How to Request Medical Records for a Personal Injury Claim

Your medical records are available, but the process isn’t always fast

Let’s say you’ve been in an accident. Hopefully your injuries aren’t too serious, but even a minor accident can result in major expenses—health care and medical treatment are costly. 

At the crux of personal injury law is the concept that the purpose is to make the plaintiff (injured person) whole, which means restoring them to the financial position they would be in if the accident hadn’t happened. 

Whether you’re filing a lawsuit, settling with another party through an out-of-pocket agreement, filing a lawsuit, or working with insurance adjusters on a claim, you’ll likely need to provide medical records to prove how much you spent on treatment, or for other reasons related to the claim.

Privacy laws restrict who can access medical records. While this is important and benefits patients, it can also mean that the process for retrieving your own records can include a few more steps than it used to.

What is HIPAA?

You probably hear “HIPAA” tossed around a lot, sometimes by people in medical offices who are preventing you from retrieving information. 

But in many cases, even these medical office employees don’t fully understand the law and what it does (or doesn’t do). 

The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that was enacted in the U.S. in 1996. The main purpose of HIPAA is to protect a patient’s confidentiality for their protected health information, while still allowing for information to be available when necessary for healthcare or related reasons. 

The Privacy Rule under HIPAA has standards for protecting individuals’ information by limiting its use and disclosure without the patient’s authorization. The patient has certain rights to their medical information, which includes the right to access and request corrections to their records.

Who can access health records under HIPAA?

1. Health care provider. A doctor, therapist, or other professional who is directly involved in a patient’s care may receive access to medical records in order to provide appropriate treatment. 
2. Health insurance. Private insurance, Medicare and Medicaid may access health records for the purposes of processing claims, verifying eligibility and coordinating benefits. 
3. Healthcare clearinghouse. These are third parties that process and standardize transactions like billing and claims on behalf of a health care provider. They are provided access to records as necessary to process transactions. 
4. Professional/business associates. Similar to healthcare clearinghouses, these businesses provide services to entities with protected health information. These could be companies that are contractors for billing, transcription, cloud storage or other services. They sign contracts with the covered entity that set forth requirements for safeguarding patients’ information. 
5. The patient or their representative. As a patient, you are entitled to access your own records under certain circumstances. You may also provide written authorization to have your records released to designated other individuals.

There are certain circumstances when a medical provider may allow access to records without a patient’s authorization, such as if there’s a public health issue or in an emergency.

A patient’s right of access to their own health records

HIPAA includes a right of access to your own health records. These are the relevant aspects of the law:

1. Access to inspected or uninspected copies. A patient may access or obtain a copy of their health record, whether it’s on paper or digital. The provider must furnish the records within 30 days of the request. In some circumstances, a provider could extend the time period to 60 days but they must provide a reason for doing so. 
2. Format of records. The patient may request a format of their choice as long as the record is readily accessible in that format. For instance, a patient may request a digital copy of a record as long as the provider has the record stored digitally. However, if there are security risks or it’s otherwise burdensome or unfeasible to have records provided in the patient’s requested format, the provider may decline the request. 
3. Amendments. A patient may request a correction or amendment if they believe the information is inaccurate, incomplete or misleading. The provider may either make the change or make a written explanation about why it was denied. 
4. Fees. A health care provider is permitted to charge a reasonable fee for copies of health records. The fee may not create a barrier to access for the patient and should be limited to the cost of labor, supplies, postage, or whatever other costs are necessary based on the patient’s delivery preferences.

How do I request my health records?

First, check to see if the provider has an online portal with your medical records. You might be able to access them directly and print exactly what you need with no muss or fuss. 

If the portal is incomplete or you don’t have one, then you should check the provider’s website to see if there’s information about how to request records. The website might have a link to a request form. 

Be prepared to complete the following information on a request form:

The HIPAA Privacy Rule requires the provider to verify the identity of a person receiving records. If you’re picking up your records in person, be prepared to show your driver’s license or other identification.

Do I need to make requests separately from each provider?

Probably yes. Unless your records are in a linked electronic portal, you likely need to make a separate request to each provider. You will need each provider’s full name, physical address, phone number, and fax or secure email (or patient portal) for each provider who is sending or receiving your records.

What if I don’t receive my records within 30 days?

This happens. Sometimes, you need to call the provider and nudge a bit to make it happen. It’s likely not intentionally withholding information, but there could be tie-ups on the administrative end. 

For example, some patients’ records have hundreds or thousands of documents. Finding exactly what’s been requested can take some time. It’s also possible that the provider has many thousands of requests each month; they likely have staff for this purpose, but it still can take a good amount of time. There’s also the possibility that your older records are on paper and were never converted to digital. That could mean that staff needs to go to a storage facility and search for them.

You can and should feel empowered to call the office and politely ask about the status of your request if you’re nearing the 30-day deadline. 

If you’re having trouble receiving your medical records related to a personal injury claim, you can ask your lawyer for help. A lawyer can’t just call and access your records (that’s one thing HIPAA specifically prohibits) but if you provide authorization, then their persuasion might make the process move faster. Contact your attorney for assistance with this or other records-related issues.