Should you sign the other insurer’s medical authorization?

What is a medical authorization, and why does the other insurer ask for one?

A medical authorization, also called a medical release form, is a signed authorization form that lets your doctors, hospitals and other healthcare providers release your medical records to someone you name. Federal privacy rules generally require one before a provider shares your records for a purpose like this ¹.

Insurance companies on the other side of a claim want your medical information to judge your injuries. Your healthcare providers can’t simply hand over your records, or other patient information, without a valid authorization ¹.

There is a second route. Once a lawsuit starts, records can be requested by subpoena or court order, with notice to you or a protective order ⁵.

Is the other driver’s insurer covered by HIPAA?

By the federal definitions, no. HIPAA covers health plans, clearinghouses and certain providers ². The definition of a health plan leaves out liability insurance, including automobile liability insurance, and automobile medical payment insurance ²³.

That is our reading of those two rules. The privacy rule governs your doctor, not the insurer holding your records after you sign.

A valid form must say as much. Federal rules require it to warn you that information may be passed on and may no longer be protected ¹.

So a “HIPAA” label tells you the provider can use the form. It doesn’t tell you the insurer must keep your records private.

What does an insurance medical authorization form have to include?

People call it a medical release form, a records release or a medical consent form. The federal rule’s word is authorization ¹⁵. Consent to use your records for treatment, payment or health care operations can’t stand in for an authorization when one is required ¹⁷. Prior authorization is different again: approval from your own health plan that may be required before a service is covered ¹⁹.

A valid authorization form must contain at least these parts ¹⁵.

Three statements must also appear. They cover your right to revoke in writing, whether treatment, payment or benefits can depend on your signing, and that the recipient may pass the information on, so it may no longer be protected ¹⁵. The form must be in plain language ¹⁵.

A form that isn’t filled out completely on any of these parts is not valid ¹⁵. The rule also generally bars combining an authorization with another document ¹⁵.

What does each line of the form allow?

Above is what a valid form must contain. Below, those same parts are laid against a real insurance medical authorization form.

One limit first. This form is from New Jersey Manufacturers (NJM), for a claim on your own insurer’s medical-payments coverage, not the other driver’s liability claim ⁸. The other driver’s authorization form will differ. The checklist still applies.

Three things stand out.

First, the form lists provider types, not names. The rule asks for a name or “other specific identification” ¹.

Second, the dates run both ways: before signing and after, for 24 months ⁸.

Third, we saw no sentence about passing information on, or about treatment not depending on your signature ¹⁸. That is a fact about this one document. It doesn’t tell us whether a provider would refuse it.

The “minimum necessary” limit doesn’t narrow a release made under an authorization. What the form says is what the provider may release ⁴. Psychotherapy notes need their own separate authorization ¹.

Who can sign a medical authorization form for someone else?

The person the records are about signs. If a legal representative signs instead, the form has to describe that person’s authority to act for you ¹⁵. The rule calls such a person a personal representative and generally treats them as you ¹⁶.

Who qualifies depends on “applicable law,” so it can differ by state ¹⁶. In general:

• For an adult or an emancipated minor: a person with authority under applicable law to make health care decisions for them ¹⁶.
• For a child: a parent, guardian or someone acting in a parent’s place who has that authority under applicable law. Exceptions apply to some care a minor can lawfully get without a parent’s consent ¹⁶.
• After a death: an executor, administrator or other person with authority to act for the person or the estate ¹⁶.

Do you have to sign it?

We didn’t find a federal rule that makes you sign. The answer may depend on your state, your policy and where the claim stands, and we couldn’t confirm a general one.

A form from your own insurer can be different. The NJM application says you must sign the attached authorizations so it can decide what you’re owed ⁸.

One state shows how much rules can vary. Nevada’s statute says a claimant “may provide” an authorization to the other side’s insurer, for records “related to the claim.” The insurer must then give you the policy’s declarations page within 5 business days, with the policy limits visible ⁷.

The same statute says the authorization “may not be revoked without cause” ⁷. The federal default is different (see below). Your state may have none of this.

Your provider usually can’t make your treatment depend on signing the insurer’s form ¹. There are exceptions in the rule, for example care given only to create information for a third party ¹.

What are your options?

People in this spot tend to pick among three approaches. Law firms describe them ¹²¹³¹⁴. That is advocacy, not a rule.

Sign it as written. You give the insurer the whole form, with everything it allows ⁸.

Narrow it first:

• Ask to limit it to accident-related injuries and the dates from the accident to now ¹²¹³.
• Name specific providers rather than “any provider” ¹¹³.
• Add an end date or event ¹.
• Ask for a copy of what it gets, as Nevada’s law provides ⁷.

