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Re: Progressive adjuster bullying patient

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You must produce the records or she will be in violation of her policy. As per the personal information I believe you can sanitize those portions of the records….but what say the attorneys on the list serve? Vern Saboe From: oregondcs [mailto:oregondcs ] On Behalf Of lauren_mccabeSent: Wednesday, May 16, 2012 5:36 PMTo: oregondcs Subject: Progressive adjuster bullying patient I have a patient who was injured in an MVA. Her vehicle and the other vehicle are both insured by Progressive, who in my previous experience has been a very difficult company to work with.My patient signed the records release restricting the adjuster's access to medical records that pertain to her MVA. Her adjuster is saying that unless she gets access to all prior records from my clinic that she has to deny the claim because the patient is not cooperating with the adjuster's demand and is therefore in violation of her auto policy. My patient suffered a whiplash injury and has never experienced an injury to her neck prior to this accident so any prior records would be to different regions anyway. My patient also has some sensitive personal history that she doesn't want to reveal to just anyone which is part of the sticking point.The adjuster has now called my office to inform us that they will have to deny the claim from this point forward due to the patient being uncooperative with their demands to see all their medical records.Any advice on how to handle this? My patient has already been referred over to Gatti et al.Sincerely, McCabe, DC, DACBSP

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In addition to Vern’s wise words, I’d add that I’ve found all PIP insurers to be pretty much the same in regards to my dealings with them. It all has to do with who the adjuster on the case is. Sounds like you have a non pleasant adjuster which can lead to a non pleasant experience. Just produce the records and treat as usual.

ph Medlin D.C.

From: vsaboe

Sent: Wednesday, May 16, 2012 5:44 PM

To: 'lauren_mccabe' ; oregondcs

Subject: RE: Progressive adjuster bullying patient

You must produce the records or she will be in violation of her policy. As per the personal information I believe you can sanitize those portions of the records….but what say the attorneys on the list serve? Vern Saboe

From: oregondcs [mailto:oregondcs ] On Behalf Of lauren_mccabeSent: Wednesday, May 16, 2012 5:36 PMTo: oregondcs Subject: Progressive adjuster bullying patient

I have a patient who was injured in an MVA. Her vehicle and the other vehicle are both insured by Progressive, who in my previous experience has been a very difficult company to work with.My patient signed the records release restricting the adjuster's access to medical records that pertain to her MVA. Her adjuster is saying that unless she gets access to all prior records from my clinic that she has to deny the claim because the patient is not cooperating with the adjuster's demand and is therefore in violation of her auto policy. My patient suffered a whiplash injury and has never experienced an injury to her neck prior to this accident so any prior records would be to different regions anyway. My patient also has some sensitive personal history that she doesn't want to reveal to just anyone which is part of the sticking point.The adjuster has now called my office to inform us that they will have to deny the cla im from this point forward due to the patient being uncooperative with their demands to see all their medical records.Any advice on how to handle this? My patient has already been referred over to Gatti et al.Sincerely, McCabe, DC, DACBSP

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Dr. McCabe -

As one who reviews of such cases, I can tell you when some aspect of the patient's history is withheld it raises suspicion. Statements like "Past history is non-contributory" actually suggest there is more information than what is not contained in the records.

Past history may be a factor, or it may not; until it is known a decision as to its significance is not possible. If the policy calls for providing certain information, the claim could be denied if information is withheld.

I, too, have had patients with sensitive components to their past history. It could be HIV, erectile dysfunction, poor body habitus secondary to obesity, and number of other conditions that the patient perceives as personal. It may become apparent when the condition is explained. There may be a concern by the insurance carrier that the condition or its treatment may complicate the patient's recovery. Side effects of many of the statin drugs include musculoskeletal complaints, as is the case with Accutane for teens with acne; these are possible examples.

That said, you, as the doctor, wish to maintain a level of trust, but at the same time be able to treat the patient for the compensible injury.

