Nearly every insurance company will inspect your records and other documentation with a fine tooth comb. In order to determine what (small) amount to initially offer you for your settlement, they will analyze the scope and magnitude of your injuries and subsequent treatment. If you lack concrete proof (such as records and other documents) detailing these injuries, then your chances of collecting any reasonable amount of money for damages decreases significantly and you will be left without any firepower to negotiate a counter offer.
Hiring a knowledgeable attorney can help you better understand the rules and what steps need to be taken such as how to obtain your records, as well as the other ins and outs of a personal injury claim. Contact Brian Mincher and Ryan Rogers of Godsey Martin law firm for more information.
Protecting Personal Information
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) ensures security for your personal health information (PHI). HIPAA safeguards your right to privacy, limiting who can access and receive your private information. It also grants you the legal right right to acquire copies of your medical records.
While HIPPA ensures your right to privacy, the government has also given each state the ability to control the process of how you gain your desired medical records. A few of the more common regulations include:
- Charging fees for processing and copying your records
- The time frame your medical provider has to release your records
- Limiting you to reviewing your records in your medical provider's office
- Other reasonable restrictions
Each state has different procedures in place as to how they release your records or even allow you to copy them. You can determine your state’s rules by visiting statelaws.findlaw.com. Information for laws specific to Texas can be found here.
HIPAA provides a shield around your personal medical information; an individual will not be able to obtain your records if they are unauthorized. However, if you have signed a Release of Information, then your protections is no longer valid and anyone can access your files. When filing a personal injury claim, the majority of insurance companies will ask that you sign this release so that they can have full access to your records. It is extremely important, upon signing this release, that you specify that you are only releasing documents related to the injuries directly related to your accident. You do not want to give the insurance company free entry to your entire history. In fact, doing so could lead to the adjuster trying to pin your current injuries on past events, which could potentially lower the amount of your settlement, even if there is no truth to the claim.
Independent Medical Exams
There is a difference between first party and third party insurance claims. Many insurance policies state that one must submit to an Independent Medical Exam (IME) for no-fault injuries as well as worker’s compensation claims.
Insurance companies generally ask for an IME in order to contest how serious your injuries are or if the treatment you have been receiving is actually necessary. If you signed your policy and it as an IME cause, then you have no choice but to submit to the exams. The results of these exams are easily accessed by your insurance company.
What happens if you refuse to submit to an IME? More than likely, the insurance company will turn down your claim and you won’t receive a dime for your injuries.
How is it “Independent”?
An IME is viewed as an objective opinion by the insurance company. As you might imagine, doctors that work in connection with insurance companies might be viewed as having a conflict on interest in their medical reports (even if they are straight as an arrow). Nevertheless, these doctors are hired to provide an “independent" medical assessment. Should the doctor provide several reports that go against the insurance company, you can imagine that they won’t be employed with them for long. As we always stress, the insurance companies have one goal – to save as money as possible. A doctor that hurts their case is of no use to them.
One last important note regarding IMEs. You are not automatically privy to the results. The insurance company will generally keep the information for themselves as they are legally allowed to deny you access. When this is the case, your attorney will be be able to file a motion to make the records part of “discovery” so they can view what the medical report states.
Third-party claims occur when the other driver is at fault and their insurance company is taking care of their defense. Such cases generally do not require an IME. In these instances, whatever medical records are created for your injuries are not available to the other party’s insurance company unless you grant them permission. Likewise, the other party’s records are not the at-fault driver's medical records will not be available to you either.
If the responsible party’s insurance company does hold back the medical records, you may be able to win access to them by filing a lawsuit; should your attorney be successful, the files can be attained via subpoena.
Even though you have the right to see your medical records, you will still face roadblocks and limitations along the way. HIPAA allows medical professionals to withhold some information; this could include:
- The doctor's personal notes. These include their particular impressions, notes to other doctors and staff, and items not directly related to the patient’s medical treatment.
- Information you may have told the doctors you never want to be released.
- Information the doctor believes should not be disclosed regarding the treatment of a minor.
- Information the doctor believes may cause significant harm to you or others.
- Information the doctor believes could lead to public alarm or unrest.
- Information your doctor obtained from other medical professionals who treated you at an earlier time. Such information would have to be requested from each individual doctor.
Requesting Medical Records by Written Notice
While this all seems like a lot of information, the process of requesting your medical records is really quite simple. Many doctors’ offices and medical facilities have forms on site and online that you can quickly fill out and submit. If not, you can always write a short letter requesting your records. Be sure to call the medical office beforehand to determine what information is required (generally your full name, social security number, address, DOB, etc.).
Generally, requests must be made in writing and by the individual the records belong to. An exception to the rule would involve an individual who is physically or mentally unable to make such a request. In these instances, a power of attorney would be required. Simply put, if you have an attorney, they can request all needed documents on your behalf. There are some exceptions to this requirement, including if you're physically or mentally unable. In that case, a Power of Attorney authorization signed by you may be sufficient.
Mincher and Rogers can Lead the Way
As you have seen throughout our articles, there are many steps and hoops to jump through in order to file your personal injury claim and win the money you deserve. You can go for it on your own, but the chances are high that you will not receive the settlement you are entitled to. Somewhere along the way, you will likely miss an important step or forget something minor that will allow the insurance company just enough wiggle room to get out of paying you a fair amount.
Attorneys Brian Mincher and Ryan Rogers of Godsey Martin law firm can help you make sure that all your T’s are crossed and I’s are dotted. They understand how insurance companies fight back and know every step you need to take in order to win. Allow them to lead the way for you; call 1-877-IGOTHIT or take sixty seconds to fill out our free case evaluation form and a member of our legal team will contact you shortly to discuss your accident and legal options. Do not delay justice another moment – call today!