Send the records yourself. You can ask your provider for a copy and designate who it goes to. The request must be in writing, signed, and name the recipient and where to send it ⁶. If you ask for a copy, the provider may charge a reasonable, cost-based fee. It is limited to copying labor, supplies, postage and any summary you agree to ¹⁸.

The provider has 30 days to act, with one extension of up to 30 more ⁶. Psychotherapy notes and records compiled for a legal proceeding are outside it ⁶.

We found no rule on what an insurer must accept in place of its own form.

How long is a medical authorization form valid?

The rule requires an expiration date, or an expiration event that relates to you or the purpose of the disclosure. It names no maximum length ¹⁵.

For research authorizations, the rule accepts “none” as the end ¹⁵.

Under the rule, an authorization is not valid once the expiration date has passed, once the provider knows the expiration event has happened, or once the provider knows it was revoked ¹⁵.

The NJM form we read is valid for 24 months after signing. It covers records from before you sign and after, while it is in effect ⁸.

You can revoke sooner, in writing (see below). Some states differ; Nevada’s statute, above, limits revoking ⁷.

What if you sign and change your mind?

Federal rules let you revoke an authorization at any time, in writing ¹. A revocation doesn’t undo what was already released based on it ¹. A valid form must also say how to revoke it, or point to the provider’s notice that does ¹⁵. The NJM form asks for a written request that is dated, signed and gives the claim number ⁸.

There is an exception. If an authorization was a condition of getting insurance coverage, and other law lets the insurer contest a claim, revoking doesn’t reach that ¹.

Some forms set an end date. The one we read ends 24 months after signing ⁸. Nevada’s rule, above, shows a state can change this answer ⁷.

When should you talk to a lawyer?

A lawyer is worth a call before you sign if your injuries are serious, the form asks for years of history, or you can’t tell what it lets the insurer see ¹³¹⁴. A lawyer can read your actual form. This guide can’t.

Free and low-cost help exists. A lawyer referral service, run through your state or local bar association, can point you to a lawyer. Some lawyers offer free services or reduced fees ⁹.

Ask whether there is an up-front fee, and whether you would owe money if you lose ⁹.

Legal aid is free civil legal help for people with low incomes. The Legal Services Corporation lets you search by address for the groups it funds ¹⁰. LawHelp.org finds legal aid by state ¹¹. Ask whether the office takes injury cases.

See also our guide on settling a car accident claim without a lawyer.

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Common questions

Sources

1. 45 CFR 164.508, Uses and disclosures for which an authorization is required · Legal Information Institute, Cornell Law School
2. 45 CFR 160.103, Definitions · Legal Information Institute, Cornell Law School
3. 42 U.S.C. 300gg-91, Definitions, subsection (c)(1) excepted benefits · Legal Information Institute, Cornell Law School
4. 45 CFR 164.502, Uses and disclosures of protected health information: general rules · Legal Information Institute, Cornell Law School
5. 45 CFR 164.512(e), Disclosures for judicial and administrative proceedings · Legal Information Institute, Cornell Law School
6. 45 CFR 164.524, Access of individuals to protected health information · Legal Information Institute, Cornell Law School
7. Nevada Revised Statutes 690B.024 · Nevada Legislature
8. Application for Benefits, Auto Medical Payments Coverage, with Authorization to Release Information (form AC-PIP31, 7/21) · NJM Insurance Group
9. How can I find a lawyer? · Consumer Financial Protection Bureau
10. Get legal help · Legal Services Corporation
11. LawHelp.org · Pro Bono Net
12. Should I sign a medical authorization release form after my car accident? · Callahan & Blaine
13. Should you sign a medical authorization after a car accident? · Horn Wright, LLP
14. Should I give the at-fault driver’s insurance company a medical authorization? · Lamber Goodnow
15. 45 CFR 164.508, Uses and disclosures for which an authorization is required (current eCFR) · Electronic Code of Federal Regulations, Office of the Federal Register
16. 45 CFR 164.502(g), Personal representatives (current eCFR) · Electronic Code of Federal Regulations, Office of the Federal Register
17. 45 CFR 164.506(b), Consent for uses and disclosures permitted (current eCFR) · Electronic Code of Federal Regulations, Office of the Federal Register
18. 45 CFR 164.524(c)(4), Fees for copies of protected health information (current eCFR) · Electronic Code of Federal Regulations, Office of the Federal Register
19. Prior authorization (glossary) · HealthCare.gov, Centers for Medicare & Medicaid Services
20. 15 U.S.C. 7001, General rule of validity (electronic signatures) · U.S. Government Publishing Office