- January 23, 2021
- Posted by: andreamcmillan
- Category: Car Accidents
If you decide to pursue a claim after being injured in an accident/incident, the insurance company will, typically, want to review the medical records relating to your injuries and medical treatment. For one thing, the insurance adjuster handling your injury claim will want to correlate your medical bills with the medical treatment you received. However, the adjuster will not have the legal right to view your medical records, unless you or your lawyer give the adjuster the records, or you sign a release (authorization form) granting the insurance company access to your medical records.
Your HIPAA Right to Keep Your Protected Health Information Private
The insurance adjuster assigned to your injury claim does not have an automatic right to see your medical records. This is because of the Health Insurance Portability and Accountability Act. HIPAA is a federal law that helps protect against the unauthorized release or disclosure of your medical information. However, if you sign a medical release form permitting a third party access to your records, you will waive your right to privacy, to the extent you have given authorization. That is why it is important for you to limit the scope of medical records that you permit the insurance adjuster to review.
Why Does The Insurance Adjuster Want Your Medical Records?
Typically, an insurance adjuster wants as much information as possible, related to your accident-related injuries. The adjuster may say the records are needed, in order to verify your injuries. However, that is not the only reason the adjuster wants your records.
An insurance adjuster usually has one main goal when handling your claim: to deny the claim altogether, or to pay you as little as possible to resolve the claim. Accordingly, the adjuster handling your claim will be looking for any information that he/she can use to accomplish that goal.
For example, your medical records from your primary care physician may disclose the fact that at some time prior to the accident/incident, you injured the same body part in another accident. The adjuster may then use that information, gleaned from your medical records, to blame the previous accident—rather than the most recent one—for your injuries. On that basis, the adjuster may offer you inadequate compensation for your injuries, or deny your claim altogether.
Be Careful What You Say to Your Healthcare Providers During Your Visits
You may not realize it, but your doctor or other healthcare provider will often write down in your medical record, things that you say during the visit. The statements may be about how your injury occurred, the degree of pain you are experiencing, or something else about your injury.
An adjuster has one objective, and one objective only—to save the insurance company money by paying out as little as possible on claims. To accomplish that, most adjusters act like forensic detectives—combing through your medical records for each bit of information they can use to support their lowball settlement offers, or refusals to settle your claim. It is important, then, that you try to reduce the risk of that happening.
Here’s an example of how your medical records can be the source of content that an adjuster can use to devalue your claim. After an accident, you call 911. Paramedics respond to the accident scene, and they evaluate you. They ask you a series of questions about which parts of your body were injured in the accident. You deny at the scene that you have back pain. The paramedics write in your records that you denied any back pain at the scene.
A week later, you follow up with your primary care doctor. During that visit, you tell your doctor that your back is hurting from the accident. You make a claim with an insurance company seeking compensation for your injuries. Months later, the insurance adjuster handling your claim gets your medical records, reviews them, and notes the inconsistency between your denial of back pain at the scene and your complaint of back pain, a week later. The adjuster points this inconsistency in a letter to you. He contends that you must have injured your back sometime after the accident, and are now untruthfully claiming the accident caused your back injury. That is an example of something that insurance adjusters commonly do.
Of course, it is not uncommon for an injury victim to start feeling pain or discomfort sometime after leaving an accident scene. However, if, when you saw your primary care physician, you failed to explain that your back pain started shortly after the accident, and further explained how the pain is traceable to the accident (for example, how your body may have moved at the time of the accident), and you failed to ensure that your doctor understood that fact and wrote it down in your medical record at the time of your visit, then an insurance adjuster will likely exploit your failures in unfairly adjusting your claim for compensation.
That is why you should be careful what you say to your healthcare providers who treat you for accident-related injuries. Always remember in the back of your mind that an insurance adjuster or insurance defense lawyer may scrutinize your medical records one day. Therefore, you should carefully state your truths to your treating healthcare providers, explain yourself carefully, and make absolutely sure they understand what you say, so they can write it down accurately in your medical records. Doing these things will help minimize the risk of having your healthcare providers omit, or incorrectly write down, some important detail that could negatively impact your injury claim.
