Medical records can play a major role in a personal injury claim. They document your symptoms, diagnoses, treatment, medical expenses, and, in some cases, whether an injury is expected to cause lasting problems. They can also help establish when symptoms began and how your condition changed after an accident.
Your medical file can also contain information that insurers may scrutinize, including gaps in treatment, prior complaints involving the same part of the body, or notes that appear inconsistent with other evidence. Reviewing your records can help you understand what they show before important claim decisions are made.
The old advice on this topic sometimes amounts to “hand over nothing,” but that is not always practical or accurate. Some disclosure may be required depending on the type of claim, applicable insurance policy, and whether litigation has begun. Other requests may be broader than necessary.
Your medical records are an important part of a personal injury claim. What follows is what to collect, how records can help establish causation and damages, what to do about gaps or errors, and what to consider when an insurer asks for access.
Why Are Medical Records Important in a Personal Injury Claim?
Medical records provide contemporaneous documentation from the health care professionals who evaluated and treated you. They can support your account of what happened, although they may also contain patient-reported information, medical opinions, incomplete histories, or occasional errors.
Records can serve several important purposes. They document that an injury exists and how it was treated. They may help connect that injury to an accident through timing, reported symptoms, diagnostic findings, and the history provided to medical professionals. They also document treatment costs and other information relevant to damages.
Insurers commonly examine medical records closely when evaluating claims. Consistent treatment and symptom reporting may strengthen the documentation supporting a claim, while unexplained gaps, conflicting descriptions, or prior treatment for similar complaints can lead to additional questions.
What Medical Records Should You Keep After an Accident?
Keep more than the discharge summary. A complete file may include:
- Emergency and urgent care records, including triage notes and the initial complaint
- Imaging and radiology reports, not just the images themselves
- Specialist and follow-up notes from orthopedists, neurologists, pain management providers, and other treating professionals
- Physical therapy records, which may document changes in mobility, strength, pain, and function over time
- Prescription history, showing medications prescribed as part of your treatment
- Medical bills and insurance statements, including explanations of benefits, payment information, and any balances you owe
- Relevant mental health treatment records, when emotional or psychological injuries are part of the claim. Mental health information may receive additional privacy or privilege protections, and separately maintained psychotherapy notes are treated differently under federal privacy law.
Keep your own notes as well. A short record of pain levels, missed work, and activities you could not perform can supplement the medical documentation and sit alongside other evidence in an injury claim rather than replacing it.
How Do Medical Records Prove Causation and Damages?
Medical records can be especially important when causation is disputed.
Insurers may argue that an injury existed before the accident, resulted from another event, or is not as closely connected to the incident as the claimant alleges. Records showing when symptoms appeared, what the patient reported, and how the condition developed can help address those arguments.
Prompt medical evaluation can make it easier to document when symptoms began and how the injury occurred. A delay in treatment does not necessarily defeat a claim, but it may create additional questions about causation that need to be explained.
A pre-existing condition does not automatically prevent recovery. Depending on the law that applies, a person may be able to recover damages when an accident worsens or aggravates an existing condition. In those situations, records from before and after the accident may help a medical professional explain what changed.
Whether a pre-existing condition affects your claim often depends on the nature of the prior condition, the injuries claimed after the accident, and the medical evidence connecting the two.
Medical records also help document damages. They may show what treatment has already been provided, what medical expenses were incurred, whether additional care is expected, and whether medical professionals have imposed work restrictions or identified long-term limitations.
What If There Are Gaps in Your Medical Treatment?
A gap in treatment is a period in which medical care stops or becomes less frequent. Insurers may question whether a lengthy unexplained gap means symptoms improved or whether later complaints are related to another cause.
Many gaps have ordinary explanations. A patient may lack insurance, transportation, or childcare. A specialist may have a long wait for appointments. Work obligations or delays in obtaining authorization for treatment may also interfere with care.
When possible, explain these circumstances to your provider so the reason for the interruption can be documented. It may also help to keep supporting information, such as referral dates, appointment records, denied authorizations, or other documentation showing why treatment was delayed.
If treatment ends because a provider believes additional visits are unnecessary or unlikely to help, having that decision reflected in the medical record is generally more informative than having the record simply stop without explanation.
Getting Copies of Your Own Records
The HIPAA Privacy Rule generally gives you the right to inspect or obtain copies of health information about you maintained in a designated record set by a HIPAA-covered health care provider or health plan.
A covered entity generally must act on a request within 30 days. One additional period of up to 30 days is permitted if the provider or health plan gives you written notice explaining the reason for the delay and stating when the request will be completed.
Fees are generally limited to reasonable, cost-based charges associated with copying the records, supplies, postage when applicable, and certain agreed-upon summaries or explanations. General retrieval fees and administrative overhead are not part of the permitted HIPAA access fee, and per-page charges generally should not be used for records produced electronically.
