Possible Requests From Insurance Adjuster

After an insurance company has received a new personal injury claim, the insurer creates a new file, and gives that same file to one of the company’s adjusters. The adjuster’s investigation could include the issuance of certain requests.

A request for documentation that related to the claimant’ injuries

X-rays of the injured body part(s): A supplement to records that had come from the treating physician

Records that relate to a pre-existing injury, if that same injury had been mentioned in previously released records

How should a claimant reply to such a request? Claimants should select one of 2 options.

What are the options available to claimant that has been asked for documentation that related to the reported injuries?

Option #1: Ask insurance company to pay the fee that has been requested by the doctor’s office. Still, do not wait for delivery of that fee; instead pay out-of-pocket for the requested documents. Then review the same documents, before sending them to the adjuster. Send only those documents that relate to the accident-linked injury.

Option #2: Ask the adjuster to explain the reason for the demand for additional records. If compliance with the request would act as an infringement on the claimant’s privacy, then refuse to cooperate. Indicate that more of the medical records would be shared with the insurance company, if the case were to proceed to a trial stage.

The second possible request: Asking the claimant to attend a scheduled IME (independent medical examination)

Most claimants refuse such a request, unless their case involves one of the following situations

—Their own insurance company has scheduled the IME.
—The claimant has filed a personal injury lawsuit.

When presenting the refusal, a claimant, or the claimant’s lawyer could state that the potential patient did not know the examining doctor, and could not judge the value of that same doctor’s opinion.

More advice on replying to one or both requests:

The implementation of any action that was suggested, following receipt of an adjuster’s inquiry, regarding documents or an IME, can be carried out more smoothly if the injured victim has hired a personal injury lawyer in Whitby.

A lawyer could pay out-of-pocket for any records from a doctor’s office, and add that payment to the all of the other costs that might arise. He/she could put any refusal in a letter that had his/her signature.

Lawyers understand best what actions could be viewed as an infringement on a given client’s privacy. They also appreciate the fact that the legal system respects that privacy.

An injured victim has more than one reason for consulting with, and then hiring a personal injury attorney. That action increases the chances for the case’s successful resolution.

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