Medical records for a car accident claim: your rights, fees and what to ask for

Why records and bills carry the claim#

An insurer will not pay for an injury it cannot see on paper. Medical records show what was wrong, when it was first noted, what treatment followed and what the doctors expect next. Bills show what that care cost. Together they are the core of the damages part of any injury claim, and the demand letter is built on them.

Adjusters read records closely for three things: how soon after the crash you were first seen, whether there are gaps in treatment, and whether anything in your history suggests an earlier injury. A record that says "patient reports pain since car accident on March 3" links the injury to the crash in a way your own account cannot. Our injury guides describe the injuries most often seen after crashes.

Your right of access under HIPAA#

HIPAA gives you the right to see and get copies of the health information that doctors, hospitals, other providers and health plans keep about you. The right covers your designated record setDesignated record set. The records a health care provider or health plan keeps about you and uses to make decisions, including medical and billing records. Your HIPAA right of access covers these records. Glossary, which for a provider means medical records and billing records. So you can ask for your bills and payment records, not only your chart.

A provider may require your request in writing, as long as it tells you so. It must then act within 30 days of receiving it. If it cannot, it may take up to 30 days more, but only once, and only if it tells you in writing within the first period why it needs more time and when you will get the records.

You can choose how you receive them. The provider must give you access in the form and format you ask for if it is readily producible, including an electronic copy of records kept electronically. That includes imaging: you can ask for X-ray, CT or MRI images on a disc or through a patient portal, along with the radiologist's written report.

What providers may charge#

Copy fees are limited. Under HIPAA, a provider may charge a reasonable, cost-based fee that covers only labor for copying, supplies, postage and, if you agree to one, preparing a summary. HHS says the fee may not include the time spent searching for and retrieving records, and that per-page fees are not allowed for copies of records kept electronically.

HHS describes three ways to work out the fee: actual costs, a schedule of average costs, or, for an electronic copy of records kept electronically, a flat fee of up to $6.50, including labor, supplies and postage. The flat fee is an option, not a cap on every request.

What to request for a claim#

Ask each provider for everything tied to the crash, and keep the requests specific. Some providers bill separately and are easy to miss, such as the ambulance service, the emergency physicians' group and the radiology group.

Itemized bills matter more than summary statements. A summary showing a single balance does not tell an adjuster what each charge was for. Payment records matter too, because a health plan, PIP insurer or Medicare that paid may be repaid from your settlement. Our guide to medical liens and subrogation explains how that works.

How to request your records#

1. List every provider. Include the ambulance, the emergency room, every doctor and therapist, imaging centers, and providers that bill separately.
2. Put the request in writing. Use the provider's form if it has one, or a short letter with your name, date of birth, the dates of service and the records you want.
3. Ask for itemized bills separately. Billing offices often handle these apart from the records department.
4. Choose the format. Ask for electronic copies through a portal or by email if you want them faster, and for images on a disc or by link.
5. Ask about the fee first. Request an estimate before copies are made.
6. Track the date. Note when each request was received. If nothing arrives within 30 days and you have no written extension notice, follow up in writing.
7. Check what arrives. Compare it with your own list of visits, tests and dates, and ask for anything missing.

If a provider refuses or ignores a request, you can complain to the HHS Office for Civil Rights, which enforces HIPAA.

HIPAA authorizations insurers send#

Instead of waiting for you to collect records, an adjusterInsurance adjuster. The insurance company employee who investigates a claim, decides what the policy covers and negotiates payment. Glossary may send a hipaa authorizationHIPAA authorization. A signed form that lets a doctor, hospital or other provider release your health information to someone else, such as an insurer. It must say what is released, to whom, why and when it expires. Glossary to sign. It lets the insurer get records straight from your providers. A valid authorization must state what will be released, who may release it, who may receive it, the purpose, an expiration date or event, and your signature and date. You can take it back at any time, in writing, except for anything already done in reliance on it.

The questions to ask are about scope. Does it cover only providers who treated you after the crash, or anyone who has ever seen you? Does it cover a few years, or your whole life? When does it expire? Some records have extra protection: under HIPAA, psychotherapy notes generally need their own separate authorization.

A claims checklist published on the District of Columbia insurance regulator's website puts the caution bluntly: "Do not sign an authorization form giving the insurer permission to look at your entire medical history." Many people instead collect the crash-related records themselves and send copies, or ask for a narrower authorization limited by dates and providers. Our guide to recorded statements covers the other early requests insurers make.

Your own insurer is different. A claim on your own policy usually means cooperating with record requests, and some states give the insurer direct rights. In Florida, for example, providers must, if the PIP insurer asks, send a report on your history, condition, treatment and costs and let it inspect and copy the records.

Keep one claim file#

Set up one folder, paper or digital, and keep everything in it as it arrives:

• every records request, with the date sent and the date received;
• records and itemized bills, sorted by provider;
• explanation-of-benefits statements and any lien letters;
• receipts for prescriptions, equipment and travel to appointments;
• notes from work about missed days and limits;
• a short journal of pain, sleep and daily activities.

A simple table helps: provider, dates of service, total billed, amounts paid and by whom. It makes the demand letter easier to write and shows at a glance what is still owed. Our claim process guide shows where this file fits in the steps ahead.