There are circumstances in which access may be denied. When a request is denied, the covered entity generally must provide the denial in writing and explain the basis for it, any review rights that apply, and how to file a complaint.
Can Insurance Companies Request Your Medical Records?
Yes, but the answer is more complicated than simply “never sign anything.”
If you are seeking benefits under your own insurance policy, the policy may contain cooperation provisions requiring you to provide information reasonably related to the claim. The exact obligation depends on the policy language and applicable state law, so refusing every request outright may create problems.
Once litigation begins, relevant medical records may also be obtainable through formal discovery procedures even if the claimant does not voluntarily sign an insurer's authorization. The permissible scope depends on relevance, proportionality, privilege, applicable state law, and the injuries actually placed at issue.
That does not mean every authorization an insurer presents should automatically be signed as written. Depending on the type of claim, the policy involved, and applicable law, there may be room to limit an authorization to records reasonably related to the injuries being claimed.
Areas that may deserve close attention include:
- The body parts and medical conditions covered by the authorization
- The time period the authorization reaches
- Which providers or facilities are included
- Whether particularly sensitive or unrelated records are being requested
- Whether records can be reviewed by you or your attorney before being produced
A request tied to a particular injury or treatment period is different from an authorization seeking unrestricted access to a person's entire medical history.
How to Correct Errors in Your Medical Records
Errors can appear in medical records, including incorrect dates, inaccurate histories, or information copied forward from an earlier note. Federal law gives patients the right to request an amendment of their records when protected health information in a designated record set is inaccurate or incomplete.
- Submit the request in writing if required. A provider may require you to make the request in writing and explain why the information should be amended.
- Expect a response within 60 days. One additional period of up to 30 days is permitted if the provider gives written notice explaining the delay.
- If the request is granted, the provider must appropriately identify the affected records and append or otherwise link the amendment to them. The provider must also make reasonable efforts to notify certain people or organizations that received the information and may rely on it.
- If the request is denied, the denial generally must be provided in writing and explain the basis for the decision.
- You may submit a statement of disagreement. If the provider refuses the requested amendment, you may be able to submit a written statement explaining why you disagree. That statement, or an accurate summary of it, generally must accompany certain future disclosures of the disputed information.
The amendment process does not require a provider to change a professional medical opinion simply because the patient disagrees with it. It can, however, provide a formal process for addressing factual inaccuracies or incomplete information.
How a Lawyer Handles the Records Side of a Claim
Managing medical records is an important part of building and evaluating an injury claim. It can involve identifying all relevant providers, obtaining complete records, reviewing them for gaps or inconsistencies, and determining whether an insurer's request reaches information that is unrelated or unnecessarily broad.
An attorney can also evaluate whether additional records are needed to establish causation, document a pre-existing condition, support future medical needs, or explain an interruption in treatment.
Medical records help show what happened medically after an accident. How negligence laws affect your claim is a separate question that determines whether another party may be legally responsible for those losses.
Frequently Asked Questions About Medical Records and Injury Claims
How long does a provider have to give me my records?
Under the HIPAA Privacy Rule, a covered health care provider or health plan generally must act on an access request within 30 days. One additional period of up to 30 days is permitted if you receive written notice explaining the delay and stating when the request will be completed.
Providers may require a request to be in writing if they inform patients of that requirement. If you believe your HIPAA access rights have been violated, you may file a complaint with the federal Office for Civil Rights.
Can I be charged for copies of my own records?
Yes, but HIPAA generally limits the fee to reasonable, cost-based charges associated with copying, supplies, postage when applicable, and certain summaries or explanations you agree to receive.
General retrieval fees and administrative overhead are not part of the permitted HIPAA access fee. Per-page fees generally should not be imposed when records are provided electronically.
Will a pre-existing condition ruin my claim?
Not necessarily. A pre-existing condition does not automatically prevent someone from recovering compensation. Depending on applicable state law and the facts of the case, an injured person may be able to seek damages when an accident aggravates or worsens an existing condition.
Medical records from before and after the accident can be especially important because they help establish what the person's condition was beforehand and what changed afterward.
Should I sign the authorization the adjuster sent me?
Read it carefully before signing.
An insurer may have a legitimate need for medical information relevant to your claim, and an insured person's policy may impose certain cooperation requirements. At the same time, an authorization can sometimes reach much further than the injuries or treatment actually at issue.
Depending on the circumstances and applicable law, it may be appropriate to discuss narrowing the time period, providers, medical conditions, or categories of records covered by the authorization.
Call Brandon J. Broderick For Legal Help
Medical records can have a major effect on how a personal injury claim is evaluated. They may help establish what injuries occurred, how they affected your life, what treatment was required, and whether additional care may be necessary.
Our team can collect and review relevant medical records, identify issues that may need to be addressed, and evaluate requests from insurance companies for medical information. Reach out today for a free consultation.