At some point during your personal injury claim, the insurance adjuster might make a request for more medical information, even though you’ve already submitted relevant documents and records. If this happens, it’s important to understand what sorts of requests the adjuster might make, why that information might be requested, and what your rights are in this situation.
Requesting More Medical Records
As your case progresses, the insurance adjuster might request more medical records. Even though you’ve probably already sent in copies of everything that you thought were relevant to the case, it might be determined that other records are needed, such as those from other professionals who examined you, or medical records from before the incident in question (to determine if a condition is pre-existing, for example). If this happens, you do not have to comply if you think the request is unreasonable and not related to the case at hand. If you’re not sure, feel free to ask the adjuster why the request is being made. If their answer is not to your satisfaction, you can still refuse the request. Make sure to explain that you are protecting your privacy, and that you are well within your rights to refuse. NEVER sign an agreement giving the adjuster permission to directly take your records–always make sure to request the records yourself from the medical office.
Requesting Medical Reports
If the insurance adjuster feels that the available medical records do not provide enough information or explain your condition adequately, they might make a request for a report from your doctor or healthcare professional to help explain or clarify certain points. If this is the case, you are once again able to determine if the request is reasonable. If it seems okay, then explain to the insurance adjuster that you yourself will make the request from your doctor. It is not a good idea to give the adjuster permission to talk directly with your doctor! Talk to your doctor afterwards and explain the request, and see if your doctor thinks such a report would work in your favor. If not, then you are within your rights to ultimately refuse the request until ordered otherwise by a judge.
Requesting a Medical Examination
When an adjuster disagrees, doubts, or wishes to question the results of a test or report, they might make a request for a new examination. As with the other requests, you are not required to submit to a new examination. Since adjusters usually choose the doctors to conduct the new examination, they are usually not in your best interest to undergo, unless you are required by an insurance policy or legal ruling.
In all these cases, remember that if an insurance adjuster is requesting more information, it’s usually not because they are looking out for your best interest. Unless ordered by a legal ruling, you are under no obligation to submit any records, or undergo any examination, if you feel that the request is unreasonable or will not help your case!
