What to Do When an Insurance Company Asks for Medical Records or Exams

Medical records can be pivotal in a personal injury case. Often these documents serve as an official testament to your physical injuries and economic damages. If you’re in the middle of a personal injury case and you receive a call from a claims adjuster, however, you should always proceed with caution. Your next moves could help or hurt the legitimacy of your claim. Here’s how to handle it.

Is the Request Reasonable?

Ultimately, you or your attorney will have to decide if a request for medical records or exams is reasonable. If you’ve already filed a lawsuit, you will have already sent copies of your medical records as part of your demand letter. On the other hand, there might be additional records that you didn’t provide that a claims adjuster might need. Examples might include radiologist’s notes (from a subsequent x-ray) or follow-up notes from a surgery.

If the request seems reasonable, tell the insurance adjuster that you will provide the records if they are willing to pay for them (there is often a small fee for processing from a doctor’s office). If they’re willing to do so, formalize the arrangement in writing.

Sometimes insurance adjusters will try to gain copies of your medical records to find a problem with your case or to discredit you. That’s why it’s essential to seek help from an attorney.

Never Sign a Medical Records Release

To the same end, it’s essential that you never give a claims adjuster direct authorization to your medical records. This gives them access to anything in your medical file, which could be used against you. Instead, only provide pertinent information and release the records to yourself, and have your lawyer review them before sending them off to the insurance company.

What About Medical Exams?

In other instances, insurance adjusters may find that the routine notes that a doctor keeps might not be enough to pay out on a claim. When this happens, they may request medical exams or further testing. Every so often, a claims adjuster and a claimant may have different opinions about how serious an injury is. This difference of opinion may be settled in negotiations, but on occasion the difference of opinion is so wide that it may require its own investigation. This is uncommon, as the insurance company will have to pay for the investigation themselves. If a claims adjuster requests some of this information, don’t do anything unless you have approval from your attorney.

Any requests for more information or testing require careful consideration and advice from your attorney These second opinions are called “independent medical examinations,” but they’re anything but. In fact, many medical professionals conducting IME’s may be selected again and again because they have a history of finding nothing wrong with the claimant.

Remember, an insurance claims adjusters job to pay out as little as possible. Don’t give them any information that makes their job easier. When in doubt, refer a claims adjuster to your attorney.