How to Get Medical Records to Prove Your Injuries and Damages in Motor Vehicle Crash and Workplace Injury Claims

 

You Must Obtain Records from Your Doctors and Other Healthcare Providers to Negotiate a Fair Settlement or Win Your Car Accident, Workers Comp, or Disability Case

 

No matter how severe your injuries, you will not recover monies after an automobile accident, qualify for Social Security Disability Insurance or Supplemental Security Income, or receive workers compensation benefits without medical records.

 

In tort law, insurance companies use medical records to verify objective injuries and calculate damages. A failure to request and obtain medical records often means no settlement offer or proposed agreement form resulting in the entry of a Workers Compensation Award Letter.

 

Defendants are not the only persons or entities that find medical records essential to workers comp and negligence law. Civil courts, the Social Security Administration (SSA), and the Workers Compensation Commission also use medical records to confirm injuries and support damages or benefits.

 

For example, the Rules of the Workers Compensation Commission allow the state agency to dismiss your case if you do not submit supportive medical evidence within 90 days of filing a workers compensation claim. 

 

In state and federal court litigation, the court may grant a motion for summary judgment to the defendant driver or manufacturer if you offer no proof of injuries or damages beyond your testimony. 

 

And the administrative law judge (ALJ) assigned to your disability claim will issue a denial if you don’t supply medical records.

 

Unfortunately, collecting medical records for litigation is often a frustrating and time-consuming administrative task. There are many roadblocks that might make you feel that you should give up. Don’t!

 

This article explains how to get your medical records after a motor vehicle collision, work-related injury, or a physical or mental disability diagnosis. It includes a Sample Medical Records Request Letter and a Medical Information Release Form. You can use this article to build your case and recover the money, medical treatment, and cash benefits you deserve.

 

If you have questions about car accident laws, how workers comp works, or Social Security Disability, call me for a free consultation: (804) 251-1620 or (757) 810-5614. See why my fellow attorneys have voted me one of the best work comp attorneys and personal injury lawyers in Virginia – and what results I can get for you.

 

 

Are Medical Records and Other Health Information Protected and Private? 

 

Yes. 

 

There is a federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), that sets standards for protecting medical records and other personal health information. This part of the law is called the HIPAA Privacy Rule. 

 

The HIPAA Privacy Rule sets limits and restrictions on who can view and use personal health information. 

 

Who Must Follow the HIPAA Privacy Rule? 

 

All “covered entities” must follow the HIPAA Regulations and the Privacy Rule. 

 

Covered entities include: 

 

• Health Plans, including health insurance companies, self-insured company health plans, Medicare, Medicaid, and HMOs

 

• Most Health Care Providers, including doctors, surgeons, clinics, hospitals, psychologists, psychiatrists, chiropractors, nursing homes, pharmacies, and dentists

 

What Health Information Does the HIPAA Privacy Rule Protect? 

 

The HIPAA Privacy Rule applies to specific health information, whether kept electronically or in writing or given orally. This information includes:

 

• Statements and data that your doctors, surgeons, nurses, and other health care providers put in your medical record

 

• Conversations that your doctor has about your treatment with nurses and other medical providers

 

• Information found in your health insurer’s computer system

 

• Billing information

 

How Do Medical Providers Protect Personal Health Information?

 

The HIPAA Privacy Rule requires covered entities to:

 

• Put in place safeguards to protect your health information and ensure they do not disclose or use your information improperly

 

• Reasonably limit the use and disclosure of protected health information to the minimum necessary to accomplish the intended purpose.

 

• Put procedures in place to limit who can view and access health information.

 

• Train employees on protecting confidentiality and health information

 

Can I Access My Medical Records?

 

Yes. 

 

Health records are the property of the health care provider that maintains them. 

 

However, the HIPAA Privacy Rule gives you the right to ask to see and get a copy of your medical records. 

 

Many states, including Virginia, have additional laws about medical record access. For example, 12VAC5-410-1260 of the Administrative Code requires health care entities (hospitals) to keep an “accurate and complete clinical record or chart” on each patient. And Virginia Code Section 32.1-127.1:03 directs health care entities to disclose your health records to you when requested. 

 

Can I Appoint Someone to Request and Receive My Health Care Records?

 

Yes.

 

HIPAA authorizes the release of medical information to a personal representative. 

 

You get to choose a personal representative. The defendant insurance company or your medical provider doesn’t select it for you. It can be a family member, a friend, or your injury attorney or workers comp lawyer.

