What Medical Records Do You Need to Disclose for an Auto Accident Claim?

lock on medical fileInsurance companies frequently request medical records when evaluating auto accident claims. They will need to corroborate your records with the medical bills you submitted for compensation.

The insurance company has no inherent right to view any of your medical records unless you sign a release form giving them permission. You need to make sure you only provide access to the records that are needed to validate your claim. Oversharing could hurt the value of your auto accident claim.

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Ontario’s Health Privacy Rights

Ontario’s Personal Health Information Protection Act (PHIPA) helps protect the privacy of your personal health information. This law gives you the right to refuse or give consent to the collection, use or disclosure of personal health information. You can also withdraw your consent for the release of your personal health information.

In an injury claim, your lawyer is typically the one who accesses medical records, after receiving written authorization from the victim. The authorization the victim signs specifies the medical records that will be released.

Typically, the records obtained go back a few years before the accident. That way your lawyer can assess your life before and after the accident.

Why Insurance Companies Want Your Medical Records

They are several reasons insurance companies often request medical records during the claims process. They want to know everything about the auto accident and the damages you sustained. They need to verify your injuries before paying out compensation.

The insurance company will want to know the prognosis your treating doctor has made about your maximum medical improvement (MMI). Generally, MMI is reached when you have recovered as much as you are expected to from your injuries.

The length of your recovery will take and the types of treatment you are undergoing will affect the value of your claim. The more extensive your injuries, the more compensation you may receive. Insurance companies are looking to limit the amount owed for damages.

Medical records are also used by insurance companies to find anything they can use to diminish or deny claims. The insurance company will look for any inconsistencies in your statements since seeking treatment to argue that your injuries were caused by something other than the auto accident. If you grant them access to all your medical records, this authorization may not be limited to the auto accident.

The insurance company may get access to other information in your medical record they may try to use to damage your credibility and devalue your claim. For instance, perhaps there is a preexisting injury that you sustained in a previous auto accident. The insurance company may say that your injuries existed beforehand and were not caused by the most recent auto accident and should not be covered.

Necessary and Unnecessary Medical Records to Disclose

If a release form is not worded carefully, you may be giving the insurance company complete access to your full medical history. That is why it is important to know what medical records should and should not be disclosed to the insurance company. An experienced car accident lawyer in Windsor is here to help.

For instance, any kind of medical information not directly associated with your auto accident claim is unnecessary and may negatively impact your ability to obtain fair and just compensation. This includes records of a previous injury or medical condition you sustained in another accident.

Medical records that are deemed necessary include diagnostic and imaging tests for injuries due to your current auto accident. For instance, X-rays, CT scans or MRIs showing a traumatic brain injury. Your doctor’s notes about your prognosis and treatment could show the extent and severity of your injuries. The insurance company will likely also want to see your treatment plan and the medications you are on to make sure that you are following your doctor’s orders and taking your healing and recovery seriously.

Handling a Medical Records Request for an Accident Claim

If the insurance company requests your medical records, it is in your best interest to politely decline the request and hold off until you have spoken with a lawyer. He or she can review the request, offer legal advice, and handle any communications with the insurance company moving forward.

Insurance companies know that auto accident victims are vulnerable and may try to trick you into giving them access to unnecessary medical records so they can justify paying less for your claim. Your lawyer can help by requesting your medical records for review before sending them to the insurance company.

Limit the Authorization

Whatever you do, refrain from signing a blanket release form. You do not want to give the insurance company full access to your medical records. Limit the authorization by only listing specific medical providers who helped treat your injuries from the auto accident and the dates this care was provided.

You can redact irrelevant information that the insurance company does not need to process your claim. Otherwise, the more information you give, the more likely it could be used against you in some way.

Right to Medical Privacy

Sometimes insurance companies may request additional medical records to try and find anything else to discredit your claim. Auto accident victims have a right to privacy when it comes to their medical history. A lawyer could help fight for your rights if this request is not reasonable or related to your claim.

However, as part of the claims process, the insurance company may require that you attend an Independent Medical Examination (IME) to help prove the extent of the injuries you sustained. The medical examiner assigned will also review your medical records. If you refuse this request from the insurance company, they may have the right to deny your auto accident claim.

Learn More About Your Rights During a Free Consultation

Greg Monforton & Partners has helped many auto accident victims over the years pursue maximum compensation for their injuries. An initial consultation is free of charge. You are not obligated after meeting with us to hire our firm, but if you do, we charge no upfront fees. We only get paid if you do.

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