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Faking an injury is harder than it sounds. It takes more than just saying, โit hurts!โ to build a credible medical history. Your medical history is a comprehensive list of data compiled throughout your life.
For this reason, itโs nearly impossible to skew your medical history in your favor. Having an objective medical history is often the only way to show the legitimacy of your personal injury. Sometimes, insurance companies also use your medical history to verify your claim.
To support your claim, seek immediate medical attention after your accident, speak openly with your physician, follow all of your doctorโs instructions, and attend follow-up visits to your doctor for extended treatment.
You may also need to avoid exacerbating your injury through exercise, physical activity, or other issues. If you fail to seek medical treatment promptly, the defendant may claim that youโre actively seeking payment for a fake injury. Consulting a personal injury law firm may help you understand your options based on your situation.
What Are Medical Records?
Medical records are official documentation highlighting the diagnosis and treatment of your injury and can be compiled over time to showcase your entire medical history. Medical records can include:
- Ambulance/paramedic records
- Emergency records
- Hospital records
- Physical records
- Records from follow-up appointments
- MRIs, CT scans, X-rays, and testing records
All of these records should include a complete description of your injuries throughout your treatment, the complete dates of treatment, the outcome of your treatment (the outcome and long-term injuries), a cost breakdown of all of your treatment, a summary of treatment, an evaluation of your current medical status, and future treatment associated with projected costs.
Medical Records: The โBest Evidenceโ Rule
In a typical lawsuit, courts generally prefer original records, but certified copies are often accepted, especially for medical records. You likely wonโt have to worry about your healthcare provider already discarding your medical records.
Federal law requires healthcare providers to retain copies of medical records for at least six years. Some providers retain these records even longer than that.
Permission To Release Medical Records
If youโve filed a claim, your personal injury attorney may ask you to authorize the release of your medical records. The request will generally include the social security number, the patientโs name, account number, and birth date.
You may choose to request different records from various dates or all of the documents in the providerโs possession. Your personal injury lawyer can request these records on your behalf if you provide your permission in writing thatโs both signed and dated.
Additionally, you can send your request to your healthcare provider via fax or mail. In fact, many preeminent healthcare providers allow patients to request their records through an online portal. If you make your request through fax or mail, itโs essential to call your provider to confirm that they received it. If your request is denied or if a third party needs access, you may be able to pursue a medical subpoena.
Medical Records: What Happens When Insurance Adjusters Request Your Medical Records
If youโve already sent a demand letter in the middle of the personal injury settlement negotiations, you may have sent a few of your records over to your insurance adjuster. In some cases, your insurance adjuster may ask for records you never sent over.
For example, if you had an X-ray in the hospital, but you only provided your doctorโs notes to your insurance adjuster, your insurance adjuster may request additional records from your radiologist.
- If there is medical evidence of a preexisting injury, your adjuster may request records regarding that injury. It is completely up to you to determine if their request is reasonable to you. After all, you have to provide your consent for any request.
- If their request seems reasonable, inform your adjuster that you are willing to provide the medical records they want if they pay for them (there is usually a small fee for the healthcare provider to copy your records).
- If your adjuster agrees to these terms, confirm this agreement in writing for legal purposes. Next, request the records and review them before sending them over to your insurance adjuster. Remove records that do not pertain to their initial request.
If their request for your medical records seems inappropriate, you are not obligated to comply. Doing so is especially important if the request does not relate to the injuries youโve suffered.
For this reason, ask your insurance adjuster to explain why they need your medical records. If youโre not convinced by their answer, politely inform them that their request is not relevant and that it would invade your privacy.
If your claim ends up in court, both lawyers may argue the merits of each side with the information provided. Donโt be hesitant to be firm with your insurance provider. Theyโre not entitled to your medical records, nor can they coerce you into giving them away without a good reason. If you think there is a violation of your rights in your claims process, consider working with personal injury lawyers.
Medical Reports: What Happens When Insurance Adjusters Request Your Medical Report
The medical records your doctor has may not reveal every detail about your current injuries and your claim. For example, your medical records may not make it clear how much of an accident contributed to your current injury and how much a preexisting injury was a factor.
Your medical records may not include the prognosis for the time of recovery. Sometimes, a doctor can tell you something about the long-term effects of your injury and wonโt include it in your medical records.
As a result, you or your insurance provider might want a report to get more insight into a medical issue. If your adjuster asks for a medical report and their request seems to be reasonable, you can provide the necessary documentation yourself without having them speak to your doctor.
