How does a 3rd party insurance co. investigate your med. history before/after responding to your demand letter?

Asked about 3 years ago - Oakland, CA

A. Is there a central database where an insurance co. can use your social security number/name/DOB to run a medical history check? - if so at what level is this search done? state, federal, medical/insurance group etc...

or. B. Are they only able to investigate and obtain records from the providers that are ONLY mentioned on the current medical release form?

I have sent a demand letter for a personal injury case. After the fact, it has dawned on my that I probably saw a doctor for the same bodypart (shoulder) about 6 years ago but CANNOT find any record in my file to confirm (it was different injury but to same shoulder). Should I call the co. and let the know or am I going to complicate/prolong the process? I don't want to look like I lied if I end up going to trial. Thanks.

Attorney answers (5)

  1. Adam David Sorrells

    Contributor Level 13

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    Best Answer
    chosen by asker

    Answered . To add to what the other lawyers wrote, and in direct answer to your question, insurance companies do have a central data base of claims histories. It is called the Insurance Index Bureau. In some states it is called a CLUE report, etc. However, this only gives the insurance company access to prior claims you may have made, e.g. workers compensation claim, old personal injury claim, etc. It does not give them access to your medical records. On the other hand, they may have a right to know about the prior injury, but this is highly fact dependent. My advice echoes the other providers. DO NOT TRY TO HANDLE THIS YOURSELF. GET A LAWYER AND MAKE SURE IT IS DONE CORRECTLY. GOOD LUCK.

    ADAM SORRELLS
    Injury Lawyer

    Disclaimer: The above was not legal advice and cannot be relied on. For informational purposes only. Time is of the essence, do not delay seeking legal advice and pursuing your legal rights.

  2. Christian K. Lassen II

    Pro

    Contributor Level 20

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    Answered . Every insurance company has a different software program that searches records.

    I must warn you that trying to settle a case yourself is the worst mistake a person can make.

    Everyone who trys to settle a case themself thinks they are being clever by saving money on attorneys' fees, but they invariably get kicked in the teeth and come back to AVVO complaining on how they got a raw deal.

    Unrepresented parties only get 11% of the money that represented parties get. A non lawyer is a paper tiger....no teeth.

    Get a lawyer with a low contingency fee, such as 29%, so you are left with the lion’s share of the settlement money. Don’t get hurt twice by using a lawyer with a huge fee.

    Click on the name of the lawyer answering your question to see their profile, and then you can click the view website tab to find out detailed information on your personal injury topic. The information provided on this website is for general information purposes only. Nothing on this site should be taken as legal advice for any individual case or situation. This information is not intended to create, and receipt or viewing does not constitute, an attorney-client relationship.

  3. Joyce J. Sweinberg

    Pro

    Contributor Level 16

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    Answered . And if you end up going to trial, who is going to represent you? You have been given good advice here...get an attorney to handle this for you. You have already provided enough facts to conclude that you have complicated your case by not revealing complete information about your past medical history. A good adjuster and a good attorney will go searching to find your medical history and yes they can find things which you do not mention in your letter to them.

    If you have any additional questions, please do not hesitate to ask me. If you find this response helpful, please click on the “thumbs up” button at the bottom.


    JOYCE J. SWEINBERG ESQUIRE
    Attorney at Law
    105 A East Maple Avenue
    Langhorne PA 19047

    215-752-3732
    jjsesq@comcast.net

    Disclaimer: Please note that this answer does not constitute legal advice. It is merely intended to provide general information to aid the poster in finding answers to the problem posed. This answer does not create an attorney-client relationship. In most cases, it is best to contact an attorney directly to find answers to your problems.

  4. Charles N. Therman

    Contributor Level 8

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    Answered . A. The attorney provides medical records, relative to the accident.

    B. Also, the 3rd party insurance company may request additional medical records for prior injuries

    C. The insurance company may possibly send out an authorization form to client, prior to retaining legal advice.

  5. Charles N. Therman

    Contributor Level 8

    1

    Lawyer agrees

    1

    Answered . A. The attorney provides medical records, relative to the accident.

    B. Also, the 3rd party insurance company may request additional medical records for prior injuries

    C. The insurance company may possibly send out an authorization form to client, prior to retaining legal advice.

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