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.
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.
All “covered entities” must follow the HIPAA Regulations and the Privacy Rule.
Covered entities include:
The HIPAA Privacy Rule applies to specific health information, whether kept electronically or in writing or given orally. This information includes:
The HIPAA Privacy Rule requires covered entities to:
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.
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.
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.
Your attorney might ask for the following data as part of the investigation and development of your case:
Your attorney should also ask for the following health information when investigating your case:
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:
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.
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:
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]
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.
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.
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.
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.
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.
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.
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.
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.