In the case of a personal injury, it is common practice for insurance to request any and all medical records available. In the event of an insurance claim, your insurance company will have an adjuster determine the appropriate compensation for your claim. The adjuster will use the information in your records and any other relevant information they find while determining the compensation for your claim.
However, insurance companies do not have an inherent right to view your records. They must request your records. In general, they only need records of the treatment you received. However, they will ask you to sign a full records release. DO NOT DO THIS. They’re looking for any possible reason to deny your claim.
Don’t I Have a Right to Privacy?
Yes, you have a right to privacy. That is the whole reason HIPAA exists. The Heal Insurance Portability and Accountability Act, or HIPAA, protects your privacy by prohibiting unauthorized access or requests to your medical records. They also give you the right to obtain copies of your health information as well.
That means insurance companies and the adjusters they use have no way of legally obtaining your medical records without your consent. They have to go through you in order to get the information they want, either by you sending them the information or by having you sign a medical release waiver.
So, when sending over your medical records, remember that you don’t have to send them everything! Before you send them medical documents, confirm with your doctor that they are relevant to your injury, and talk to an attorney first. Your attorney can go over your rights and make sure you only send necessary information without putting your claim in jeopardy.
What is a Medical Release Waiver?
A medical release waiver is a written statement that gives an insurance company and its adjuster the right to directly request medical records from your doctor and other healthcare providers.
While you have every right to fair compensation, you’re going up against giant corporations interested in their bottom line. They will use anything and everything in your medical records to deny you coverage. This could be a pre-existing condition, a doctor’s note from when you were a kid, anything!
Your adjuster may try to trick you into signing over your entire medical release. They’ll try to devalue your damages. They’ll tell you they need to clarify something about your past. They might even sneak that document in a packet of other documents that are actually necessary.
Do not let them get away with this!
What If I Don’t Send Anything?
If you don’t send them any relevant information, your insurance provider or the provider for the at-fault party may deny your claim. While you have every right to privacy, you do have to send them the information relevant to the injury itself. But what constitutes a relevant or necessary medical record? Here are some examples:
- X-rays of broken bones
- MRI results for the specific injury
- Medications that you needed for the pain experienced
- Any treatments that you received during a hospital stay
This list is not comprehensive, and no matter what, consult with your doctor and an attorney first! The adjuster you are working with does not represent you and is not there to help you. They are there to help the insurance company. Make sure you have somebody on your side.
How Can I Fight Their Dirty Tricks?
There are many ways that adjusters will use their position to their advantage and try to filch you out of the money and coverage you are rightfully owed. Let’s go over some of their most common tactics.
Prevent Them From Asking You Leading Questions:
They will sneak in questions like “how are you doing today?” to get you to say, “I’m fine.” Or they will ask about your accident and say, “Could you have done anything differently?” To admit fault. Side-step their questions, or have an experienced attorney speak with the adjuster on your behalf.
Don’t Let Them Blame You for an Injury or Accident
Adjusters will try to pin the blame on you in order to reduce your claim or outright deny it. Do not allow them to falsely assign blame and push back verbally, and provide evidence that you are not at fault. Never say the words “I’m sorry” or “I could have done….” They record everything and will use that to deny your coverage.
Be Prepared for Downplaying or Minimizing of your Injuries, Treatment, and Suffering
They don’t care what your injuries are, how badly you’re suffering, or what treatment you received. They will tell you it’s not serious, you didn’t need that treatment, or that you’re overreacting. Understand your medical records, and provide throughout and descriptive explanations for the severity of your injuries and the necessity of your treatment.
Have an Attorney Speak on Your Behalf
Insurance claims adjusters understand the laws around insurance and health care. They know the law much better than you and will use that to their advantage. Your attorney is there to represent you and protect you from all these dirty tricks we’ve mentioned and more. They have the legal know-how and expertise to make sure that you are treated fairly and that you get the payment you deserve.
If you are someone you know is considering hiring a lawyer, we highly recommend this site, where you can get a free, no hassle consultation from an experienced attorney in your area.
Skip the Phone. Stick With Email
Phone calls can be dangerous when speaking with an adjuster. Not only will they ask you leading questions, but it’s also easier to get caught up in the conversation. You might begin talking about something irrelevant that they can use later, or they may try to get you worked up so that you’ll lose focus. Communicating with your adjuster exclusively through email correspondence guarantees everything is in writing and gives you a chance to review what you want to say before you send it.
What Should I Do When Sending my Medical Records?
Before you send over your medical records, make sure do you have everything in writing. Leave nothing up to ambiguity. If they say they need medical records, ask them what records they specifically need. If you feel like they are not medically necessary, push back against their request, explaining why it is not necessary.
Do not sign any documents they sent to you without thoroughly reading them yourself and also going over them with an attorney. They will be able to catch any sneaky language that the insurance company will use to their advantage.
Once you and your attorney have agreed on what documents to send over, check to see if there will be any cost to obtaining those records. HIPAA prevents unauthorized access to your medical records, but you could still be charged by the medical provider for access. If there is going to be a cost, send a written request to the adjuster to pay for that request.
Once you have all of the documents needed, go over them one last time with your attorney and remove any documents or records that do not pertain to the claim. If they continue to ask for these documents that are not necessary, be firm and tell them no. They’re just trying to find a reason to deny your claim or reduce the amount given.
The Do’s and Dont’s of Your Medical Records
Dealing with an insurance provider is a stressful endeavor, but it’s not the end of the world. Just make sure to follow this list of do’s and don’ts so that you can protect yourself and your claim with insurance.
Do’s
- Consider working with an attorney to protect your legal rights and to have an expert on your side.
- Make sure that you do send them the medical records that are actually relevant to your case. This will ensure that you are fairly compensated.
- Review all of your medical records with your doctor before you send anything.
- Det everything in writing with insurance and your adjuster.
- Be firm when speaking with or emailing Insurance representatives and Adjusters.
- Remember, the adjuster is not your friend. They work for the insurance company, not you.
- Carefully review all material given to you by your insurance company or the adjuster. There can be fine print used later against you. This is also why an attorney is incredibly important.
Dont’s
- Do not sign a medical release form if requested. This gives them carte blanche with your medical history, and they’ll snoop around for ways to deny or lower your claim.
- Never answer any of the leading questions they ask you. They’ll try to use this against you in the future.
- If they try to tell you your injuries are not that bad or that your treatments weren’t necessary, do not let them do this to you! You were the person injured, not them.
- Avoid speaking over the phone as much as possible. This leads to ambiguity, and they might try to use your words later out of context.
- If they do make an offer to settle your claim, don’t accept it! Their first offer is most likely going to be a lowball and an attempt at getting out of a case as quickly as possible for as cheap as possible.
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