Proof Is Everything: Why Your Medical Records Are Important

Why Do Insurance Companies Review Medical Records?

Doctor Writing On Patient Medical Files​The adjuster who evaluates your personal injury claim will closely look at the files you submit to substantiate your personal injury claim. If the medical bills submitted by your attorney do not match up with corresponding medical reports documenting your injuries, the adjuster will become suspicious. Any bills submitted without a matching medical report might even be wholly discounted by the adjuster, resulting in you not receiving payment for that medical expense. Follow the adage that “If it is not in the chart, it didn’t happen.”

How Can Medical Records Be Used As Evidence In a Personal Injury Claim?

Remember that it is the job of the insurance adjuster to be skeptical of the claims they see. Do not take it personally that they don’t seem to trust your claims at face value. They have an interest in questioning everything and reviewing the evidence to ensure that the claims they pay out are legitimate. Any claims that you and your injury attorney make without supporting documentation might lead the adjuster to wonder if your claim is padded or exaggerated at all.

One thing your attorney might provide the insurance adjuster is a breakdown of expenses or settlement notebook detailing all the expenses you are claiming. This file must contain a copy of every bill for which you are claiming reimbursement. Most insurance adjusters will perform a process called reconciliation and verification, which involves matching up each bill with a corresponding medical report.

Look Out for Copies

By the same token, each medical report you send should appear unique and specific to your claim. Adjusters are on the lookout for reports that appear to be generic copies run off a word processor with only the name changed. These types of reports point to certain “mills” that produce the same medical reports over and over for the purpose of gaming the insurance system. Certain doctors and health care providers might become known to insurance adjusters for this very purpose.

How Far Back Can An Insurance Company Request Medical Records?

Many insurance company will try to request records as far back as they are available (this could be 10 years or more). Your attorney can help you determine how far back you want to allow the insurance company to look into your medical history. Do not sign anything that allows the insurance company unrestricted access to your medical records, as this could lead to "fishing expeditions" in which the insurance company tries to tie unrelated pre-existing medical conditions or accidents to your current injuries. Your attorney can help you navigate these waters as well.

Get Help With Your Injury Claim Today

Make sure your personal injury claim is complete and convincing. Get help with your personal injury claim from a St. Augustine injury lawyer at Canan Law.

Call (904) 849-2266 or contact us online to discuss your case.


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