insurance company does not have the right to see any medical records that do not pertain to the injuries being claimed.
The federal Health Insurance Portability and Accountability Act (HIPAA) protects personal health information from being disclosed by most health care providers unless specifically authorized by the patient or allowed by law. HIPAA also gives patients the right to view or obtain copies of their health records.
A person who wants to obtain copies of their medical records or allow a third party to have access to certain records can complete a Medical Records Release Authorization Form. Medical record release requests must generally be completed within 30 days or the requestor is entitled to an explanation for the delay.
A provider is allowed one additional 30-day period to comply with the records request.
When a personal injury claim is made, an insurance company will want to look at a claimant’s medical records in order to verify the nature and extent of the claimed injuries. Insurance companies typically have their own medical record release forms, which they may encourage claimants to sign as a requirement for processing their claim.
The problem with insurance company medical record release forms is that they tend to be very broad. They may authorize any provider of medical treatment to release all medical records pertaining to any illness or injury or treatment, not limited to the injuries that are the subject of a particular claim.
By signing an insurance company’s release form, a claimant may authorize the insurance company to access medical information that is not pertinent to the claim being made.
In reviewing a claimant’s medical history the insurance company may find evidence of prior injuries and use that information to try and discredit the current claim.
A medical records release form for a personal injury claim should be limited to only those records that pertain specifically to the injuries being claimed. If there are concerns about the information contained in the records, a claimant or their attorney can obtain the medical records and review them before they are provided to the insurance company.
Insurance company medical records release forms are intentionally broad because the insurer wants to discover some other explanation for the injuries being claimed.
Unsuspecting claimants who sign a broad release form for an insurance company can unnecessarily complicate their claim by allowing access to their entire medical history.
When a claim for injury is submitted to an insurance company, the carrier has the right to review all medical records that have reference to the injury being claimed. Typical records that would be appropriate to provide to an insurance company for a claim might include:
Sometimes a new injury reinjures an old injury or makes it worse. An insurance company may become aware of the older injury during a review of a claimant’s medical records. If a person sees the same doctor for both injuries, the notes from the examination may reference the older injury in relation to the newer injury.
Insurance companies will use the fact of the older injury to try and minimize the damage done by the newer injury to reduce the value of the current claim. A claimant is still entitled to compensation for the new injury, but a pre-existing condition can make valuing the claim more contentious and complicated.
Insurance companies responding to personal injury claims may request that a claimant submits to an independent medical examination (IME). Insurance companies typically reserve the right to have a claimant’s injuries evaluated by a physician of their choosing. The doctors who conduct IMEs are specialists regarding the claimed injuries and routinely perform these examinations for insurance companies.
While the request may claim that the examination will be independent, the purpose of the examination is to generate medical evidence that contradicts what a claimant’s own doctor has said about the injuries. A claimant submitting to an IME must be aware of what the doctor is trying to do. Personal injury attorneys often know the doctors who perform IMEs and can help a claimant prepare for the examination generally and a specific doctor in particular.
It is important that the information given to an IME doctor is consistent with the information provided to other medical professionals – unless actual circumstances have changed. Information should be limited only to the claimed injuries, and the exchange should be polite and professional, not overly friendly or chatty.
An IME doctor generates a report about the injuries found and the impact the doctor believes they will have. A claimant can request to review the report for any inaccuracies in factual information.
Making a claim for personal injury against the insurer of an at-fault party initiates an adversarial relationship between the claimant and the insurance company. This means a claimant must be careful not to give away any more information than is required by law and must remember that the insurance company is doing everything possible to minimize the value of their claim.
An insurance company can only require access to medical records about the claimed injuries and must limit the scope of a requested IME to an evaluation of just those injuries.