Insurance Company Wants Your Medical Records After a Car Accident? Read This Before You Sign

Why Does the Insurance Company Want Your Medical Records?

Medical evidence is a central part of most car accident injury claims.

An insurer evaluating a claim may reasonably want documentation showing:

• What injuries were diagnosed after the accident
• When treatment began
• What medical treatment was provided
• Whether additional treatment is expected
• How the injuries affected your ability to work or carry out normal activities
• How much the medical care cost

Those records can help establish both the nature of the injury and the financial losses associated with it.

The issue is not whether medical information is relevant. In most injury cases, it clearly is.

The more important question is how much medical information the insurer actually needs to evaluate the claim.

 

What Does a Medical Records Authorization Allow?

A medical authorization gives healthcare providers permission to disclose protected health information to the person or organization identified in the authorization.

Under the federal HIPAA Privacy Rule, a valid authorization generally must identify the information to be disclosed, who is authorized to disclose it, who may receive it, and when the authorization expires. It must also explain the individual’s right to revoke the authorization in writing.

The U.S. Department of Health and Human Services explains the requirements for a HIPAA authorization in its HIPAA Privacy Rule guidance.

Importantly, HIPAA does not prohibit you from voluntarily authorizing disclosure of your records. Its purpose is to establish rules governing how protected health information may be used and disclosed.

Once you sign a valid authorization, healthcare providers may be permitted to release the information covered by it.

A Broad Authorization Can Reach Much Further Than the Accident

The exact wording matters.

An authorization could potentially permit disclosure of:

• Records from the treatment immediately following the crash
• Prior treatment involving the same part of the body
• Records from primary-care physicians
• Prior surgeries or injuries
• Prescription records
• Mental health or other sensitive medical information, depending upon the authorization and applicable law
• Records created after the authorization was signed if the authorization is broad enough to encompass them

HHS specifically recognizes that an authorization may permit disclosure of an entire medical record if it is drafted to cover that information.

That is one reason to read the form rather than treating it as routine paperwork.

 

Why Would an Insurer Want Your Medical History From Before the Crash?

One of the insurer’s jobs is determining whether the medical problems being claimed were actually caused by the accident.

If you hurt your back in a collision, for example, the insurer may want to know whether you had previously been treated for back pain.

A previous medical condition does not automatically defeat an injury claim. An accident can aggravate or worsen a pre-existing condition, and the consequences of that aggravation can still be important to the claim.

But prior records can also give the insurer information it may use to challenge causation.

An adjuster may argue that:

• Your symptoms existed before the crash.
• The accident did not cause the medical condition.
• Treatment after the collision relates primarily to an older injury.
• A prior condition explains some or all of your current limitations.

This is why medical history can become a significant point of dispute in a serious personal injury case.

It is also why giving an insurance company unrestricted access to unrelated medical information may not always be the best way to document a legitimate claim.

 

Do You Have to Sign the Insurance Company’s Authorization?

When the request comes from the other driver’s liability insurance company before a lawsuit has been filed, you should not assume that you must sign whatever authorization the adjuster sends simply because the company requests it.

The insurer still needs sufficient medical information to evaluate an injury claim, however.

Refusing to provide any medical evidence at all can make it difficult for the company to evaluate the injury, treatment or damages and can delay or prevent meaningful settlement negotiations.

The practical issue is therefore often not whether records should be provided, but which records are relevant and how they should be obtained and disclosed.

One alternative may be to obtain the relevant records and bills yourself and provide them to the insurer rather than signing an unrestricted authorization allowing the insurer to request records directly from multiple providers.

Federal law generally gives patients the right to access their own medical and billing records, subject to limited exceptions. The U.S. Department of Health and Human Services provides more information about those rights in its medical records guidance.

Your Own Insurance Company Can Be Different

The situation can be different when the request comes from your own insurer.

For example, a claim involving medical payments coverage or uninsured/underinsured motorist coverage may be governed partly by the terms of your own insurance policy. The policy may impose cooperation or documentation requirements that do not apply in the same way to a claim against another driver’s liability carrier.

That does not mean every request from your own insurer is automatically unlimited or appropriate. It means the policy and the particular coverage should be reviewed before deciding how to respond.

