Insurance Adjuster Requests for Medical Records and Exams

As your personal injury case proceeds, the insurance adjuster will want documentation surrounding your injuries and your medical treatment, and in some situations, you might be asked to undergo an "independent medical examination" (IME). In this article, we'll offer some pointers on dealing with these kinds of requests. (Get the basics on who insurance adjusters are and what they do.)

When the Insurance Company Requests Your Medical Records

If you've sent a demand letter as part of personal injury settlement negotiations, you probably already sent at least some medical records over to the adjuster. But they might ask for certain additional records. For example:

• If X-rays were taken, but you've provided only the records from your doctor and not from the radiologist, the adjuster might ask for the radiologist's records.
• If there is an indication of a preexisting injury, an adjuster might ask to see medical records concerning that injury.

Is the Insurance Company's Request for More Medical Records a Reasonable One?

It's up to you to decide whether the request is reasonable. If it seems to be, tell the adjuster you'll provide the records if the insurance company is willing to pay for them (health care providers often charge a small fee for preparing and sending records). If the adjuster agrees to pay for the records, confirm the agreement in writing. Then request the records yourself and review them before sending them on to the adjuster, removing any records that don't pertain to your accident injuries.

Fighting the Insurance Company's Request for Your Medical Records

Unfortunately, some adjusters like to get additional medical records just to snoop around in your medical history to see if there's anything they can use against you, or use to embarrass you. If the request for additional medical records seems overbroad—that is, not related to the injuries you suffered in the accident—politely inform the adjuster that:

• you don't believe the records are relevant to your claim, and
• that providing them would intrude into your privacy.

Remind the adjuster that if you end up filing a personal injury lawsuit in court, your lawyer and the insurance company's attorney will be able to argue over this issue, but that at this point you can see no reason to allow prying into your personal medical history. Be firm with the adjuster. There is nothing wrong or suspicious about protecting your privacy. Get details on your medical records and your privacy.

Don't Let the Insurance Company Access Your Medical Records Directly

Never sign an agreement authorizing an adjuster to directly obtain any of your medical records, and never give the adjuster verbal permission to obtain them. Always obtain records yourself. Review them to make sure they pertain only to your claim and don't unnecessarily reveal the rest of your private medical history. Then provide the adjuster with those records that pertain directly to your accident injuries.

When the Adjuster Requests a Medical Report

The records that doctors regularly keep might not provide a full explanation of a medical issue that's important to your injury claim. For example:

• your medical records might not make clear how much of your injury is likely the result of an accident, and how much might be attributable to a preexisting injury
• the prognosis or timeline for your full recovery might not be included, or
• the doctor might have told you something about long-term effects from your injuries, but not included that statement in your medical records.

You might want a report from your doctor to clarify the issue in question. If the adjuster asks for such a report, tell them you'll consider the request and will give an answer within a certain amount of time—a week or two. Then contact your doctor and find out what the report might include, and how much the doctor would charge for the report.

If it sounds like the report might do you some good, you can contact the adjuster and agree to request a report if the adjuster agrees to pay for it. If the adjuster says yes, send a confirming letter.

Learn more about initial claim discussions with an insurance adjuster.

When the Adjuster Requests an "Independent Medical Examination"

Once in a while, a personal injury claimant and an adjuster will have widely different opinions about:

• the seriousness of the claimant's injury
• the long-term or permanent effects of the injury, or
• the actual cause of the injury

If this difference of opinion can be resolved in personal injury settlement negotiations tips, the adjuster might ask whether you'd be willing to be examined by a doctor designated by the insurance company. Although these second opinions are referred to by insurance people as "independent medical examinations" (IMEs), they are anything but independent. The doctors who conduct the examinations are chosen (and paid) by insurance companies because they almost never find anything seriously wrong with an insurance claimant.

Do I Have to Agree to an Independent Medical Examination?

In most situations, you're only required to agree to (and attend) an IME if:

• you're making an injury-related claim under your own insurance policy (under your own uninsured motorist coverage, for example), or
• you've filed a personal injury lawsuit is filed).

Get tips on handling an IME as part of your injury claim.

In any other situation (such as when you're making a third party claim with the other driver's insurer), if an adjuster asks if you are willing to have an IME, politely refuse on the grounds that you don't wish to be examined by a doctor you do not know and whose opinion you have no way of judging. Remind the adjuster that if your claim later winds up in court, the insurance company can then follow the appropriate legal procedures to request an IME.

Next Steps In Your Injury Claim

Sometimes it makes sense to handle your own personal injury claim, but there are certainly situations that call for the help of an experienced legal professional. If the insurance company is hassling you over your medical records, or pushing you to attend an IME—or they're just not taking your claim seriously—it might be time to talk to a lawyer. Learn more about when you need a lawyer for a personal injury claim, and get tips on finding the right injury lawyer.

For an in-depth guide to getting the best resolution to your injury-related insurance claim or lawsuit, get How to Win Your Personal Injury Claim, by Joseph L. Matthews (Nolo).