How Insurance Adjuster Investigates Claimant’s Medical History?

An adjuster might ask for documents that relate to a claimant’s injuries and treatment. Adjusters study those documents, in hopes of finding information on a former injury or a pre-existing condition.

How claimants should respond to request for medical documents?

• Request should not represent effort to obtain irrelevant material.
• If adjuster has asked to see such material, seek an explanation for the adjuster’s request.
• If doctor plans to charge for any records, the insurance company should cover that cost.
• Records should be sent to claimant first. Claimants ought to review their records, before handing them over to the adjuster. It is each claimant’s right to protect his or her privacy.
• Never sign a form that gives the insurance company the right to gain access to all of any claimant or plaintiff’s records.

Why there might be a point where the claimant’s doctor gets asked to clarify some of the information in a given patient’s records?

The records do not offer the insurance company any clear insight into the doctor’s prognosis.The physician had shared some information with the patient, but failed to add to the record a notation, regarding the comments made to the patient.

How to approach the need for a doctor’s clarification?

Patient/claimant should speak with the doctor. The adjuster should not be given the doctor’s contact information. The patient should learn how much money the doctor would want for completing such verification.

Sometimes the insurance company asks a claimant or plaintiff to attend an independent medical exam (IME).

Why would it make such a request? This happens in cases when the opinion of claimant and adjuster differ, with respect to severity of injury and the line of best treatment for injury.If claimant or plaintiff were to agree to a request for an IME, then both of those injured parties ought to understand what the law requires of the insurance company.

-The insurance agency should pay for the IME, as per a personal injury lawyer in Elmhurst

-The examining physician must observe only those parts of the patient’s body that were affected by the accident. No patient should get a whole-body examination during an IME.

Would an injured claimant or plaintiff have the legal right to refuse to attend an IME?

Yes, both claimants and plaintiffs would have the legal right to make such a refusal, if either of them was uncomfortable with the thought of having an unknown physician exam them.

By the same token, both claimants and plaintiffs have the right to be a no-show at a scheduled IME, if either of them has failed to appreciate the value of the examining doctor’s opinion. Furthermore, after an IME, the lawyer for an injured client could contest the value of the examining doctor’s opinion.