Can The Insurance Company Request to Review My Full Medical Records?

Can The Insurance Company Request to Review My Full Medical Records?

It is a common requirement for insurance companies to request medical information from claimants and their health-care providers to substantiate illness or injury-related claims before benefits are paid out.

In your initial application for benefits, you were likely required to include medical records specifically addressing why your health condition prevents you from working. You may have even received requests for more detailed reports weeks or months after submitting the application, which you also complied with. Now, your insurer may be requesting your permission to review your full medical records.

There are a couple of reasons why the insurance company might make such a request. First, they may be looking for evidence that your injury or illness was a pre-existing condition, which, depending on the details of your policy, may deem you ineligible for benefits. Second, they may be looking for evidence of misrepresentation (incorrect information you innocently or fraudulently provided or omitted from the insurer) when you first purchased the policy or became eligible for coverage under your employer’s group plan.

Are you required to comply with the insurance company’s request for authorization to view your full medical records? The general answer is, yes. Most policies have a clause that gives insurers permission to request a claimant’s full medical records and other personal information such as tax returns or T4s. Failure to cooperate with the insurer’s request could result in your benefits being denied or cut off. Review the details of your policy thoroughly to be certain that your insurer’s requests are reasonable.

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