The Importance of Medical Records in Your Lawsuit: Hear from Our Team
Law firms like Wallace Miller go through the process of requesting medical records in order to make the strongest case possible for our clients. Medical record retrieval and review is a complicated process, especially in cases with multiple plaintiffs.
Here’s our breakdown on the basics of medical records, insights from Legal Nurse Consultant Debbie Pritts, and details from the professional team responsible for obtaining records.
The process of requesting medical records for a legal case
When someone signs onto a litigation with Wallace Miller, they fill out a Retainer Agreement outlining the terms of their case. They will also fill out a packet that includes questions on their potential claim, information on their medical history, and a HIPAA release form.
Based on the information provided in the packet, the team at Wallace Miller will contact the client’s medical providers to request the records needed for the case. These providers may include hospitals, doctors’ offices, pharmacies, labs, and other medical facilities.
What medical information will I be asked to provide?
While the information you will be asked to provide depends on the details of your case, you will likely need to give the names and contact information of the doctors that diagnosed and treated your injury or illness. Along with details on your physicians, you will be asked to provide information on hospitals, pharmacies, and other facilities, as well as the dates on which you received care.
What is HIPAA?
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 protects the privacy of individuals’ health information. It establishes federal standards that regulate how patient health information can be shared. Clients at Wallace Miller whose cases involve medical information fill out a HIPAA release form, which provides our law firm with permission to request and review their medical records.
We take our clients’ privacy seriously. All medical information is held in a secure internal system and accessed only by the legal team working on an individual’s case.
Barriers to requesting medical records
When a law firm requests medical records, some providers charge third-party fees. As part of our handling of a case, Wallace Miller covers all upfront expenses. However, since this money comes out of any potential settlement, we do what we can to minimize these fees.
If a provider charges an excessive fee to access a client’s medical records, we reach out to the case team and client. They may opt to pay the fee, or they may go through the process of requesting the records themselves.
Under HIPAA, patients have the legal right to access their health records. Providers must release the records promptly and provide the documents electronically if requested. As a result, individuals can access their own records much more quickly and cheaply than a third party like a law firm.
When issues arise with medical records, the most effective next step is typically the client reaching out directly to their provider. The medical records team at Wallace Miller can guide you through the process of requesting access and provide sample language for contacting the healthcare facility.
Denials of medical record requests
Requests for medical records can be denied. This is a relatively common occurrence and does not mean the end of your case.
Record denials may happen for several reasons, including:
- Typos in the information provided, such as the provider’s name, phone number, or address.
- Incorrect dates of care. If you’re not sure when you saw your doctor, you may be able to call the office and request that information.
- The age of the records. For confidentiality reasons, most providers destroy medical records after ten years have passed.
- Ineffective storage, record-keeping, organization, or accessibility on the provider’s side.
- Requests for wet signatures or specific authorizations. Some providers require patients to physically sign and scan a document in order to release their records. Our team will walk through this process with you and make sure the provider receives the information they need to grant access to your medical history.
If the provider informs us that no information on a patient or record has been found, we may reach out to you for proof of treatment, such as an aftercare summary. Our team can then send this proof to the provider to verify that the client was seen at a specific facility on a given date.
Regardless of the reason for the denial, your legal team will work with you to contact the provider and resolve the issue.
Processing medical records
After our team receives your medical records, we will review and analyze all documents to make sure that they contain the information we need. Sometimes, medical records don’t include all necessary details on the patient’s diagnosis and treatment. In these situations, we may reach out to the client or provider again to verify the dates of care, physician details, and other information.
Hear from Legal Nurse Consultant Debbie Pritts
Debbie has been a Legal Nurse Consultant (LNC) working with the attorneys at Wallace Miller for 20 years and has more than two decades of clinical nursing experience. As an LNC, she assists in reviewing medical records and works with the attorneys to help them gain a complete understanding of the medical aspects of their cases.
What information do we get from medical records in litigation?
