The Truth About Insurance Companies and Your Medical Records

Today we're gonna talk about what the insurance company does with your medical records to try to use them to undermine the value of your case.

The Importance of Medical Records In Your Personal Injury Case
After an accident or injury, your medical records often serve as a diary to help establish and help demonstrate the injuries, the losses, the impact that an injury might be having on your life following an accident. So they're critically important to your case, to your ability to advance your case is what's been documented in your medical records.

So on the one hand, they can help your case, but the insurance company will go through those medical records very intently with an effort to try to use or find things in those medical records to reduce the value of your case. 

Insurance Tactics: Unrelated Injuries
The insurance company is going to look through your medical records and try to claim that your injuries are unrelated to the accident.

So how do they do that? They look to see whether or not the accident is recorded as the history for those injuries. So if you're in the doctor's office or you're getting an imaging study done, or you're getting some kind of treatment, what do the records say? Do they say that's because of the slip and fall accident, the motor vehicle accident? Or do they say it's a new onset? 

The 'New Onset' Argument
Insurance companies love the word new following a car accident, especially if it's months following the car accident that this is a new symptom or recent onset or something that started two days ago when your accident occurred two months ago. Because to them that will be evidence that that treatment, that symptom, that injury is not related to the car accident or whatever the event is, slip and fall, whatever it might be.

Delays in Seeking Treatment
So another example would be where somebody's involved in an accident, they experience back pain, but they wait weeks or several weeks before seeking medical treatment. Thinking their back pain's going to improve on its own. The insurance company will say that that period of time, that gap in treatment or that delay in treatment is evidence that that injury didn't start from the car accident, that it was either pre-existing, completely unrelated, or it's something new and unrelated.

How do you counteract that defense? How do you avoid that defense? If you're in an accident, seek treatment immediately, no matter how minor it seems, no matter how confident you are that it will get better on its own with time. Go to the doctors, go to a hospital, go to urgent care, go somewhere, get checked out.
Protect yourself, and document that those symptoms started as a result of the accident. 

How Gaps in Treatment Affect Your Claim
The second way that the insurance company will use your medical records to try to undermine your claim is they will look for gaps in treatment. To say that you've made a complete recovery from the accident. 

Gap in treatment means somebody has neck pain or back pain after an accident. Maybe they sought treatment, maybe they treated for several weeks in fact, did physiotherapy but then weeks or months go by without any treatment whatsoever. No attendance at any doctors or clinics. And so the insurance company will look at that gap and the larger the gap in time is between treatment, the more they'll use that against you to suggest you completely healed or were recovered, and then the new treatment that occurs maybe months later is unrelated to your accident. That it's the onset of a new injury, new symptoms, and completely unrelated. And so from that period forward, they're saying they're not responsible because your injury healed. That's why you stopped going to the doctor's. 

As long as you're having symptoms, go to your doctors, report your symptoms so that the insurance company can't argue later that your gap in treatment signifies that you were completely recovered. And if there are situations where you're missing appointments or you're just unable to attend the doctor's office for a specific period of time, document that so it doesn't look like a gap in treatment.

Or the next time you see your doctor tell them that you've been having these symptoms ongoing, that you've meant to come here sooner, that you tried to get an earlier appointment so that it's clear that in fact it's not a gap in treatment, but it was an inability to get treatment during that period of time for some reasonable reason. 

How Insurance Companies Downplay Your Injuries
Another reason closely related to the last, the insurance company will say that that's also proof that your injuries weren't that significant, that you didn't even take them that seriously. So if you're not going to the doctor's office, the insurance lawyers or the adjusters will argue obviously it wasn't that bad. Your client wasn't going to the doctor because they weren't hurt that much. The symptom wasn't that significant. 

One of the scenarios I see is where there's a period of time with no treatment whatsoever for the accident injuries, but there is attendance at the doctor's office for a cough or a cold, and that really plays into the insurance company's hand because they say, look, it wasn't even as significant as the common cold. Common cold got your client out of bed, in their car, to the doctor's office, complaining and trying to get help. But this back pain, this neck pain, this radiating leg pain, whatever it might be that you're trying to say is from the accident, really couldn't have been that serious because it didn't get them to the doctor in the same period of time.

Don't let the insurance companies make that argument. Go to the doctors, report your symptoms, and again, if there's a period of time where you can't make it to the doctor, document why so it doesn't appear to be a gap in treatment. 

Don’t Let Insurance Companies Blame Your Pre‑Existing Injuries
Insurance companies love to scour medical records for anything that was preexisting. Any signs or symptoms that preexisted your accident. If they find within your records that you had some previous discomfort, pain, treatment in the same body parts that you're complaining were hurt as a result of the crash, the insurance company will latch onto that and argue that the injuries you are claiming are actually preexisting.

Best way to counter that, make sure you tell your doctors if your symptoms are different. If you have pre-existing issues or conditions with those same body parts, it's okay. Just be honest about it. And to the extent that the accident has made those symptoms worse, has changed those symptoms, has created more symptoms, new symptoms, that's what you wanna do, you wanna help distinguish that. Tell your doctor how it's changed, tell your doctor how it's been made worse. The insurance company will be far less successful in arguing that it's a preexisting issue. 

We also have a video and podcast episode specifically on preexisting health issues, so I encourage you to take a look at that for more details.

Misinterpretation of Medical Records
So insurance companies will also try to misinterpret or come up with all kinds of alternative explanations. Okay, not just in medical records, but just generally. But in your medical records, they'll do that quite often. So they'll go through records where anybody observing that's reasonable, it's obvious that this is a continuity of care, that this symptom is related to the accident. This is a symptom that started after the accident, but the insurance company will look to see not only what's in the records, but what's not in the records. 

So if somebody's going back to the doctor months later and it's not explicitly mentioned that this is ongoing or continuing from the accident, the insurance company will say, well, look, yeah, they went to the doctor six more times in that year, but they never mentioned the car accident. And so the insurance company will take that to mean it wasn't from the accident because nowhere in those notes does it mention the accident over that period of time. 

Reminding Healthcare Providers
So whenever you go get treatment for your accident related symptoms, don't just assume your doctor's going to remember that this is all from the accident. Remind the doctor, remind the healthcare provider. I'm still having X symptoms. I'm still having back pain because of the accident I had three months ago. I'm still having neck pain because of the accident. Just mention it each and every time when you're giving the history of the symptoms that you're there for. And that will go a very long way in eliminating the possibility of the insurance company bringing up this nonsense defense that your symptoms are not related to the accident.

Protecting Your Case From Insurance Tactics
Those are some of the ways that an insurance company can use your medical records to try and undermine your case. But again, it all boils down to this. If you're injured in an accident, seek medical attention, report all of your symptoms to your healthcare providers, remind them that it's from the accident, and keep a treatment log in terms of what you're doing and what your symptoms are and if in doubt, reach out to your lawyer and get advice.

Have Questions? Contact Us Today!
If you have any questions, if you're in an accident and you're not sure what to do, you can reach out to us anytime. Our phones are open 24 hours a day, seven days a week. Or you can go on our website and request a free consultation.

​Andrew Iacobelli is an experienced personal injury lawyer who established Iacobelli Law Firm with offices in Florida and Texas. Andrew restricts his practice to the representation of personal injury victims in claims involving serious injuries, Catastrophic Injuries, and wrongful death.  Andrew is a lifetime member of the Million Dollar Advocates Forum.