Medical Records: Your Rights

Approximately 62 million people sought medical attention for injuries in 2021. Typically, in individual injury cases, the liable insurance company will ask for a copy of your medical records to prove the extent of your injuries. For an insurance company to decide whether to pay compensation for a personal injury, they need to know the extent of the injury. In addition, they need to know whether you have pre-existing conditions. In personal injury lawsuits, you may be obligated to release your medical records if ordered to do so by a court. Obtaining your medical history can be complicated, so it is important to know all your rights.

An accurate and concise summary of a patient's medical history is indispensable in personal injury lawsuits. According to the Federal Health Information Portability and Accountability Act (HIPAA), all covered entities (i.e., health plans and healthcare providers) are obligated to provide individuals or the entity of your choice, upon request, with their protected health information (PHI). No matter when your records were created, you have the right to unrestricted access to your PHI as long as it is protected by a covered entity. You will need your medical records if you or a loved one wishes to pursue compensation for a personal injury claim. Below, we provide information about your rights to your records and how you can obtain them in this article. 

The Federal Health Information Portability and Accountability Act (HIPAA)

HIPAA's privacy standards permit the essential use of information while protecting the identity and privacy of the patient receiving care. HIPAA is a federal law that establishes standards to protect individuals' medical information and documentation (defined as "protected health information" or PHI). Under HIPAA, the privacy rule ensures that covered entities safeguard the use and disclosure of an individual's PHI to protect the patient's privacy and sets certain limitations on how this information can be used. Covered entities are health plans, healthcare clearinghouses, and healthcare providers who electronically transmit health information in connection with transactions.

The Privacy Rule ensures that individuals' health information is protected by covered entities while still allowing vital health information needed to provide and promote excellent healthcare and to protect the public's overall health. The privacy rule applies to all transactional conduct, including all electronic transactions.

Do You Have to Release Your Medical Records?

While you will likely need to disclose some of your records, you must only release the documents relevant to your claim. You have the right to keep everything else private. Only you or your representative can access and review your records. A healthcare provider may send copies of your documents to another covered entity as needed for treatment or payment or with your permission. The Privacy Rule requires all HIPAA-covered entities to provide individuals with access to their PHI upon request, and this includes the right to inspect the copy and direct the covered entity to where to transfer a copy of your PHI to the entity of your choice. 

However, while you are not always obligated to release your medical records in their entirety, medical records are a significant part of your personal injury claim because they can prove that you suffered an injury from an accident caused by another party's negligence. In the instance of personal injury claims, you may be legally obligated to release your medical records if you are ordered by a court, which generally happens when a lawsuit is filed. However, though you need to provide relevant medical records to validate your claim, you should talk to an attorney first. 

How To Get a Copy of Your Medical Records

All healthcare providers, hospitals, and other healthcare facilities must provide a copy of a patient's health record upon their written request, attorney, or any other authorized representative’s request. According to the Privacy Rule, you can inspect, review, and receive copies of your medical and billing records held by covered entity health care providers and plans. It is important to note that your provider cannot deny you a copy of your records because you have yet to pay an outstanding bill. However, a  provider may charge for the reasonable costs of copying and mailing the records. 

1. Check Your Provider's Patient Portal

If your provider has an online patient portal, you can request your records through the website's record request page. A patient portal is a secure website where patients can contact their providers, make appointments, and review lab results. However, the information you need is unavailable through the patient portal. In that case, other ways exist to request your records from your provider. 

2. Check Your Provider's Website

While most providers conduct their record requests through their respective patient portals, if you need access to your records through your portal, you should refer to your doctor or provider's website for instructions on retrieving these records via their selected portal interface. 

3. Call Your Provider's Office

Accessing, maintaining, and reading your medical record is your right. Suppose you or a loved one are experiencing difficulty retrieving medical records online. In that case, it is essential to contact your provider to ensure that you have options to obtain access to your documents. If you have questions regarding access to your or a loved one's medical records, or you'd like to discuss the content of your records, please refer to the instructions on your provider's website. 

4. Fill Out a Request Form

The HIPAA release form must be obtained from a patient before their protected health information can be shared with other individuals or organizations, except for routine disclosures for treatment, payment, or healthcare operations permitted by the HIPAA Privacy Rule. Suppose you accessed your PHI via a patient portal. In that case, your provider will include the appropriate release form before you view any records. 

