Why Insurers Need Access to a Claimant’s Medical Records

by | Published on Aug 22, 2014 | Medical Record Review

Insurers/employers request employee medical records to make sure that he/she is receiving the right treatment; moreover, they also have to make sure that claimants are not abusing the privilege granted to them in the form of medical treatment. Any Workers’ Compensation claim involves the detailed evaluation of the employee’s medical records, and workers have to comply with the request to release their healthcare records because it is perfectly legal. Usually, the claimant will have to undergo an Independent Medical Evaluation that is scheduled by the insurer or employer, and in this case the evaluator will need a complete medical history of the injury. This is to give the best possible rating for partial/permanent disability.

The medical notes that are requested will be only those that are relevant to the work-related injury. Just as the insurer or employer requests the work injury related medical information from the employee, the employee can also request copies of medical details that are in the possession of the employer/insurer. Another important thing to know in this regard is that the treating physician can also be issued a subpoena duces tecum (a subpoena for producing evidence) for supplying the copies of the requested medical records. When a subpoena duces tecum is issued, the opposing party has a period of 30 days to note an objection to the subpoena. The subpoena will be sent to the healthcare provider if there is no objection noted. The insurer/employer will be looking for evidence that the injury being treated is indeed a work-related injury. Therefore clear medical documentation regarding the injury is of immense significance in a Workers’ Compensation case.

Lawyers dealing with personal injury and Workers’ Compensation cases benefit from precise medical summaries that save them the trouble of going through each and every piece of documented evidence. Medical records can be categorized and organized neatly, and the required summary extracted to provide a clear view of the case and its prospects. In this regard, a detailed medical case chronology is also highly relevant since it would help to lay out the medical encounters and events as and when they occurred. A lawyer/attorney armed with all the required medical evidence and a clear understanding of the case should have no problems in going ahead and winning the case.

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