Should I Give My Medical Records To The Insurance Company?

A claims representative has access to your doctor or medical records only if you give them access. That means they cannot call your doctor and say, “I’m with such and such insurance company. I want the records on your patient so that we can evaluate their claim.” Your doctor cannot give that information to anyone, not even your lawyer, unless you authorize it. To grant authorization, you must sign a HIPAA authorization form. The HIPAA authorization form allows your doctor to release your medical information to those people you allow to receive it. When a client retains me, among the documents that I ask them to sign, besides a retainer agreement, is a HIPAA authorization. That way, I can obtain their medical records. The same holds true for an insurance company.

Now, if you’re dealing with an insurance company on your own, typically, they’re going to send you some documents to sign. Those documents will include an authorization so that they can get your medical records, which is reasonable. However, if you look at the authorization that the insurance company sends you, you will see that it is an authorization for your entire medical history. They can go back to your birth. They can get records from any of your doctors and get information on your medical care and your medical history that is completely unrelated to your injuries and you bodily injury claim. This is an invasion of your right to medical privacy. Why do insurance companies want an authorization that broad? The reason is that they are information vacuums. Their aim is to get your past medical history to see if there’s anything in your history that can be used to blame your current complaints on, such as a prior incident or condition, even from a long time ago for an injury or condition that has long ago resolved. If they can wrongfully blame your injuries or your need for treatment after a collision on something old or irrelevant, they’ll do it.

If you’re representing yourself, don’t sign anything until you have read and understood it. If you don’t understand it, or if you don’t agree with it, do not sign it. Yes, they’re entitled to relevant medical records that explain your injury and your treatment, but it doesn’t require them to go back years or decades into your past medical history that has nothing to do with your injuries in your current claim.

Why Do Insurance Companies Need My Medical Records?

On the surface, an insurance company’s request for medical records may seem quite reasonable. After all, they are supposed to reimburse you for medical expenses after an accident or injury. Therefore they surely need to know and understand what those expenses are.

However, there is a vast difference between what insurance companies need, and the medical records they want. Insurance companies will often request medical records going back much much further than necessary, sometimes, all the way to your birth.

Knowing your entire medical history offers two main advantages to insurance companies. First, they might be able to find an alternate or contributing explanation for why you needed a specific medical intervention, thus diminishing the amount they need to pay you. Second, this extensive medical history could also be used to better assess your risk to them as a client, potentially leading to higher premiums.

Ultimately it might make sense for insurance companies to request and use recent medical history. Legally, you may be obliged to surrender some of it to be compensated. But in practice, the amount of personal medical information insurance companies seek is far greater, and you should always be careful what you sign over.

What Will An Insurance Company Do With My Medical Records?

In theory, an insurance company will only use the medical records you share after an accident to assess your injury and determine compensation. They need to see what surgeries you needed, what prescriptions you had to fill, and which doctors were involved. In practice, however, they are eager to put medical records to use to find ways to pay you less, not more, compensation.

In the immediate aftermath of an accident or injury, this may mean looking back through your medical records and history to identify pre-existing conditions. These prior medical issues, they will argue, could be the true cause of the medical care you needed or could have exacerbated the injury. In other words, their policy shouldn’t have to cover some or all of your expenses.

The other, more long-term, desire for medical records comes from the ongoing process of underwriting. Underwriting is their term for assessing your risk to them as a client, how much they are likely to have to pay you in the future, and thus how much they should charge you in the present. In other words, they may decide to charge you more each month.

Finally, an insurance company could use your future medical records to assess whether a compensation plan, such as disability payments, is still needed. If your employer’s insurance is paying you monthly after a workplace accident, but records show you stopped going to physical therapy or have completely recovered, they could use that as a reason to stop paying the disability coverage.

Is It Safe To Tell My Doctor Everything Concerning My Health, Injuries, And My Health History? Will Any Preexisting Conditions Be Used Against Me?