Your provider's medical request release form may be organized differently (as there is no standard form). Still, these are the questions you're likely to see or need to answer to retrieve your records:

• Your name, date of birth, and record number (if available)

• To what specific covered entity should the documents be sent? 

• If there's a particular date you would like the records by.

• The doctor or provider within the practice you need information from.

• The range of dates you need info from.

• The type of information you would like to see on the record.

• Any necessary paperwork proving your legal right to access the records 

Reasons To Release Your Medical Records

1. Making a Switch to a New Doctor

Suppose your current doctor is retiring, or you are in the market for a new provider. In that case, you'll need copies of your medical records following your last appointment with your previous doctor to ensure the continuity of your care. You can request that your prior healthcare provider send these copies directly to your new physician so you can bring them to your first appointment with your new physician. 

2. Assessing Medical Treatment Expenses

After you've signed the medical record information release form, your healthcare providers can distribute your information to the necessary covered entities, such as your attorney or for a trial. You can revoke your medical release form at any point. 

3. Medical Billing

Insurance providers need clinical documentation to justify reimbursements for any treatment received or medical expenses accrued due to your injury. If you have received treatment at a healthcare facility, its billing department will need to know how to bill you. You need copies of your medical records to avoid duplication of cost and treatment and being charged for procedures that may not benefit you. If a provider needs to document these services to the facility's billing department sufficiently or they fail to have recent copies of these procedures, you could avoid a claim denial. These circumstances can be avoided by having a complete and up-to-date copy of your medical records. 

4. Insurance Billing

Insurance companies play a significant role in keeping folks financially secure when life's uncertainties, such as illness, accidents, and death, by paying out claims to clients who have experienced some loss. However, for insurance providers to give compensation, they can only do so if they have proper documentation of the circumstances in which payment is warranted. After you've received care from a healthcare provider, your health insurance company will need to know the exact details to determine how much of the cost they will cover. 

5.  Health studies

Research institutions need certain kinds of health data to perform studies to develop new medications or treatments. With the correct permissions, scientists and other medical professionals can assess these medical records after patients have agreed to release them. Suppose you want to participate in a clinical trial for a new drug or treatment. In that case, you must fill out a medical release of information form so your doctor can share your PHI with the researchers.

6. Legal Proceedings

Medical records can supply vital information regarding the extent and nature of a plaintiff's injury. Cases that use medical records as evidence include instances where there is an injury, disfigurement, or death. When personal injury attorneys prepare for legal proceedings, they need access to your PHI because it will allow them to build your case and demonstrate that your current condition is the direct result of the accident that you endured. 

7. Marketing Purposes

Sometimes, healthcare facilities utilize patients' experiences and diagnoses to promote a particular treatment type or medication. For example, suppose you were diagnosed with the disease and underwent successful treatment. In that case, the healthcare facility may request to use your story for a marketing campaign for that treatment. If you choose to participate, you must sign a form releasing your medical information. 

How Long Does It Take To Get Your Medical Records?

By law, healthcare providers must provide your requested medical records within 30 days of receiving the request. However, providers may take an extension of an additional 30 days by notifying you of the cause of the delay. Therefore, your medical records may take up to 60 days to arrive. Suppose you have not received your documents after 30 days (or 60 days with the extension), or your request was denied. In that case, you can file a complaint with the United States Department of Health and Human Services (HHS). It is important to remember that you must file your complaint within 180 days of the denial or deadline for your claim to be reviewed. 

According to the privacy rule, a covered entity is permitted to impose a reasonable, cost-based fee for the request of PHI. In addition to the records themselves, you will also be responsible for shipping costs. In physical documents, the price of your documents may vary from state to state. However, a provider generally may charge at most $1 per cost for each page of the record. Many providers also opt for a flat fee, especially for digital catalogs, that you pay for retrieving and reviewing documents. 

Can My Injury Attorney Obtain My Records For Me?

Your attorney will almost certainly ask you for permission to release your medical records if you have hired them to represent you in a personal injury lawsuit. They can request your medical records if you give written permission to your healthcare provider that is signed and dated. The request can be sent by mail or fax; many healthcare providers allow patients to request records online. Please refer to Expertise.com’s directory to connect with the best personal injury attorney suited for your situation.