medical records

Medical Records: Why and How We Request Them

A key role in any injury case is providing medical evidence to your injury. Your medical records will tell the story of your injury, beginning from the date you were injured until you have reached your maximum medical improvement. They can and should prove that your injuries were a direct result of someone else’s careless decisions.

Insurance companies will ask for your medical records to assess the extent of your injuries prior to any fair settlement offer. Injury claims that have thorough medical records are more likely to receive a favorable outcome. If there are incomplete records, the insurance companies will not see your injury to its full extent. Our job is to request all of your related medical records and illustrate to the insurance company the damages you suffered.

At the beginning of your case, we will ask you to sign a medical authorization. This medical authorization complies with The Health Insurance Portability and Accountability Act of 1996 (HIPPA), which protects individual’s private health information. It limits who can have access to and who can request copies of your medical records. By signing this authorization, you are giving our firm permission to do this on your behalf. This way, we take on the responsibility of obtaining all of your medical records so that you do not have to forward them to us.

Once we have your signed authorization, we begin requesting your records that very same day. In most cases, our clients seek emergency treatment after their injury. When that is the case, our firm requests those records from the ambulance, emergency room or urgent care immediately. A formal request letter along with the signed medical authorization is sent directly to the medical provider’s medical record department, usually via fax. For the most part, this is the fastest way to send a request and to receive a response to the request for the medical records.

After the initial request has been sent, we follow up with the medical records department within one to two weeks, depending on each individual facility’s procedures. It is absolutely necessary to follow up with the requests, even though it can sometimes be time consuming on our end. Too many times we have heard excuses as to why the request has not been completed. For example, the medical records department may advise that they received the request but did not follow up after putting it in the queue to be processed. Often, medical record facilities claim that they never received the request in the first place and need it to be faxed a second or even third time. Without any follow up, medical record departments have fallen short too many times.

It is vital that this process begins as early as possible, as most facilities’ standard turn-around time is thirty days. This time frame usually begins from the date that they receive the request, which does not always mean the date that we send it. Some treaters, especially hospitals or franchised providers, use third-party companies to process their medical record requests due to their large network of facilities. When a third-party company is involved, it can take even longer for the request to be logged into their queue for processing, which is when the thirty-day time frame begins.

Once we have confirmed that our medical records request has been received and is in the process to be completed, we follow up with it every one to two weeks. This ensures it is being completed in a timely manner and we receive it as soon as possible.

Often, your medical records will require a pre-payment or incur a fee for processing. We cover that invoice up-front and add it to the case expenses. As always, if there is no recovery, you will not owe us this money back.

We will repeat this process when ordering your medical records as you complete treatment with different providers. For example, you may see your primary care physician only once or twice while also consistently seeking medical treatment with a physical therapist. If you are finished with your primary care physician, we will immediately request those records even though you are still receiving treatment somewhere else. Once you have finished all of your treatment, we will then request those final records.

Requesting your records as soon as you have finished with any treater helps us review them in a timely manner. This way, we can begin organizing and building your case as we receive the records versus waiting until you have been discharged from treatment. We find this helps expedite cases to the next step, which is sending the demand package to the insurance company.

In cases where there are severe injuries, medical records may be needed in order for someone to see a specialist. Most specialists require time prior to an appointment to review records from the provider who diagnosed the injury, like the emergency room or the urgent care, as well as any radiology images. If treatment has been extensive prior to the specialist, they would require that information as well, like physical therapy appointments and steroid injections. This is often the case for people who have been diagnosed with traumatic brain injuries and concussions, people who have torn ligaments or broken bones, and people with disc herniations and bulges. This record review by the specialist prepares them for the initial appointment as well as helps them establish a new treatment plan.

Your medical records tell the story of your injury, from beginning to end. Your treating doctors document and generate all aspects of how the injury occurred, how the injury has impacted your life, and what they believe the final resolution of what your injury will be. Your medical records are essential, if not the most essential, pieces of evidence in your injury claim. They not only lay the foundation for your case; they also can help you with receiving the medical treatment you need to reach full recovery. They are the necessary proof to the insurance company that your injury from someone else’s negligence deserves adequate compensation.
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