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How Long Does It Take to Review Medical Records for the Claims Process?

If you’re waiting for the results of a claim, it can be frustrating or confusing to see the process hit a snag. More often than not, the slowdown is related to medical record documentation.

Published on:
March 15, 2024

If you’re waiting for the results of a claim, it can be frustrating or confusing to see the process hit a snag. Unfortunately, claims processing delays happen frequently in the system. More often than not, the slowdown is related to documentation – more specifically, documentation related to your medical records. 

Medical records are the documents associated with you as a patient over your lifetime — the notes from each time you’ve visited a physician, gone to the emergency room for an injury, or had an x-ray. Depending on your age, health, and other factors (like where you live), you can have vast sets of medical records that will all impact the processing time for your claim. 

How long do medical records take to review?

Claims involving medical records usually fall into a few categories: injuries or accidents at work, collisions on the road, or medical malpractice are all examples of medical related claims.

The timeline for your medical records doesn’t stop at the accident or illness leading to the personal injury claim. After the claim is officially reported, the investigation into liability for the claim begins. This involves looking into the circumstances behind the claim and the amount of coverage under the policy. When this is done, the claims adjuster will also look into witness testimonies, expert advice, and medical data. 

The medical records involved in the claims process are used for the adjuster to make a decision on the claim. This means the files documenting your health situation, plus the results of an independent medical examination (IME) if necessary. 

What’s in these files? Everything that might possibly impact the result of the claim. In order to assess whether an injury was caused by a third party, the lawyer needs to show that the area was working pretty well before the claim. This involves medical records. 

For example, if you break a collarbone in a car accident, the claims adjuster might ask for the x-ray taken by the doctor, the notes from your emergency room visit, and the follow-up visits in the days after. They may also request notes from your medical radiologist who took the x-ray.

In this hypothetical example, the adjuster sees a note about a prior collarbone injury you told the radiologist about during the scan. Now the adjuster decides to go back into your medical file to see some files from the last 10 years, looking for the report. This means manual time spent seeking out this information and reviewing it (sometimes with the insight of an expert examiner) before finishing the claim. The topic actually came up at the New York Self Insurers Association’s 2024 meeting: Edward Nicosia’s presentation showed how ‘loss of use’ injury payouts are carefully adjusted for a prior claim. The injury-related paperwork will follow the claim from IME to lawyers as they determine precisely the extent the previous injury relates to this one - involving a substantial number of files and a significant amount of time.

How long does the medical record review process take? Some personal injury lawyers suggest it takes around 30 days for medical record review in a normal case. However, with the example described above, your medical records can take another 60 days or more as the adjuster works to collect evidence that could be related to the claim. 

What can speed up medical records review? 

Medical records review is a time consuming process. It’s also traditionally been done by hand. This means hundreds (or even thousands) of pages for your adjuster to work through, and this is time consuming for any type of claim. 

Fortunately, artificial intelligence (AI) can help streamline the medical record review. With generative AI tools like medical record summaries, automatic indexing, chronological timelines of the claim, or insights into what these hundreds of pages contain, claims adjusters have the information that they need at their fingertips. 

They also have the information they’re missing, meaning documents, and files, can be requested ahead of time to streamline their workflow.This is similar to the discovery process in personal injury law. After casting a ‘wide net’ and requesting every file you might need, AI tools can help adjusters, lawyers, and insurance professionals hone in on missing information - and access it in less time. 

AI tools are capable of reviewing 750 pages in about an hour, far beyond the capacity of humans. Human brain power comes into play at critical points in time, making professional decisions and ensuring accuracy within the claim. In essence, the AI tool becomes an assistant or extension of the human professional. This means faster medical review, and a quicker resolution to your claim!

Kristen Campbell
Content Writer

Kristen is the co-founder and Director of Content at Skeleton Krew, a B2B marketing agency focused on growth in tech, software, and statups. She has written for a wide variety of companies in the fields of healthcare, banking, and technology. In her spare time, she enjoys writing stories, reading stories, and going on long walks (to think about her stories).

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