In Good Form
Obtaining Medical Information.
Ellsworth T. Rundlett III
May/June 2007 issue
documents described and boldfaced in this article are
clicking on the form’s name in the article or by visiting the
"Forms" section of our Web site.
The forms in this article include:
Letter Requesting Hospital Record (click to download)
Letter Requesting Doctor’s Office Notes (click to download)
Letter to Doctor Requesting Narrative Report (click to download)
Client’s Form for Medical Expense Records (click to download)
Instruction Letter to Client (click to download)
Request for Reconsideration Letter (click to download)
Installment Payment Letter (click to download)
Partial Payment Letter (click to download)
Common Medical Abbreviations (click to download)
Case Processing Timetable (click to download)
Trial Management Checklist (click to download)
When assisting in
personal injury cases, medical information is the most important
verification of your client’s injuries. Obtaining that information is
not always as simple as just requesting it. Your request must be
specific and supported by a medical authorization form. Furthermore, it
must be directed to the medical facility or doctor with a clear promise
that the information will be paid for promptly.
One of the biggest
decisions is how much information you need. In small cases, the
emergency report from the hospital, X-ray reports, doctor’s office
notes, physical therapy notes and copies of all medical bills might be
all you need. In cases where the client has spent considerable time in
the hospital, I recommend obtaining the entire hospital record. Some
attorneys always request the physician’s entire medical file. However,
in small cases it’s important to limit the amount of information
requested because it can be expensive and will clutter a file with
In more significant
cases, the attorney must at least review the entire file before suit, as
that file will be reviewable by the defense attorney. In these cases,
many attorneys make the mistake of requesting only the hospital
emergency report without making the request clear that the entire
record, including nurses’ notes, should be sent. Nurses’ notes often
contain important evidence with respect to pain, suffering, complaints,
medication effects and objective symptoms, such as swelling and vital
In many jurisdictions,
the hospital record is admissible in and of itself under the business
records exception to the hearsay rule. In such jurisdictions, the
statute or rule of evidence might require that the hospital record be
certified. Make sure you request this when you order the record so that
it can be admitted into evidence without having to call a witness to
testify as to the accuracy and content of the medical record.
The following letters
will help you efficiently obtain and track complete medical
Remedies for Excessive Medical Information Charges
Personal injury legal
professionals throughout the country often complain about doctors,
chiropractors and medical facilities that charge exorbitant fees for
medical reports, medical records, depositions and in-court testimony. If
you are involved in a situation where a medical provider has charged or
insists upon receiving an excessive fee for medical information, your
first step is to ascertain whether standards or fee schedules for
medical information exist in your state.
Some medical associations
and even medical or legal symposiums have adopted uniform schedules for
medical information, depositions and court testimony. Contact your local
bar association, state bar association, state trial lawyers association
or state medical association to see if a fee schedule has been adopted.
Another source is your state workers’ compensation system, which might
have adopted fee schedules for depositions, hearing testimony and
medical records. If you find a fee schedule, obtain a copy and check the
charges in your particular case to determine whether the doctor or
medical institution has charged an excessive fee. If the fee appears to
be excessive, send a copy of the fee schedule to the doctor’s office and
request that the doctor reconsider the amount charged and accept a fee
consistent with the schedule.
If there are no standards
or fee schedules in your state, you can either look to your own
experience in receiving bills for medical information or you can contact
other attorneys in your area, including defense attorneys who process
medical information, to determine a consensus of opinion on the fee. Do
not contact the doctor until you have become sure in your own mind that
the fee charged is blatantly excessive. Once you have determined that
the fee is excessive, consider the following alternatives:
1. Contact the doctor’s office requesting
Before you actually request the reconsideration, call the office manager
of the doctor’s office or medical facility and find out if the bill is
correct. If the manager or staff member replies affirmatively, politely
suggest that the fee is higher than the usual and customary charges for
information of this nature. Inquire as to whether there is something
different about the information provided that requires a more expensive
fee. Then, respectfully request that the staff member reconsider the
amount. If the bill is reduced, promise to send a check by return mail
and thank them for their courtesy.
