How to Effectively Request Your Medical Records: A Guide for Personal Injury Claims

Table of Contents

• Your Legal Right to Your Medical Records Under HIPAA
• What Records to Request for a Personal Injury Claim
• Common Mistakes to Avoid
• HIPAA Authorization vs. Subpoena
• Fees in Practice: Reasonable Cost-Based Charges
• What to Do If They Don’t Respond or Overcharge
• Next Steps

The federal HIPAA Privacy Rule grants you a “right of access” to your protected health information (PHI) in a “designated record set,” including your medical and billing records. According to 45 C.F.R. § 164.524, you have the right to inspect or obtain copies of:

• Medical and billing records maintained by your health care providers
• Enrollment, payment, claims, and case management records held by health plans
• Other records used to make decisions about you

However, there are key exclusions such as psychotherapy notes and information compiled in anticipation of legal action. Understanding what you can and cannot access is critical for a smooth request process.

When requesting records for a personal injury claim, focus on the documentation that will substantiate your case. Here are the core categories you should request:

• Emergency Room / Urgent Care Records: Triage notes, physician notes, discharge summaries.
• Imaging and Diagnostic Reports: Radiology reports, laboratory test results.
• Office Visit / Treatment Notes: Progress notes, surgical reports.
• Billing Records: Itemized billing statements with CPT and ICD-10 codes.
• Prescription History: Medication lists from treating providers.

Make sure to specify the date range for which you need these records, ideally from one year prior to the incident to the present.

• Not Requesting Itemized Bills: Always ask for complete, itemized billing records.
• Requesting Only Summaries: Summaries may miss key details necessary for your claim.
• Forgetting Imaging Discs: Request both the radiology reports and the actual imaging files.
• Signing Overbroad Releases: Limit your authorization to relevant records only.
• Not Identifying the Correct Records Custodian: Ensure your request goes to the right entity.

Before litigation, you can use a HIPAA-compliant authorization to request records. This allows for faster access and more control over what is released. Once a lawsuit is filed, subpoenas may be necessary to compel non-party providers to produce records. Ensure that any subpoena complies with HIPAA requirements.

Under 45 C.F.R. § 164.524(c)(4), providers can only charge reasonable, cost-based fees for copying and delivering records. This includes labor for copying, supplies, and postage. Be aware that:

• No per-page fees for electronic copies are allowed.
• Providers cannot charge extra simply because records are requested for a legal claim.

If you believe charges are excessive, request a breakdown of the fees and reference HIPAA regulations.

If you do not receive a response within the 30-day deadline, follow up with the provider’s records office. If necessary, escalate to the HIPAA Privacy Officer. If the issue remains unresolved, consider filing a complaint with the HHS Office for Civil Rights (OCR).

What is HIPAA?

HIPAA stands for the Health Insurance Portability and Accountability Act, which protects the privacy of patients' medical records.

How long does it take to get my medical records?

Under HIPAA, providers must respond to your request within 30 days, with one possible 30-day extension.

Can I be charged for my medical records?

Yes, but fees must be reasonable and cost-based, and certain charges are not allowed.

What if my request for records is denied?

You can file a complaint with the HHS Office for Civil Rights if your request is denied without a valid reason.

Do I need an attorney to request my medical records?

No, you can request your records directly, but an attorney can help navigate complex situations.