In liability claims, an authorization from the injured party is required to obtain medical records.

In liability claims, an authorization from the injured party is required to obtain medical records.

• A. Investigate the claim
• B. Obtain medical records
• C. Contact the insured
• D. Issue a partial claim settlement

Answer: (B)

Access to an injured party’s medical records in liability claims hinges on privacy protections for health information. An authorization is required because medical records contain protected health information that cannot be disclosed to an insurer without the patient’s consent. The signed authorization specifies who can receive the records, what records, and for what time period, and it may include revocation rights and an expiration date. With a valid authorization, the insurer can request records from healthcare providers to verify treatment, understand the extent of injuries, link symptoms to the incident, and quantify damages. Without it, providers are legally prohibited from sharing the records, which can stall the claim or raise legal issues. The other actions listed—investigating the claim, contacting the insured, or attempting a partial settlement—are part of claims handling processes, but they do not replace the necessity for patient authorization to obtain medical records.

Access to an injured party’s medical records in liability claims hinges on privacy protections for health information. An authorization is required because medical records contain protected health information that cannot be disclosed to an insurer without the patient’s consent. The signed authorization specifies who can receive the records, what records, and for what time period, and it may include revocation rights and an expiration date. With a valid authorization, the insurer can request records from healthcare providers to verify treatment, understand the extent of injuries, link symptoms to the incident, and quantify damages. Without it, providers are legally prohibited from sharing the records, which can stall the claim or raise legal issues. The other actions listed—investigating the claim, contacting the insured, or attempting a partial settlement—are part of claims handling processes, but they do not replace the necessity for patient authorization to obtain medical records.