Do I have to give the other driver's insurance company all of my medical records?

Why the Insurance Company Wants Medical Records

Even when an insurer accepts fault for a Durham car accident, it may still investigate whether the collision caused the claimed injuries and how those injuries affected the person’s life. Accepting fault does not necessarily mean the insurer accepts every injury, expense, or claimed loss.

Medical records may help establish:

• What symptoms were reported after the collision.
• When the injured person first sought care.
• What conditions medical providers evaluated or treated.
• Whether symptoms changed during recovery.
• Whether providers connected a condition to the collision.
• What medical expenses relate to the claimed injuries.

Records and itemized bills serve different purposes. A visit note describes the evaluation and care, while an itemized bill documents the charges. A claim package often needs both.

North Carolina Medical Records Are Not Automatically Open to the Adjuster

Under N.C. Gen. Stat. § 8-53, confidential medical information generally may be furnished with the patient’s authorization, although a court may compel disclosure when necessary for the proper administration of justice. In practical terms, the other driver’s adjuster ordinarily cannot simply obtain all of your records from every provider without authorization or another lawful basis.

That does not mean medical information can be withheld while the insurer is expected to pay an injury claim. A claimant generally must provide enough relevant documentation for the insurer to evaluate the nature, cause, and extent of the claimed injuries. If adequate information is not supplied, the adjuster may delay evaluation, dispute causation, or decline to include an unsupported condition or expense.

Which Records May Be Reasonably Relevant?

The appropriate scope depends on the injuries and losses being claimed. For neck pain, back pain, and concussion symptoms, relevant materials may include records from the collision date forward from providers who evaluated or treated those conditions. Diagnostic reports, visit summaries, discharge instructions, referrals, work notes, and related bills may also matter.

Earlier records can become relevant when they involve:

• The same body part or similar symptoms.
• A prior collision or injury that could affect causation.
• A medical condition the insurer argues contributed to the current complaints.
• Prior restrictions or limitations that overlap with the losses now claimed.

A prior condition does not automatically defeat a claim. It can, however, create a need to distinguish the person’s health before the crash from the symptoms and limitations afterward. A focused set of earlier records may provide that comparison without opening unrelated medical history.

Highly sensitive records should not be treated as automatically relevant merely because an injury claim exists. However, if a claimant relies on a physical, emotional, or marital effect as part of the claimed harm, information supporting that effect may become relevant. The proper scope depends on what is being claimed and how the issue can be documented.

Review a Medical Authorization Before Signing

An adjuster may send a medical authorization that permits the insurer to request records directly. Before signing, check whether the form is broader than the claim requires. Important terms include:

• Providers: Does it name particular providers, or does it apply to anyone who has ever treated you?
• Date range: Is it limited to a reasonable period, or does it cover your entire medical history?
• Types of information: Does it include unrelated or especially sensitive categories of records?
• Purpose and recipient: Does it identify who may obtain the information and why?
• Expiration: Does it state when the authorization ends?
• Communication rights: Does it permit direct discussions with providers in addition to obtaining written records?

One possible approach is to obtain the relevant records and bills and submit them to the insurer rather than signing an unrestricted authorization. Another is to use a limited authorization identifying the providers, conditions, and dates involved. The insurer may request additional information if the initial production leaves a genuine question about prior symptoms, causation, or treatment.

A claimant should not omit records that directly bear on the claimed injuries or create a misleading medical history. Selective disclosure can damage the insurer’s assessment of the claim and may create more serious issues if a lawsuit is filed.

What Changes If a Lawsuit Is Filed?

A pre-suit insurance request is different from formal discovery in a lawsuit. Once litigation begins, the parties may request documents and information relevant to the disputed issues. A court can resolve disagreements and may order appropriate medical information disclosed.

Filing an injury claim does not necessarily make every medical record discoverable. The claimed conditions, prior medical history, disputed causes, and requested damages help define what is relevant. Court procedures may also provide ways to challenge requests that are unreasonably broad or burdensome.

How Ongoing Treatment Affects the Records Decision

When someone is still receiving care, the medical record is still developing. Sending records too early may provide only a partial picture of symptoms, progress, expenses, and any continuing limitations. Updated records and bills may be needed later.

An early settlement offer does not necessarily reflect the complete medical history or the full effect of the injuries. A settlement release may end the bodily injury claim even if symptoms continue or additional expenses arise. The issue is not whether every medical record should be disclosed, but whether the relevant record set is complete enough to evaluate the claim before any final paperwork is signed.

How This Applies to the Described Injuries

For a person reporting neck and back pain and concussion symptoms after a North Carolina crash, records from the providers addressing those complaints are likely important. Earlier neck, back, neurological, headache, or similar records may also be relevant if they help distinguish prior symptoms from changes following the collision.

If the injuries have affected sleep or the marital relationship, the person should document those effects accurately and discuss with counsel what information is actually needed to support the claimed harm. Those sensitive issues do not automatically justify access to an entire lifetime of unrelated medical records.

Documents to Gather Before Responding

• The insurer’s proposed medical authorization.
• A list of providers seen because of the crash.
• Medical visit summaries and discharge instructions.
• Diagnostic and imaging reports.
• Itemized medical bills and health insurance statements.
• A list of earlier treatment involving the same symptoms or body parts.
• Letters, emails, and settlement offers from the adjuster.
• A copy of any release or authorization already signed.

Keep complete copies of everything sent to the insurer. It is also useful to record which provider’s materials were included and the dates covered.

Do Not Let Record Discussions Hide a Filing Deadline

Many North Carolina personal injury actions are subject to a three-year limitations period under N.C. Gen. Stat. § 1-52, although the correct deadline depends on the claim and facts. Negotiating with an adjuster, sending medical records, or waiting for a response does not automatically extend the deadline for filing a lawsuit.