 

Your attorney can then request your medical records directly. 

 

What Medical Information Does My Attorney Want? 

 

I ask clients to give me a complete medical history. This information includes injuries, illnesses, disabilities, and treatment before the accident that is the subject of the claim or lawsuit, and the same information post-accident.

 

Past Medical History That is Important to Your Injury Case

 

Your attorney might ask for the following data as part of the investigation and development of your case: 

 

• A list of every mental or physical examination you have ever had for employment, insurance, selective, service, armed forces, or litigation purposes

 

• A list of all surgeries or procedures (injections, chiropractic adjustments, etc.) you underwent before the incident

 

• A list of every Functional Capacity Examination (FCE), Consultative Examination (CE), or Impairment Rating Evaluation you have had, mainly if you’ve been involved in other personal injury, workers comp, or disability cases

 

• Every accident or injury you have suffered, no matter how minor and regardless of whether it resulted in a claim for damages or benefits. There is a good chance that the insurance company will find out about it and use your failure to disclose it to attack your credibility.

 

• A list of all doctors, nurses, chiropractors, and physical therapists you’ve seen in the past 25 years

 

• Any illness or chronic condition, either before or after the motor vehicle crash, slip and fall, or workplace injury: Some chronic conditions cause symptoms similar to physical injuries. For example, psoriatic arthritis or rheumatoid arthritis can cause joint pain. The defense will use this to its advantage, and your attorney needs to know about it to counter this defense. 

 

• Any complaints, symptoms, or injuries you have ever had involving the same body part injured in the incident, as well as when the problems stopped

 

• All physical, intellectual, and emotional disabilities you had in the ten years before the incident

 

• Whether you used or took any of the following substances within the 24 hours before the incident: alcoholic beverages (beer, liquor, wine, etc.), marijuana, cocaine, or any other drug or prescription medication of any kind: This information might establish contributory negligence in auto accident claims and a willful misconduct defense in workers comp. However, you can overcome a positive post-incident drug test to win your case. 

 

• Whether you have used any illegal substance or drug in your life, including the type of drug and the period you used. This information is used by insurers to impeach credibility, though you can limit the harm with pre-trial motions and honesty. 

 

Current Medical Information That is Relevant to Your Injury Case

 

Your attorney should also ask for the following health information when investigating your case:

 

• A list of every doctor, hospital, or medical facility that you have seen for the injuries you sustained in the incident

 

• A list of any medication, vitamin, or supplement you have taken for the injuries suffered in the incident.

 

• What complaints and symptoms you have that you relate to the incident

 

• Whether any health care provider has stated that you will need future medical treatment and, if so, what type of treatment you may require

 

• Whether you have suffered any additional accidents or injuries since the incident that is the subject of the case

 

• Whether you have received any work restrictions from health care professionals

 

• Whether any medical provider has released you from care, and why. This includes both full duty and light duty releases. 

 

• Whether any medical provider has referred you to someone else, and why

 

• Whether you have had a change in your medical condition, including a new diagnosis

 

• Whether you decided to change doctors, and why

 

• Whether you have received a total body impairment rating pursuant to the AMA Guides

 

Why Does My Attorney Want All My Health Information?

 

One word: Preparation. 

 

A thorough investigation soon after the incident is essential to negotiating a far car accident settlement or winning at trial. Waiting until after filing a lawsuit or beginning the discovery process will hurt your case. It might take some time, but there will be damage. 

 

A case analysis cannot be complete without collecting all medical records and health information. I use my clients’ medical information to:

 

• Prove an objective injury

 

• Determine whether the injury caused, aggravated, exacerbated, accelerated, or flared degenerative disc disease or degenerative joint disease

 

• Assess whether there is evidence of a head injury (post-concussion syndrome, skull fracture, traumatic brain injury, etc.) that has not been addressed because of a focus on orthopedic injuries

 

• See how medical providers describe the accident and determine if I need to interview these medical providers to clear up harmful accident descriptions that affect liability or damages.

 

• Determine what medical providers can serve as expert witnesses for the damages portion of your case

 

• Decide if I need to retain expert witnesses to increase the claim’s value

 

• Calculate past medical expenses

 

• Prepare a projection of future medical costs related to the incident.

 

• Review billing information to determine potential lien holders

 

• Find diagnostic imaging results that can prove objective, severe injuries to the insurance adjuster, judge, or jury.

 

• Assess your initial complaints and how those have improved or worsened over time

 

• Decide what doctors, surgeons, nurses, and counselors might be helpful to the case.