It is not only safe to tell your doctor about your health, your injuries, and your health history. You must give this information to your doctor if you want him to be able to provide the best medical care he can. You must tell the truth in all circumstances, especially to your doctor. If you’re going to rely upon your doctor to help you he or she needs to know the truth about your injuries and your relevant medical history. Your doctor is going to ask you, or give you papers to fill out, inquiring about your past medical history. If you don’t give your doctor accurate information, he or she will not have the information that they need to correctly diagnose your condition or treat you correctly. Why consult with a doctor if you’re not going to be honest and give the information needed to treat you? Again, the cardinal rule is to be honest and tell the truth. Remember, your credibility is at stake. Once you lose your credibility, it cannot be recaptured. Any lack of credibility or honesty can follow you throughout your entire case, all the way to a jury.

Juries Are Very Suspicious To Begin With

Any evidence that you hide, gives them a reason to decide the case against you. Not only do you risk your own credibility if you don’t accurately tell the doctor about your injuries and past medical history, but your doctor who is trying to help you will likely to turn against you. If your doctor is professionally embarrassed when confronted with the fact that their favorable opinions are based on inaccurate or incomplete information that you provided, he will not be inclined to further help your case. Therefore, tell the doctor everything that they need to know. Most importantly, tell them the truth.

In regard to preexisting conditions, yes, the insurance company will try to use them against you in your personal injury case. That is where we come to the crux of the question, “Is it safe to tell your doctor everything?” Yes, it is safe. However, the real concern behind that question is the fear that a prior condition or injury will hurt your case. It is understandable that you may worry that you will not be believed when you say you injured your neck, your back, your knee or your shoulder if you’ve had chronic pain, or prior injuries or treatment to those parts of your body. Common sense tells you that having a preexisting condition is potentially a bad thing for your case. You may naturally want to avoid or minimize it. However, I am here to tell you that preexisting conditions are not as bad as you might think. In fact, I use my clients’ preexisting conditions to great advantage to make their cases stronger.

The Danger Is Not In Admitting The Existence Of Your Past Conditions

The danger, the absolutely worst thing you can do is fall into the trap of denying or inaccurately minimizing a preexisting condition. Because if you do that, you will get caught in a lie that the insurance company will use to suggest your entire claim is fraudulent or that you cannot be relied upon to tell the truth. That is what ruins good cases and brings bad results in settlements and trial. Rest assured, if you have a preexisting condition in your records, the insurance company is going to become aware of it. If you deny or minimize it when you shouldn’t, you fall into their trap from which there are few escapes. Your credibility will be severely damaged. Then, even when you’re telling the truth about other matters, the insurance claims representative, judge, jury, or anybody else involved in your case, will not know whether to believe you or not.

How Can A Preexisting Condition Be Used To Help You?

How can a preexisting condition be used to help prove that you were injured? It’s easy. First, by admitting it in the first place, you’re establishing your honesty, integrity, and credibility. That makes your other testimony or statements immediately believable. People that tell the truth and admit things that they might otherwise be inclined to deny are seen as truth-tellers. Once you’re seen as a truth-teller, you’re golden. Second, once you’ve been injured, or if you have an ongoing medical problem or pain, it’s far easier for you to get injured or to aggravate that condition in a second injury producing incident. That helps explain why and how you were injured in the incident that led to your claim. It is why you need more medical care than a previously uninjured person might need. It’s why your injury didn’t go away. It’s why you need more care than the insurance company would expect. It’s why you are more susceptible to being injured in the first place. In other words, a preexisting condition helps explain and justify a larger and more serious claim.

Preexisting conditions allow me, as an attorney, and your doctor, to explain why the defendant’s negligent act was like kicking someone when they’re already down. That’s an analogy that juries understand. They empathize with how hard your situation is to deal with in addition to life’s other obstacles. They can take note of how you’re valiantly, bravely, and successfully coping with your problems while this incident is pushing your life over the edge and making everything else far worse.

Finally, your medical records that show your prior injury or condition provides us with what is known as a baseline. A baseline shows the specific nature of your prior condition. It shows how the condition affected your day-to-day life or ability to engage in what is called activities of daily living (ADL). We can then compare your pre accident baseline with your new baseline to show your increased complaints of pain, increased need for medical care and treatment, or reduced ability to engage in your ADLs. This new and changed information is absolute gold in the claims process. Therefore, you don’t want to mess that up by covering up or lying about your preexisting conditions.

For more information on Personal Injury Insurance Laws In California, a personalized consultation is your next best step. Get the information and legal answers you are seeking by calling (818) 530-1770 today.