 

What Should You Check Before Signing a Medical Authorization?

Before signing, read the authorization itself rather than relying only on the adjuster’s explanation.

Pay particular attention to:

1. Which Providers Are Covered?

Does the form identify the hospital and doctors who treated you after the accident, or does it authorize every healthcare provider who has ever treated you?

A broadly worded authorization may permit the insurer to contact providers who had nothing to do with the injuries involved in the claim.

2. What Types of Records Can Be Released?

Look for language describing what information may be disclosed.

Is it limited to records relevant to the injuries from the accident, or does the authorization encompass your entire medical history?

3. What Time Period Does It Cover?

A request for records from treatment immediately before and after an accident is different from a form seeking decades of medical history.

Prior records may sometimes be relevant, particularly when the same medical condition or body part was treated before the collision. But there should be a legitimate reason for the scope of the request.

4. When Does the Authorization Expire?

HIPAA authorizations must contain an expiration date or an expiration event related to the authorization.

An open-ended authorization deserves particular attention.

5. Who Can Receive the Information?

The authorization should identify the person or category of persons authorized to receive the information.

Remember that once protected information has been disclosed to a recipient that is not itself subject to the same HIPAA restrictions, the information may no longer receive the same federal privacy protection.

 

Can You Revoke a Medical Authorization After Signing It?

Generally, yes.

The HIPAA Privacy Rule provides a right to revoke an authorization in writing.

However, revoking the authorization does not undo disclosures that were already made while the authorization was valid.

HHS explains that revocation becomes effective once the covered entity receives it and does not reverse actions already taken in reliance upon the authorization.

That distinction is important.

Once records have already been sent to the insurance company, revoking the authorization does not cause the insurer to forget or return information it has already received.

 

What Happens If a Car Accident Lawsuit Is Filed?

The rules change once an injury claim becomes litigation.

During a North Carolina lawsuit, both sides can use the formal discovery process to obtain relevant, nonprivileged information.

North Carolina Rule of Civil Procedure 26 allows parties to seek discovery concerning matters relevant to the pending claim or defense. Depending upon the case, that can include medical records, written discovery, depositions, examinations and other evidence.

The rule can be reviewed at North Carolina Rule of Civil Procedure 26.

Filing a lawsuit therefore does not mean medical history becomes completely private simply because a claimant prefers not to disclose it.

Relevant medical information can be discoverable.

The difference is that formal litigation provides procedures for determining what information is relevant, what is privileged and whether a request is excessively broad.

 

Why Medical Records Can Affect More Than Just the Value of Your Claim

Insurance companies compare records carefully.

They may look for inconsistencies between:

• What you told the adjuster
• What you told your doctors
• Your prior medical history
• The injuries described in the crash report
• The timing of your treatment
• Activity restrictions documented by medical providers

Something as simple as an old medical note can sometimes become the basis for an argument that an injury was not caused by the collision.

That does not mean prior medical history should be hidden. Attempting to conceal relevant medical treatment can seriously damage credibility.

The objective is accuracy and appropriate disclosure — not giving an opposing insurance company unrestricted access to irrelevant private information simply because a standard form was placed in front of you.

 

Do Not Confuse Cooperation With Giving Up Control of Your Records

An injured person making a legitimate claim should expect to provide evidence supporting that claim.

Medical records and bills are often essential evidence.

But there is an important difference between reasonably documenting your injuries and signing a blanket authorization without understanding what it permits.

Before providing an authorization, consider:

• What injuries are actually part of the claim?
• Which providers treated those injuries?
• Are prior records genuinely relevant?
• How far back does the authorization extend?
• Could the necessary records instead be obtained and supplied directly?

The larger or more complicated the injury claim, the more important those questions can become.

 

Talk to Kellum Law Firm Before Signing Broad Insurance Forms

If you were injured in a North Carolina car accident and an insurance company is asking you to sign a broad medical records authorization, you do not have to guess about what the form allows.

Kellum Law Firm can review the accident, the insurance request and the medical issues involved in the claim and explain what information may reasonably need to be provided.

Our North Carolina personal injury lawyers represent injured clients throughout the state in claims involving automobile accidents and other negligent conduct.

Contact Kellum Law Firm for a free case evaluation. We’re With You All The Way.