Debbie: For many of our cases, we need a very limited amount of information. We need the information for proof of use of either the device or the drug. And then we need proof of the injury. We may also need information on confounders, or a history of other risk factors that they might have had.
Can patients request their own medical records?
Yes, every person has a right to their medical record. Usually, a client can request their records electronically.
Most of us can now access our own medical records through the after-visit summaries in our electronic records. You can get a copy of your medical records simply by going into the healthcare provider’s portal and requesting it.
If anybody ever has a question about how to access their records, our staff is prepared. They’re trained to help our clients access their records efficiently and cost effectively.
The most recent government guidance on patients’ rights to access their health information is available here.
Is it better to go through a law firm to request records or request records yourself?
Clients often rely on us to obtain medical records, because they feel it’s difficult for them to do. If there are problems with record access, though, it can be quicker and more efficient if a client gets their own medical records.
When my sister was in the hospital, she wanted to look at her records. I told her how to do it, she sent in the request, and in 24 hours she had her records in her portal. It’s never that quick for us, as a third party—there’s always a longer process to follow.
When does the Legal Nurse Consultant get involved in a case?
The nurses get involved in cases where it takes more intensive medical knowledge to go through the records, like in cases of medical malpractice. Or, if we’re looking at potential bellwethers, we will scrutinize the records more closely to determine what the strongest cases are. For these cases, and individual one-off cases, the nurse will do a more specific, detailed chronology.
Frequently Asked Questions: A conversation with our Pre-Litigation team
The Pre-Litigation team at Wallace Miller assembles much of the preliminary information necessary to file a client’s case. This includes gathering documents from the client, requesting and verifying medical records, and preparing filing resources.
What does the medical records team do?
After we have a list of providers, our team will make sure we have everything we need to request a patient’s records. This includes Retainer Agreements, authorizations, and other specific forms for different cases.
We go through our criteria to make sure that the diagnosis is correct and that clients have received treatment on cases where that’s required. Sometimes if they’re going to start treatment but they haven’t yet, we’ll hold off on ordering those records until they see the provider.
After we’ve verified the information in the client forms, we’ll proceed with ordering records. Then, as we receive denials from providers, we’ll work through those. We reach out to the clients, usually via email, if we need more information.
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Why can’t my law firm get my medical records?
Getting medical records is a complicated process. Sometimes a request for records will be denied by the provider. In this situation, we aren’t saying that those records don’t exist—we may just need additional information from you. That way, when we go back and resubmit the request, they’re less like to deny access to the records again.
What if I don’t know what dates I saw my doctor?
It’s important to have the correct dates when requesting medical records. If you’re not sure when you saw your doctor, you can call their office and ask for the time frame on dates of care.
I don’t know how to download, sign, or upload a form.
Our team is available to walk through the process of downloading, signing, and submitting a form together. We’ll help you fill out your name, signature, and other details and provide instructions to upload your form.
If you’re not able to access your forms electronically, we’ll mail them out to you. Once you get them in the mail, you can give us a call and we can fill them out together.
We know that filling out these forms can be complicated and stressful. We can’t do it for you, but we can help you. So don’t give up on yourself, and don’t give up on your case.
What happens if Wallace Miller can’t take my case after reviewing my medical records?
Sometimes people go through the process of talking with someone on our team and providing access to medical records and we aren’t able to take their case. They may feel understandably upset, because even though they don’t qualify for our case criteria, they still went through a difficult experience.
Even if you don’t qualify with our firm, you may still have a case elsewhere. We recommend reaching out to law firms that specialize in your type of injury to see if they are able to help.
What information should I have before I call?
If you have questions about whether you may be eligible for a case with us, we encourage you to call our office. Our team will discuss your circumstances with you and help you determine your options going forward.
If you have medical records, aftercare summaries, or other documents that show you saw a provider about a specific injury or illness, hold onto them. Those documents can be helpful for the medical records team. If you don’t have that information, don’t worry—our team will help you request it from your providers.