 

• Search for indications of malingering or exaggerating symptoms that the defense might use

 

• Look for accidents or injuries suffered after the incident resulting in the claim for damages.

 

• Determine if a client might require psychological treatment for Post Traumatic Stress Disorder (PTSD), depression, or anxiety related to the incident

 

• Find ways to differentiate past injuries or chronic illnesses from current injuries and symptoms.

 

• See if there is proof of drug use or financial problems. 

 

• Assess how the insurance company might defend the case

 

• If you were hurt in a workplace accident, determine if there is a potential third-party liability claim

 

• See if the medical records support a substantial claim for pain and suffering damages

 

A good attorney can deal with bad facts. Surprises, however, are more challenging. With the above information, you and your attorney can avoid surprises during mediation, negotiation, and trial. And determine if an early settlement or more aggressive approach is best for you.

 

Sample Letter to Healthcare Provider Requesting Medical Records

 

You now know what health information is essential to your automobile accident or workers comp case. Let’s take a look at how to collect your medical reports.

 

Here is a sample medical information request letter that I send to health care providers and facilities that have treated or examined my clients.

 

[Date]

 

[Name and Address of Hospital, Physician, or Medical Facility]

 

Re: Medical Records for [Your Name]
[Your Date of Birth]
[The Last Four Digits of Your Social Security Number]
[Your Patient Account Number or Medical Record/Identification Number]
[The Date(s) of Medical Treatment]

 

Dear [Name of Physician]:

 

I represent [Your Name] in a claim based on personal injuries arising from an accident on [Date of Accident]. 

 

Please send me a copy of my client’s entire medical record, including but not limited to:

 

• Medical history forms completed by my client
• Emergency room records
• Admission and discharge records
• Consultation reports
• Nurses notes
• Test results
• X-ray interpretations
• Diagnostic imaging films and reports
• Surgical and operative notes
• Referrals
• Work status notes
• Impairment ratings
• All other documents and statements of any kind or nature

 

I am enclosing a signed medical authorization form for the requested records. 

 

I understand that you may charge a “reasonable” fee for copying the records. However, I require pre-authorization if your charge for copying the patient’s records is more than $50.00. 

 

Please send the requested records to the following email address: [Attorney’s Secured Email Address]. If you cannot produce the records in an electronic format, please mail the requested documents to me at the address on my letterhead. 

 

I look forward to receiving the requested records within thirty days, as specified under the Health Insurance Portability and Accountability Act (HIPAA). If you cannot honor my request within thirty days, please notify me of this by letter and state the date when I might expect to receive the records. 

 

Should you have any questions or need more information, please call me. 

 

Sincerely,

 

[Attorney Name]

 

Sample Medical Records Authorization Form for Use in Car Accident, Truck Accident, and Workers Compensation Litigation

 

Here is a sample medical records authorization form you can complete to help your attorney or personal representative request and obtain your health care records.

 

Though this letter may satisfy the state laws in your state, make sure you speak with a local attorney before relying on it.

 

Records Authorization Form

 

Patient Name: ____________________

 

Address: ____________________

 

Social Security Name: ____________________

 

Date of Birth: ____________________

 

Health Care Provider: ____________________

 

I have retained the law firm identified in this Authorization to represent me in specific claims. 

 

So the firm may effectively represent me, I authorize you to release the protected health information described below to the law firm. 

 

Description of Information:

 

This release applies to all documents, records, reports, nurses notes, doctors notes, progress notes, therapy notes, patient billing and charge information, intake sheets, questionnaires, X-Rays or other films, photographs, studies, or memorandum or correspondence of any kind relating to the examination, hospitalization, or treatment of all physical, psychiatric, and neurological conditions. 

 

This Authorization applies to all records both before and after the date of signature. Nothing shall be altered, modified, removed, deleted, or withheld. 

 

Recipient of Information:

 

My attorneys are [Name of Attorneys]. With those persons working for them at the offices of [Name of Law Firm], my attorneys may request and receive my medical records. 

 

My attorney’s address is [Address of Law Firm].

 

My attorney’s email address is [Attorney’s Email]. 

 

Communication with Medical Providers:

 

I authorize my attorneys to consult with any health care or mental health care provider about my injuries and conditions or any treatment or services I have received or may require. 

 

I ask you to cooperate with my attorneys when they request information.

