How Far Back Do Insurance Companies Check Medical Records?

If you’ve ever filed an insurance claim for an injury or accident, you may have been asked to provide access to your medical records. Insurance companies routinely request medical records to validate claims and determine payout amounts.

But how far back can they legally access your medical history? Do they have unlimited access once you’ve filed a claim?

Understanding how far back insurance companies can check your medical records is important. You need to know your rights to privacy and how to prevent fishing expeditions into your entire medical history.

In this comprehensive guide, we’ll cover:

• What’s in your medical records
• Why insurance companies want access
• Legal retention periods for medical records
• Strategies insurance companies use to get records
• Scope limitations when sharing records
• Protecting your right to privacy
• Working with a personal injury lawyer

What’s in Your Medical Records?

Your medical records provide a detailed account of your health history. They can include records from:

• Primary care physicians
• Specialists like cardiologists, OBGYNs, and dermatologists
• Hospitals
• Urgent care clinics
• Therapists and counselors
• Dentists
• Optometrists
• Physical therapists
• Diagnostic testing facilities

Records can include information like:

• Patient history
• Diagnosis notes
• Physical exam notes
• Lab and test results
• Treatment plans
• Prescription information
• Billing/insurance records
• Correspondence between providers

Records related to an insurance claim focus on validating the injuries, diagnosis, treatment, and long-term effects. This includes records like:

• Paramedic/ambulance run sheets
• Emergency department visit notes
• Hospital admission and discharge summaries
• Radiology reports (x-rays, MRIs, CT scans)
• Physician office visit notes
• Physical therapy evaluations
• Billing codes and costs for treatment

Accurate medical records are crucial for getting a fair insurance settlement. But oversharing records can hurt your claim too.

Why Insurance Companies Request Medical Records

Insurance companies don’t request access to your medical history out of generosity. Their goal is to minimize payouts, whether through denying claims or lowball settlement offers.

Medical records give insurance adjusters ammunition to:

• Find pre-existing conditions to argue the accident didn’t solely cause the claimed injuries
• Claim treatments were excessive or unnecessary
• Argue injuries have healed or were never as severe as claimed
• Dispute the long-term impacts of injuries
• Claim prior medical issues make relapse likely

By getting unlimited access to your history, they can cherry pick benign records that weaken your claim when taken out of context.

How Long Do Medical Providers Retain Records?

Retention regulations require healthcare providers to keep medical records for a minimum time period. But specific record keeping laws vary between:

• Federal requirements under HIPAA
• State statutes and regulations
• Hospital systems and clinics individual policies

Most providers follow the general guidelines:

• Adult patient records: Minimum of 7 years from the last treatment or patient interaction. Many keep records for 10 years or longer.

• Minor patient records: Minimum of 7 years after the patient turns 18 years old. Some states mandate retaining until the patient turns 21 or 23.

• Specific types of records: Certain records have longer retention periods, like pathology slides (10 years) and x-rays (5 years).

• In cases of death: 3-10 years after date of death.

While providers aren’t obligated to keep records indefinitely, many choose longer retention periods to avoid litigation over enforcing destruction.

How Insurance Companies Try to Access Medical History

Insurance companies can’t simply demand your full medical records. They need your authorization or a court order.

Common strategies include:

Blanket Authorization Forms

Insurance adjusters often push claimants to sign blanket authorizations allowing unlimited access to medical history. This gives them free reign to obtain any record from any provider.

Don’t assume you have to comply with these requests. You can deny them or modify authorizations to only allow relevant records.

Subpoenas

Insurers can subpoena medical records from your providers. This bypasses the need for your authorization.

Subpeonas must specify what records are being requested. Make sure your attorney reviews subpoenas to prevent overreach.

Court Orders

For contentious claims, an insurer may petition the court for a order granting access to medical records or an independent exam by the insurance company’s doctor.

Court orders should limit records to just what’s needed to evaluate the insurance claim. Never assume a court order grants blanket access.

Limiting Record Requests to Relevant Providers and Timeframes

You aren’t obligated to provide unlimited medical record access. Only share records relevant to the insurance claim.

Recent Timeframe

Aim for records created around the time of the accident or injury event. Go back further only if a pre-existing condition directly relates to the claimed injuries.

Specific Providers

Only include records from providers involved in treating the claimed injuries. For example, if you have a back injury, records from your dentist or optometrist are likely irrelevant.

Review Records Before Sharing

Thoroughly review all records before sharing to redact unnecessary information protected under HIPAA or state privacy laws.

Protecting Your Rights to Medical Privacy

You have a right to keep your medical information private and prevent fishing expeditions by insurers. Here’s how to guard your rights:

• Decline blanket authorizations. Modify to only allow relevant records.
• Review and redact records before sharing.
• Get written justification for record requests. Deny vague or excessively broad requests.
• Consult a personal injury attorney before sharing records.
• Let your healthcare providers know in writing if you don’t want certain records disclosed.
• Object to subpoenas that seem like fishing expeditions.
• Consult an attorney if an insurer seeks a court order for records or an independent exam.

Partnering With a Personal Injury Lawyer

An experienced personal injury lawyer can advise you on:

• Reviewing and releasing only relevant medical records
• Drafting customized medical record authorizations
• Handling subpoenas or court orders for your records
• Communicating with healthcare providers about protecting sensitive information
• Negotiating privacy protections in any insurance claim settlement

Don’t jeopardize your injury claim by allowing the wrong records to fall into the hands of insurance companies. Understand your medical privacy rights and seek legal counsel to ensure they are protected.