Why Is The Insurance Company Asking For Medical Authorizations

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That’s a very common reaction. Insurance companies routinely request medical authorizations as part of their claims investigation. The goal is ostensibly to verify the nature and extent of your injuries, the treatment you’ve received, and its costs. However, it’s crucial to understand the scope of these authorizations and protect your privacy. They aren’t simply interested in the injuries caused by this accident. They are looking for pre-existing conditions to blame your current pain on, or prior issues they can use to devalue your claim.

Granting blanket authorizations – allowing access to all your medical records for all time – is almost always a mistake. While you’re legally obligated to cooperate and provide relevant information, you’re not required to surrender your entire medical history. A strategically limited authorization, focused specifically on the injuries sustained in the accident and the treatment related to those injuries, is the proper approach.

I’ve been practicing personal injury law in San Diego for over 13 years. I was fortunate enough to begin my career defending insurance companies, which gave me an intimate knowledge of how they evaluate, devalue, and deny claims. They use these authorizations to build a defense, and you need to be prepared.

What information can an insurance company legally request?

California law allows insurance companies to obtain information reasonably related to the claim. This generally includes medical records, billing statements, and diagnostic reports pertaining to the injuries you allege. They can also request your employment history to verify lost wages, and potentially interview family, friends, or coworkers about your limitations. However, this isn’t a free pass to rummage through your entire past.

They cannot ask for information that is irrelevant to the accident and your injuries. For example, if you’re claiming neck and back pain from a car accident, they aren’t entitled to your childhood dental records. Requests for your complete psychiatric history, unless directly related to the accident (e.g., PTSD), are often overly broad and can be challenged.

Insurance adjusters will often phrase these requests very broadly, attempting to obtain as much information as possible. Don’t be afraid to push back and request clarification. A carefully worded authorization, limiting the scope of the release, will protect you from unnecessarily exposing sensitive personal information.

Should I sign anything before talking to an attorney?

Absolutely not. Once you sign an authorization, you’ve lost control of your medical information. It’s best to consult with an attorney before providing any documents or statements to the insurance company. We can review the request, draft a limited authorization, and advise you on how to respond appropriately.

The insurance company may attempt to imply that refusing to sign an authorization will jeopardize your claim. This is generally a scare tactic. While cooperation is important, you have the right to protect your privacy and control the flow of information. A reasonable refusal, based on the scope of the request, is unlikely to be grounds for a denial of your claim.

Navigating these requests can be complex, and it’s easy to unintentionally waive your rights. An experienced attorney can handle all communication with the insurance company, ensuring that your rights are protected and your claim is properly investigated.

What happens if I accidentally sign a broad medical release?

If you’ve already signed a broad medical release, don’t panic. It’s not necessarily a death sentence for your claim. However, it’s important to address the situation immediately. I will review the release and attempt to limit its scope, if possible. We can also proactively gather your medical records to ensure they are presented in a favorable light.

Even with a broad release, the insurance company still has the burden of proving that your injuries are not related to the accident. We can challenge their interpretation of your medical records and present evidence to support your claim. The key is to be proactive and seek legal counsel as soon as possible.

Remember, insurance companies are businesses, and their goal is to minimize payouts. They will use every available tactic to devalue your claim, including exploiting broad medical releases. Having an attorney on your side levels the playing field and protects your interests.

What if the insurance company subpoenas my medical records?

A subpoena is a legal document compelling you to provide information. Ignoring a subpoena can result in serious consequences, including being held in contempt of court. However, even with a subpoena, you still have rights. You can file a motion to quash the subpoena if it’s overly broad or seeks irrelevant information.

An experienced attorney can analyze the subpoena, determine its validity, and file any necessary motions to protect your privacy. It’s crucial to respond to a subpoena promptly and properly, even if you believe it’s improper. Failure to do so could harm your case.

In San Diego, we frequently litigate these types of issues. Subpoenas are part of the normal process, and there is a standard procedure to object and resolve them.

Can I withhold prior injuries if they are unrelated to the accident?

Generally, yes. You’re not required to disclose prior injuries that are unrelated to the current accident. However, it’s important to be honest and forthcoming about any pre-existing conditions that may affect your recovery or treatment. Withholding relevant information could damage your credibility and jeopardize your claim.

The key is to distinguish between prior injuries that are completely unrelated to the accident and pre-existing conditions that may have been aggravated by the accident. An attorney can advise you on what information you are required to disclose and how to present it in a way that protects your interests. A nuanced understanding of these rules can make all the difference.

Ultimately, honesty and transparency are the best policy, but you’re also entitled to protect your privacy and control the flow of information. A skilled attorney can help you navigate these complex issues and ensure that your claim is handled fairly.