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  • Writer's pictureRobert Schuerger II

When an Insurance Adjuster Requests for Medical Records and Exams, What Is the Right Response?

There are many instances when an insurance company or an insurance adjuster requests for medical records and exams as part of ongoing investigations into the personal injury claim.

Victims do not always know how to respond to such requests, or what their rights are when it comes to requests for medical records or medical examinations.

As such, many victims in Cincinnati, Ohio, end up allowing an insurance company access to certain medical records that may end up being used against them in personal injury cases.

Whenever victims are not sure about the right steps to take, even when dealing with their own insurance company, it is best to approach an experienced attorney and ask for a free case review. They can assist with questions like What if the claims adjuster denies coverage for my injury?

Over the years, Schuerger Shunnarah Trial Attorneys has become the champion of Ohio residents seeking compensation for their medical bills, lost wages, property damage, and other damages in personal injury claims.

Victims should not sign or agree to any medical release or medical exam without first consulting one of Schuerger Shunnarah Trial Attorneys' experienced personal injury lawyers.

Why Are Medical Records and Exams Important to an Insurance Company?

Why Are Medical Records and Exams Important to an Insurance Company?

When investigating the car accident or other cause of a victim's injuries, the insurance company or its insurance adjuster may request access to certain medical records so that they can determine how much may be deemed fair compensation.

However, there are limits to what the insurance company is allowed access to.

The only reasonable times the insurance company may ask for medical records are, for example, when:

  • Determining the total cost of the medical treatment

  • Confirming that the injury claim is valid due to the injuries being related to the car accident

  • Determining the nature of any future medical expenses that may arise

Looking at these reasons, it is clear that in some cases, when an insurance adjuster or insurance company requests additional medical records, it can be a reasonable request.

However, victims should tread carefully because this may not be the only reason why the insurance company wants a peek at a medical record.

A lot of consideration is required before giving an insurance adjuster/company access to medical records.

Two Reasons to Not Sign a Medical Authorization Form

If the insurance adjuster who is requesting access to a victim's medical records works for the at-fault party's insurance company, this is a good time to pause and reconsider permitting them. Schuerger Shunnarah Trial Attorneys can answer more questions like What does an insurance adjuster do?

Here are two reasons why allowing access to a confidential medical report may not be a good idea in such cases:

  • Allowing insurance companies access to a victim's medical records could hurt their chances of winning the personal injury claim in court if the insurance adjuster finds something in their medical history they can use against them, such as a pre-existing medical condition.

  • If other medical issues unrelated to the accident injuries the victim suffered are released to the insurance company, this may become an invasion of privacy.

A Look at an Independent Medical Examination (IME)

Independent medical examinations (IME) are requests made by the insurance company to have the victims examined in a neutral doctor's office so they can have further insight into the injury claim and determine whether it is related to the accident.

An insurance company may ask for an independent medical examination if they spot something interesting in the medical records of accident victims, such as a preexisting injury, which may complicate settlement negotiations.

If an insurance adjuster asks for an independent medical examination, the victim should seek legal advice before agreeing.

Two Types of Requests for Medical Records

Not all insurance adjuster requests for medical records should be regarded as being suspicious.

Victims must remember that receiving fair compensation is a negotiation after all, so some level of cooperation with the claims adjuster may be necessary.

Experienced attorneys can help victims choose when to sign an agreement authorizing access to medical records based on how necessary the request is.

Necessary Medical Records

Certain medical records are important to an insurance adjuster's investigations and should be made available, such as:

  • Hospital discharge papers

  • Details of daily treatments

  • Any prescribed medications

  • X-rays and MRI results

Unnecessary Medical Records

Other types of medical records should not be released to the insurance company if they are unrelated to the personal injury claim, such as:

  • Medical history not related to the accident

  • Records about a pre-existing medical condition

Preventing Insurance Company Access to Medical History and Records

The following are some of the considerations accident victims should make when an insurance company tries to obtain records in preparation for a personal injury claim:

  • If the request seems reasonable, the victim may allow an insurance adjuster access to medical records granted that they provide written confirmation that they will cover any fees related to this request.

  • Authorizing the insurance adjuster free access to all the victim's medical records is not advisable. It is better that the victim receives the records first and then chooses which ones are related to the accident injuries.

  • When asked for medical records unrelated to the accident, victims should remind the insurance adjusters of their legal rights regarding privacy.

  • Victims should avoid giving recorded statements about their injuries as these will be used against them.

  • The insurance companies should not be allowed to talk directly to the victim's doctor about any medical issue whether related or unrelated to the accident without first consulting the victim's law firm.

Can Insurance Companies or Insurance Claims Adjusters Access Medical Reports Without Permission?

No one is allowed to access the victim's medical reports without written consent. Any such access will be a violation of the victim's rights and can be used against the insurance companies.

What About When Victims Need the Money Desperately?

In some cases, victims may find themselves burdened by medical bills without any wages to fall back on, leaving them desperate for money.

Insurance companies are quick to capitalize on such situations and will try to get the victim to agree to many things in their desperation, such as allowing full access to their medical records.

While waiting may be difficult, victims need to speak to an experienced attorney first.

A Personal Injury Attorney Can Help

A Personal Injury Attorney Can Help

If victims are not sure whether they should sign a medical release that will give insurance companies access to their medical records, they can approach Schuerger Shunnarah Trial Attorneys and ask for a free consultation to discuss how to serve their best interests.


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