 

Purpose of this Authorization

 

The information sought is for the my use or the use of the named law firm to prosecute any claim for damages or benefits for my personal injuries and medical conditions.

 

This Authorization covers information and documents whose disclosure is otherwise prohibited by state or federal statutes or regulations, including all HIPAA rules and regulations.

 

Expiration Date

 

This Authorization is in force for three years from the date of execution because of this case’s nature.

 

Right to Revoke this Authorization

 

I have the right to revoke this Authorization while it remains in force by giving written notice of revocation to the listed health care provider.

 

No Conditions on Treatment

 

I understand that I may refuse to sign this Authorization. My refusal to sign will not impact my ability to obtain medical treatment, my eligibility for workers compensation benefits or the payment of medical care, or the receipt of monies for damages suffered.

 

Re-Disclosure

 

I understand that the information used or disclosed may be subject to re-disclosure by the person receiving it and no longer protected by federal privacy laws and regulations.

 

Other

 

A reproduced copy of this Authorization is as valid as the original.

 

What Can I Do if My Health Care Provider Refuses to Provide Medical Records?

 

Some health care providers are slow to respond to requests for medical providers, and others refuse to produce documents at all. Both scenarios can hurt your case. 

 

My firm spends significant time requesting medical records, following up on requests, and enforcing doctors’ compliance with HIPAA and state medical records laws.

 

You have options when it comes to collecting medical evidence. The best choice for you will depend on the type of claim and where you are in the litigation process. 

 

What to Do When a Health Care Provider Refuses to Release Medical Records in a Workers Compensation Claim

 

If you are an injured worker having difficulty collecting medical records from a physician, you have two options. 

 

First, you can submit a letter to the Workers Compensation Commission asking for its assistance in obtaining health records. Your request should include a statement about how the documents are relevant to your claim and what attempts you have made to get the papers. A Deputy Commissioner with the Commission has the power to issue a subpoena to the medical provider. 

 

Second, your lawyer can serve an attorney-issued subpoena duces tecum on the medical provider, detailing the requested records and asking for a response within a reasonable time frame. This is a common occurrence during the workers comp discovery process.  

 

A subpoena duces tecum is a legal writ issued by your attorney as an officer of the court to compel the production of evidence under a penalty for failure. 

 

If the medical provider fails to produce records in response to a properly served subpoena, your attorney can submit a Motion to Compel the Production of Documents with the Commission. The Commission will then issue an Order to the medical record ordering the production of your health information. A failure to respond may result in sanctions, including monetary penalties, against the medical provider. 

 

What to Do When a Health Care Provider Doesn’t Produce Medical Documents in a Personal Injury Case

 

Collecting medical records from unresponsive health care providers in personal injury actions is similar to obtaining records in workers compensation claims.

 

If you have filed a complaint with the court and a hospital or doctor refuses to produce documents, your attorney will issue a subpoena. The health care professional’s failure to comply with the subpoena will result in your attorney filing a Motion to Compel with the court.

 

What to Do When a Health Care Provider Refuses to Release Medical Records in a Social Security Disability Claim

 

I recommend submitting medical records as part of your initial application for Social Security Disability benefits. 

 

If a treating doctor or psychologist refuses to respond to your request for records, submit a written letter to the Social Security Administration asking for its assistance. But don’t do this until you have sent at least two requests to your medical provider. The SSA has the power to issue a subpoena to health care providers; however, my experience is that you must show that you made multiple attempts to get the records on your own. 

 

Other Options if Your Medical Provider Refuses to Produce Records and Reports

 

If a medical provider denies your right to get a copy of your health records, you have four other options to use when you use the options discussed above. 

 

First, you can file a formal complaint with the health care provider. 

 

Second, you can file a formal complaint with the corporate entities affiliated with the medical provider. For example, submit a grievance to Bon Secours, HCA, or VCU Health if your doctor works for one of these organizations. 

 

Third, notify your health insurer (private insurance, Medicare, or Medicaid) of the challenges you are having. 

 

Fourth, submit a health information privacy or security complaint with the U.S. Department of Health and Human Services (HHS). 

 

Top-Rated Injury Lawyer to Help You Get Your Medical Records, Build Your Case, and Put More Money in Your Pocket

 

You’ve suffered a life-altering event. You have more important things to worry about than the administrative task of obtaining your medical records.

 

Focus on your health and recovery while my firm builds your case and helps you get every penny you deserve.

 

Call now for a free consultation: (804) 251-620 or (757) 810-5614. You have nothing to lose by calling – and much to gain.