Paralegal Practice Tips: Medical Records

Well-qualified paralegals who are responsible for obtaining and reviewing medical records in workers’ compensation practices should:

■ Know the relevant state statutes, case law and/or state agency rules regarding obtaining and disclosure of medical records, as well as contact with medical providers.

■ Know how frequently contacted medical providers accept medical record requests.

■ Keep medical record release forms or authorizations for frequently contacted medical providers in a form file (paper or digital image).

■ Obtain an itemized billing statement from each medical provider to compare with the medical records and verify that no records are missing.

■ Have a working knowledge of basic medical abbreviations used by many medical providers.

■ Prepare a medical record summary for each client.

■ Know where to look up CPT and ICD-9 diagnosis and billing codes.

■ Contact medical providers regarding the injured worker’s unpaid medical expenses.

■ Prepare a medical expense summary when medical expenses have been paid by group health insurance, Medicare or Medicaid, or the injured worker.

■ Know if state statutes and/or state agency rules prohibit medical providers from dunning or pursuing collection actions against patients who have workers’ compensation claims pending.

■ Know if the state agency requires that an itemized statement of medical expenses be attached to any clincher or settlement agreement submitted for approval.

Excerpt from Workers’ Compensation Practice for Paralegals (Carolina Academic Press 2008)
Addendum: Most of these practice tips apply to handling medical records in other types of civil injury cases as well. An itemized statement of medical expenses should be included in settlement packages for personal injury, wrongful death and medical malpractice claims, and may be attached to plaintiff’s responses to defendants’ discovery requests for the amount of medical damages and/or “specials”. A good habit to develop when managing injury cases is to prepare an initial itemization of medical expenses when the firm accepts the case for representation and then continue to update it until the patient reaches maximum medical improvement (“MMI”) or is discharged from ongoing care.