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When The Insurance Company Wants a Medical Authorization

By Aline Miranda on June 7, 2013

Many insurance companies will make a low ball settlement offer and refuse to increase it without first seeing your medical records Do you have a right to refuse to turn over your medical records? The answer is both yes and no.

In order to prove your injury claim, you should be prepared to turn over to the insurance company all of the medical records related to your injury, but not more. For example, if you are claiming a low back injury for which your primary care doctor prescribed physical therapy, you should expect to have to turn over the records from your primary care doctor and physical therapist. You may not have ever had physical therapy before, so all of your therapist’s records are related to your injury. But what about your primary care doctor? In most cased, the primary care doctor is the first responder to every medical condition their patient experiences. This may include conditions that have nothing to do with your low back. Why turn them over to the insurance company? Does the insurance company have a right to know that you had a prior back injury last year? Sure, but what about the flu you had last winter? Or a miscarriage? Giving the insurance company authorization to obtain your medical records directly from your medical providers will allow them unrestricted access to ALL of your medical records. Where is the limit of what the insurance company should be able to learn about your medical history in order to properly evaluate your injury claim?

The reality is that the insurance company will pore over your medical records looking for anything that will improve their negotiating position so they can force you to accept a low ball offer.

You have a right to refuse to provide medical records for conditions that are unrelated to the injuries that form the basis of your claim. That right is protected by the California Constitution. You are not required to waive your privacy rights simply because you were injured through no fault of your own and you want to be fairly and justly compensated for that injury.

If you are facing a big insurance company, you need someone on your side to look out for you.