Often, a polite letter is
more effective than a phone call. A letter allows the doctor or his or
her staff to consider the tone of your request and take time to
respond. I recommend sending a letter if you don’t know the doctor or
have never dealt with his or her office before. Use the
Request for Reconsideration Letter
(click to download).
Another option is to
instruct your client to contact the doctor’s office or medical facility
to complain about the bill. If your client has a long-standing
relationship with the doctor or facility, or if the doctor has received
a substantial amount of money for medical treatment (for example, a
chiropractor who has received several thousand dollars for numerous
treatments), it might be appropriate for the client to contact the
doctor or facility and request a reduction of the bill.
2. Pay the bill in installments.
If the bill is substantial, that is, several hundred dollars or more,
it’s appropriate to send payments on an installment basis. Send a letter
indicating that the bill is higher than customary and that your client
is unable to pay the cost all at once. Remind the doctor that your fee
agreement with the client makes the client responsible for the cost of
medical information. See
Installment Payment Letter
(click to download).
3. Send an amount that you deem fair and
indicate that the payment is to be considered in full satisfaction of
If you believe there is a significant chance that your case will settle
and that you will not require the doctor’s testimony at trial, and if
you don’t expect to have future contact with this particular doctor or
facility, you can simply send a check in an amount you deem fair and
reasonable. Attach a letter stating that you consider the check to be in
full satisfaction of the doctor’s charges. See
Partial Payment Letter (click to download).
4. Delay payment and inform the doctor
that the amount will be paid at the time of settlement or verdict.
way to deal with an excessive bill is to put it on hold until you have
resolved the case. This advice goes against my strong recommendation
that medical information be paid for immediately. However, in cases
where the fee is absolutely excessive, you can let the doctor know that
it’s your usual practice to pay for bills immediately, but in this
instance it’s necessary to delay payment until the funds are available.
Remind the doctor that the fee is your client’s responsibility and that
it’s necessary to wait until the client has received settlement proceeds
to pay for the bill.
5. If the doctor insists on an excessive
fee before sending the information, forward the payment under protest.
There are many circumstances in which doctors request an extremely
excessive fee before they will issue a report. In those cases, you
should send the amount requested and indicate that you are paying the
bill under protest. After you receive the report, if you still believe
the charge was absolutely outrageous, write to the doctor and request
reimbursement of a portion of the amount paid. If the doctor refuses,
you can threaten to report the incident to the state medical licensing
board or the state medical association.
Some doctors refuse to
come to court or attend a deposition unless they are paid an excessive
fee up front. In one case, a prominent surgeon in one of New England’s
largest cities demanded a deposition fee of $3,000 before he would
testify. If you are faced with such a situation and you believe the
amount requested is extremely excessive, use the subpoena power under
your state statutes or rules of procedure to require attendance at trial
or deposition, especially in a small to medium case. Explain to the
doctor that his fee will be considered by the court after the verdict
and that the court will determine whether the amount requested is
reasonable. Further advise the doctor that if the verdict is sufficient,
your client will consider payment of the full amount requested.
6. Pay the bill.
There are circumstances
in which you will just have to grit your teeth and pay the bill in full,
especially if the doctor is likely to be a witness at trial. I don’t
recommend alienating your primary witness over $100 or $200. It has been
my experience that, despite excessive witness fees, the doctor’s
testimony was so good that the case settled very reasonably or the
verdict was well in excess of the amount offered before trial.
Keeping Small Cases on Track
Most small personal
injury cases should follow a fairly expedient timetable. I have seen
many cases come to my office from clients who have left other lawyers
because their case had not yet settled. When I go through the files on
those cases, I often notice that the case is several years old, with a
minimal offer from the insurance company. Insurance carriers love these
stale files. They know that even if the case proceeds to trial, their
ultimate exposure will still be only a few thousand dollars.
Case Processing Timetable
(click to download)
as a general guideline to assist you in keeping track of your small
cases. Also, use the
Trial Management Checklist (click to download)
to monitor the progress of your case. When you have completed each step,
indicate the date in the respective column. Review the checklist
periodically to make sure the case is not getting stale and that the
proper procedures are being followed.
Small cases get old,
forgotten and decrease in value as time goes on. Don’t let this happen
to your files. Keep your cases on track and avoid having the files
become burdensome anchors.