When I write the history in such as case I try to provide as much information as possible without breaching the trust with the patient. It might read:

Patient reports that she has not previously suffered any injuries beyond a sprained ankle in her youth. She is being medically managed for a condition that does not appear to effect the musculoskeletal system or any areas injured in the collision of May 16, 2012. She reports no other serious illnesses. There have been no hospitalizations (if there has not been any) or surgeries (again, if there have not been any). I am providing you with a copy of her records of prior treatment at this office. Per the patient's request I have redacted information about her medically managed condition. If you require further clarification, please have one of your consulting doctors contact my office.

If your response to an inquiry is hostile or resistive, it may appear as if you are hiding something. That only serves to heighten the perceived problem.

I hope this helps.

Tom Freedland, DC

Posted by: "lauren_mccabe" lauren_mccabe@... lauren_mccabe

Wed May 16, 2012 5:35 pm (PDT)

I have a patient who was injured in an MVA. Her vehicle and the other vehicle are both insured by Progressive, who in my previous experience has been a very difficult company to work with.My patient signed the records release restricting the adjuster's access to medical records that pertain to her MVA. Her adjuster is saying that unless she gets access to all prior records from my clinic that she has to deny the claim because the patient is not cooperating with the adjuster's demand and is therefore in violation of her auto policy. My patient suffered a whiplash injury and has never experienced an injury to her neck prior to this accident so any prior records would be to different regions anyway. My patient also has some sensitive personal history that she doesn't want to reveal to just anyone which is part of the sticking point.The adjuster has now called my office to inform us that they will have to deny the claim from this point forward due to the patient being uncooperative with their demands to see all their medical records.Any advice on how to handle this? My patient has already been referred over to Gatti et al.Sincerely, McCabe, DC, DACBSP

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Which one of us is representing her?? There's no black and white answer here. Right now, if the patient has not released pre-accident records, then you can't produce them. My suggestion would be to communicate with the attorney (and have him/her resolve the issue). While an insured has a duty to cooperate, that doesn't mean that any prior records request is required under the PIP policy cooperation clause. It's one of those "it depends" scenarios. Also, whatever the adjuster says over the phone is basically irrelevant. They can and do say all sorts of things. Also, a denial of coverage in writing for failure to cooperate is generally reversed once the insured begins to cooperate again. Circles.

In any case, right now it's not your right or privilege to waive the doctor-patient privilege that the patient has invoked.

G.

Gatti, Gatti, Maier, Sayer, Thayer, & Associates

1781 Liberty St. SE

Salem, OR 97302

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msmith@...

From: oregondcs [mailto:oregondcs ] On Behalf Of vsaboeSent: Wednesday, May 16, 2012 5:44 PMTo: 'lauren_mccabe'; oregondcs Subject: RE: Progressive adjuster bullying patient

You must produce the records or she will be in violation of her policy. As per the personal information I believe you can sanitize those portions of the records….but what say the attorneys on the list serve? Vern Saboe

From: oregondcs [mailto:oregondcs ] On Behalf Of lauren_mccabeSent: Wednesday, May 16, 2012 5:36 PMTo: oregondcs Subject: Progressive adjuster bullying patient

I have a patient who was injured in an MVA. Her vehicle and the other vehicle are both insured by Progressive, who in my previous experience has been a very difficult company to work with.My patient signed the records release restricting the adjuster's access to medical records that pertain to her MVA. Her adjuster is saying that unless she gets access to all prior records from my clinic that she has to deny the claim because the patient is not cooperating with the adjuster's demand and is therefore in violation of her auto policy. My patient suffered a whiplash injury and has never experienced an injury to her neck prior to this accident so any prior records would be to different regions anyway. My patient also has some sensitive personal history that she doesn't want to reveal to just anyone which is part of the sticking point.The adjuster has now called my office to inform us that they will have to deny the claim from this point forward due to the patient being uncooperative with their demands to see all their medical records.Any advice on how to handle this? My patient has already been referred over to Gatti et al.Sincerely, McCabe, DC, DACBSP

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