Never Give An Insurance Company Overbroad Access to Your Medical Records
In signing a medical records authorization (release) form, you may assume that you are only permitting the insurance company to obtain copies of your most recent medical records. However, if the medical release is not carefully worded, you may be granting the insurer access to your entire medical history—something that is usually not in your best interest.
Never give an insurance company access to medical records that are not relevant to your injury claim. To do so would be like handing the insurance adjuster a fishing pole, and inviting him/her to go on a fishing expedition into your life.
Limit the Scope of Your Medical Records That the Insurance Company Can Get
Sometimes an insurance company will send you a blank medical records authorization (release) form that allows the company to request your medical records directly from your healthcare providers. If that happens, you should limit the scope of the release by only allowing the insurer to access records for: (1) the specific healthcare providers that have treated your injuries since the accident/incident; and (2) the timeframe you received that medical care. If you fail to limit the scope of the medical records you permit the insurance company to access, you will give the company the ammunition it needs to hunt for information it will use to devalue or deny your injury claim.
Sometimes after making an initial request for your medical records, an insurer may request additional medical records, in order to hunt for anything else that could be used to lowball or deny your claim. If the request seems unfair, do not agree to it.
Instead, ask the insurance company to explain why it needs the additional records it is seeking. If the company does not give you a reasonable explanation, then seek legal assistance. The Law Offices of Andrea McMillan will review the request, and provide you with the help you need.
What Records Are Necessary for The Insurance Adjuster’s Review and Evaluation of Your Claim?
Charts, notes, X-rays and other diagnostic tests related to the accident/incident are considered necessary medical records for an insurance adjuster’s review. Likewise, records of daily treatment provided during a hospital stay, or medications prescribed to help relieve accident-related symptoms and provide pain relief, are also relevant to your claim. All of those records are considered relevant to your claim, because they help to show the extent and severity of your injuries.
On the other hand, any type of medical documentation not directly related to your claim is considered irrelevant, and unnecessary for the adjuster’s review. As discussed, those records could actually hinder your ability to recover compensation for your injuries.
Handling a Medical Records Request from An Insurance Company
If an insurance adjuster has requested access to your medical records, it is in your best interest to wait until you consult with a lawyer who can review the request. After reviewing the request, your lawyer will advise you of your legal rights, and communicate with the insurance company on your behalf, so you no longer have to.
Sometimes, an insurer may attempt to trick an injury victim into providing unnecessary access to records, in an effort to pay less for a claim that may be worth more. You can protect yourself by having a lawyer request your medical records from your healthcare providers, in order to review them before having them sent to the insurance company.
We’re Here to Help You! Call Us. We Care, and Will Fight for You!
Are you unsure about which medical records you should allow the insurance company to access? The Law Offices of Andrea McMillan, a West Palm Beach-based personal injury firm, will obtain your medical records, and only provide the insurance company with the ones that are legally necessary, and relevant to your injury claim.
Before she started representing injured people almost 25 years ago, Andrea McMillan, with the Law Offices of Andrea McMillan, spent years working as a lawyer for insurance companies, defending injury claims. She knows how insurance companies think, and the tactics they may use to hurt the value of your claim. Let her handle your personal injury claim for you. She is prepared to help you negotiate a claim, or even file a lawsuit, if your injuries are severe enough, in order to pursue the maximum compensation you deserve for your injuries.
Your initial consultation is 100 percent free and confidential. We charge nothing up front for our services, and only receive payment if we help you win. There is no obligation to move forward, even after learning about your rights and available legal options. Call the Law Offices of Andrea McMillan at (561) 612-5700 today for a FREE, no-obligation review of your claim. We’ll fight for you!