Is the insurer requesting your complete medical file because it has doubts about your personal injury claim? Medical information may be needed to assess your symptoms and limitations, but a request must be relevant and sufficiently targeted. Ask which medical question needs to be answered, which period is needed and who will receive the data. A general suspicion of fraud does not automatically justify unrestricted access to your medical history.
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Written by Onur Arslan, attorney at Arslan Advocaten. Do you have questions about your own situation? Get in touch.
Why is medical data requested?
In a personal injury case, it must be established which symptoms were caused by the accident and what consequences they have. Information about earlier, similar complaints may be relevant for this. The first visit to the GP, the course of treatment and the response to physical strain can also help in the assessment.
However, a treating doctor does not automatically describe all the legal consequences. The medical assessment and the question of which damage is legally attributed to the accident are separate steps. A pre-existing condition does not in itself rule out compensation. What also matters is the situation that would probably have existed without the accident.
The role of the medical adviser
Medical information must be processed with care. The medical adviser assesses its medical significance; a claims handler does not need the complete medical file for every part of their work. Ask how the insurer organises access and which information ends up in a non-medical investigation report.
The Medical Section of the Code of Conduct for Personal Injury Claims (GBL) sets out principles for a careful medical assessment process. That focus on relevance and restraint also matters when a dispute arises about the reliability of a claim.
A targeted authorisation
Check which healthcare provider will be approached, which information is being requested, for which period and for what purpose. An authorisation to request data from one specialist is something different from permission to approach all healthcare providers about your entire life.
If the request is too broad, propose a concrete alternative. For example, first information about the relevant complaints within a defined period, followed by further questions if there is a demonstrable reason for them. A complete refusal without explanation can needlessly block the assessment. A targeted response protects your privacy and also moves the claim forward.
Earlier complaints are not the same as concealment
A file may contain old back problems, psychological complaints or earlier accidents. This does not automatically mean that you deliberately withheld information. Look at which question you were asked, what you could reasonably remember at the time and whether the information was relevant to your answer.
A discrepancy between medical reports also needs context. A GP often takes brief notes, written for a treatment question. The absence of a detail in a consultation note does not in itself prove that the detail is incorrect. Have alleged contradictions assessed both medically and legally.
If the insurer alleges fraud on the basis of medical information
Ask for a precise explanation of the accusation. Does it concern the existence of the complaints, their cause, their severity, the limitations or an incorrect statement? Each of these steps requires its own substantiation. A difference in medical opinion is not automatically an intent to deceive.
Also ask whether the medical advice is complete and which investigative question was put to the adviser. If a difference of opinion persists, an independent expert examination may be worthwhile. Agree in advance on the expert, the questions to be put, the available documents and the costs. This prevents a second report from repeating the same ambiguities.
Frequently asked questions
Do I have to hand over my entire GP file?
Not every request for the complete file is justified. Whether it is necessary depends on the dispute and the relevant medical history.
May I send information directly to the medical adviser?
Agree on a secure route for medical documents. Ask who will have access and how the medical advice will then be shared.
May I leave out unfavourable documents?
You must answer relevant questions honestly. Limiting information in a targeted way is something different from deliberately concealing relevant data.
Can an old complaint rule out my entire claim?
That does not follow automatically. The nature of the old complaint, recovery before the accident and the likely course of events without the accident are important.
Who assesses an authorisation that is too broad?
Your lawyer and medical adviser can jointly assess which information is needed and draw up a reasoned alternative.
Can Arslan take over a case during a medical examination?
That can be looked into. We first assess the existing arrangements, deadlines, available advice and the funding of the further handling of the case.
Read more about multiple accidents, challenging an expert report and the burden of proof in insurance fraud.
Have the request for information or the medical fraud allegation assessed before you sign a broad authorisation.
This page provides general information and is not legal advice about your own situation. No rights can be derived from its content.
