You Must Provide the Insurance Company with Relevant Medical Records if You Have a Pending Workers Compensation Claim or are Receiving Benefits


Ask any Virginia workers comp attorney to name the most important part of your claim and he or she will tell you that it’s the medical evidence. This article explains what medical records you have to turn over to the insurance company in a workers compensation claim and what records you do not. If you have any questions about the workers comp discovery process or are looking for legal representation, call, text, or email Corey Pollard for a free consultation. We’ve helped hundreds of injured employees get approved for benefits and receive top-dollar lump sum settlements in their workers comp case.


When Do I Turn Over Medical Records in My Workers Compensation Case?


After you file a claim for benefits with the Virginia Workers’ Compensation Commission your employer’s insurance carrier will ask you either to send them copies of your medical records or to complete a medical records release form, which allows the insurance company to request your medical records. Most injured employees do not like this and see it as a violation of their privacy and their rights under HIPAA. On the other hand the insurance company sees it as a necessary step to determine whether it has to pay workers comp benefits and what type of medical treatment you need to get better if the injury is covered under the Virginia Workers’ Compensation Act. The insurance carrier also wants your medical records so that it can send them to their in-house medical evaluators or an outside doctor who will conduct an Independent Medical Evaluation (IME).


Many injured employees contact me when the insurance company starts investigating their medical history. A common question is, “Does my employer and its insurer have the right to see all my medical records?”


The answer is no. Your employer and its insurer are only entitled to your relevant medical records.


Under the Rules of the Virginia Workers Compensation Commission each party must provide the opposing party with copies of all relevant medical documents as they are received. A party cannot wait until the day before hearing to turn over medical records it has had all along.


The employer and insurer are entitled to your medical records if they are related to your work injury or if they are related to treatment you received for the body part injured in the accident in the five-year period prior to the accident. In other words the insurance carrier is entitled to records related to past treatment for the body part injured in this accident, provided they don’t ask for records from too long ago. If a medical records is unrelated to the work injury, you don’t have to turn it over.


Though the insurer will ask you to send copies of all medical records in your possession, they are more interested in receiving a list of all medical providers you have treated with for the work injury. This way the insurer can issue a subpoena duces tecum to the medical provider. If the subpoena is served properly then the medical provider must turn over the medical records requested.


Because the employer and its insurer will request records from your medical providers, you should always tell your doctors about the work accident. If the medical records indicate that you do not know how the injury happened or are silent on the cause, you will have difficulty winning your case at trial.


If you have specific medical records that you are worried about the insurance company getting ahold of, tell your workers comp attorney. That way your attorney can make sure that the insurance company complies with the rules and applicable law and does not get any medical records outside the scope of your claim.


If you have any questions about medical records in your Virginia workers comp case, call, text, or email us.


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