How far back can an insurance company go in requesting past medical records?
Question: “I had a car accident and herniated a disc. The claims adjuster sent a form telling me to sign letting them get medical records going back 15 years. Can insurance companies demand medical records going back years?”
The quick answer is that a reasonable request for medical records before an accident may sometimes be OK.
At the same time this raises serious questions.
Do insurance companies have a right to snoop into previous medical records not related to an accident case?
If “reasonable” requests for old medical records are OK what does that mean?
What justifies insurance companies digging around for old medical records?
My medical records are confidential, how is it the insurance company’s business?
Insurance inquiries for past medical records
Insurance companies love prying into old medical records of those with claims after an accident. You may suffer injuries from a car accident. Your medical treatment may stem from a slip and fall injury. Insurance companies love snooping into your past medical problems in an injury claim:
“Allstate lawyers typically ask policyholders to produce their personal medical records for their entire lifetime, no matter when they occurred.”
From Good Hands to Boxing Gloves, David Berardinelli, p. 112.
That focuses on Allstate. But five or more major U.S. insurance companies hired the same consultant and adopted similar aggressive claim practices. They ask for personal medical records for an injured person’s “entire lifetime”. Why do they request the information? To embarrass the person making the claim and weaken their insurance claim. You can fact check the source of these statements down in the footnotes.
If an insurance adjuster sends you an open ended authorization to get your medical records remember the above. Ask yourself and the adjuster whether it’s relevant to your case. Never sign an open-ended medical release.
How far back can insurance companies go to get your medical records?
An experienced personal injury attorney handling an accident claim will obtain all relevant records for you. After reviewing the records we will tell you if issues exist that could hurt your case. In a perfect world, if you have never had an accident before or if the part of your body injured in your accident has never been injured before, it is none of the insurance company’s business what your previous medical records say.
At the same time the world is not perfect. If medical records show something relevant to the accident claim you still don’t throw in the towel and sign a blank medical release. Specifically what is relevant?
Insurance companies love going on “fishing expeditions” looking for anything and anything that might be out there to hurt your case. You may have had an old sports injury in high school. You might have seen a physical therapist or chiropractor previously. Insurance adjusters want to “go fishing” to find something they can use against you.
What is the law on preexisting injuries?
The law holds that where someone causes an injury that combines with a preexisting condition, causing additional harm, the negligent party is liable for all the consequences. So, even if some medical issue existed before your accident, the person who caused your accident, and in this context their insurance company, faces legal responsibility for the extent to which the accident made that condition worse. The law labels this exacerbation. In short, it means the person who caused the accident holds responsibility for the combined effects of the harmful results of his/her wrongful act and any pre-existing disease or condition.
The bottom line here tells us that the insurance company wants to rub your nose in any imperfection in your pre accident medical condition. But the law supports your claim that the accident took you as you were before the accident and caused additional harm.
Caution in rejecting all insurance medical requests
Nothing here tells you to do anything other than to be fully honest and truthful. We all know there are ways to be taken advantage of, and in this context that includes insurance companies looking at your injury claim. At the same time there are ways to be fully truthful and honest but at the same time refuse to allow the insurance company handling your accident case take advantage of you.
Red flags go up in dealing with your own insurance company. When you seek payment of your own medical bills either from “PIP” in a no-fault state or “Med Pay” elsewhere, this is your own insurance company. In the small print of your insurance policy you agree to reasonably cooperate with the insurance company.
There have been cases in which those injured in accidents submitted medical bills to their own insurance company. The company requested medical records for the pre-existing condition to determine whether accident treatment was reasonable and necessary. And where the person injured in the accident refused to allow the release of prior medical records, the insurance company denied payment of medical bills.
As indicated in the case noted below against Plymouth Rock Assurance Corp., insurance companies impose a duty to cooperate with your own insurance company. That duty, fortunately or unfortunately, finds support in court. At the same time, the law does not support an all-out fishing expedition by insurance companies for all of your medical records before an accident.
When Do I Allow an Insurance Company to Get my Pre Accident Medical Records?
Courts only allow relevant evidence. So why should insurance companies pry into irrelevant records? As documented before, such insurance probes intend only to embarrass you and reduce the value of your case.
Legal definitions of relevance in most states require that evidence allowed in court must be more probative than prejudicial. That means in the context of old medical records, insurance companies might be able to use records that show a relevant condition to which their negligent person caused a worsening.
At the same time insurance adjusters and their lawyers attempting simply to embarrass or fuzzy up the issues will likely find no friend in court. Knowing this provides insight when insurance companies send out open ended requests for any and all medical records going back to the beginning of time.
The author of this article, Andrew D. Myers, practices personal injury law in Massachusetts and New Hampshire.
Photo model: Courtney Babel
Anderson v. Plymouth Rock Assurance Corp., 2009 Mass.App.Div. 11, (2009). (PIP claim denied where claimant refused to allow request for relevant prior medical records.)
From Good Hands to Boxing Gloves, David Berardinelli, Trial Guides, LLC, 2008.
HIPAA & Medical Record Confidentiality, HHS.gov.
Mongeon v. Arbella Mutual Ins. Co., 2004 MASUP, 2002105. (Aggravation of pre-existing injury.)