You may inform the adjuster that you will consider their request for your medical report, and you will reach back out with a response (within a week or so). Next, contact your doctor and find out whether or not they will be willing to write a report for you.
See how much they will charge you to write this report. Then you can contact your insurance adjuster and find out if they are willing to cover the cost of obtaining and sending the medical report. If the adjuster agrees, send them a confirmation letter.
Privacy Concerns
Every state has specific terms for obtaining medical reports to achieve a legal purpose. Familiarize yourself with the state and federal rules regarding the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
For example, the HIPAA Privacy Rule and state guidelines give you the right to access medical records in California. The HIPAA Privacy Rule sets this legal precedent for medical records across the country.
Reasons For Releasing Medical Records
There are several advantages to releasing your medical records in support of your personal injury claim.
- It allows both you and the defendant to determine the physical injuries and the feasibility of a specific case.
- It provides details of the extent and nature of the claimantโs current injuries.
- This helps to calculate the damages the injured party sustained.
- It allows a medical professional to determine the true cause of the claimantโs injuries and assess whether doctors practiced the right care.
Another major reason why assessing medical records is important is that it helps the defendant better understand the plaintiffโs preexisting injuries. Hereโs a scenario in which releasing medical records can become an issue. Letโs say that a person is suing a grocery store because they fell into a sinkhole and broke their ankle. The grocery store may have reason to believe that the claimant has aggravated an existing ankle injury that the person suffered while playing basketball a few months ago.
How Medical Records Can Impact Your Case
As the claimant, your medical records can be used to:
- Determine the extent of your injuries and the merit of your claim.
- Show the legitimacy of your injuries, either in negotiations or in court.
- Calculate damages associated with your injuries, which may also include intangible damages such as pain and suffering.
- Calculate future damages, such as rehabilitation sessions and/or therapy.
- Determine the cause of your injuries and whether your doctor practiced reasonable care.
What Is Maximum Medical Improvement (MMI)?
MMI is the point at which your doctor asserts that your condition has been stabilized. This simply means that your condition is not expected to get any worse and is also not expected to get much better. It may be ideal for you to reach MMI before resolving your claim. Reaching MMI means that you have made a full recovery. You may be able to seek compensation for the pain and suffering youโve experienced, depending on the specifics of your case.
Functional Capacity Evaluation (FCE)
If you have previously held a job or are of working age, your doctor may recommend an FCE if your ability to return to work is impaired by your lingering disability. An FCE is a comprehensive test that will screen your ability to work. It will even evaluate your cognitive capacity to check for brain injuries. Overall, an FCE is crucial for pursuing damages based on a personโs lost earning capacity.
Medical Records Matter At The Settlement Table
Of course, you will need to submit your medical records in court. Some people may ask, why does submitting medical records matter since many civil suits are resolved through out-of-court settlements? Your medical records can help support your claim during negotiations. Insurance companies may consider your claim valid if you have clear, documented proof of your injuries. Documented evidence of your condition, such as medical records from your healthcare provider, is an important piece of evidence that can be beneficial for your claim.
Independent Medical Examinations
If your medical records support your side of the story, the defendant or insurance company may request an independent medical examination (IME) by their doctor.
You may be required to participate in an independent medical examination based on your insurance policy or via court order. Sometimes, you can refuse an independent medical examination, but your refusal can have an impact on your claim.
The purpose of an independent medical examination is to:
- Verify that you are injured.
- Check whether your injury is as serious as you claim.
- Confirm whether your injury was caused by your accident.
- Find a way to undermine your claim.
If you end up filing a lawsuit, you and your lawyer will have access to the independent medical examination report if the defendant plans to use it in court. The report may support your insurance companyโs side, but your personal injury lawyer can still dispute the results of the report, especially because your insurance company chose their own doctor, who conducted the investigation.
Speak With Our California Personal Injury Attorneys
If youโre looking for a personal injury lawyer in California, Arash Law is ready to assist you. Our lawyers have years of experience managing injury cases on behalf of our clients. In addition, you wonโt owe us attorneysโ fees unless your case results in a settlement or verdict. If you donโt receive compensation, you wonโt owe us payment for our legal services. We will discuss these fees, as well as other case-related costs that will be charged separately regardless of the outcome, during your consultation. Give our injury law firm a call at (888) 488-1391 or contact us online to speak to a member of our legal team and request a free initial consultation.
