medical records personal injury cases

The Role of Medical Records in Personal Injury Claims

At The Law Offices of John J. Perlstein, our Orange County personal injury lawyers have truly seen it all. From our nearly 25 years of experience, there is one element we cannot stress enough: the importance of medical records.

Regardless of whether the injury is a burn or amputation, it needs to be medically documented. Obtaining this documentation is a key factor in strengthening your case. Without it, your Orange County personal injury claim may not stand a chance in court!

What Medical Records Do You Need In a Personal Injury Claim?

Each case will vary depending on the severity of the injury and treatment plans. Below are some examples of medical records that may be useful to obtain. Note, this list is not exhaustive.

It is advisable to seek written records or recipients of any notes, expenses, and other records related to your injury. With this information, an Orange County personal injury attorney can help determine relevance.

  • Doctor’s diagnosis: A documented diagnosis is the most basic element needed. This record proves there is an injury and can be the backbone of the case.
  • Medical bills: Always keep receipts of any medical expenses paid out of pocket and by your insurance company. These breakdowns can prove the extent of compensation needed.
  • Hospital records: Admission to the hospital can prove the existence of injury. If these are time-stamped with the date following the accident, this can also help prove causation.
  • Detailed notes from doctor’s appointments: In some cases, it may be beneficial to receive descriptive notes from your care provider outlining your condition and treatment plan. An expert’s opinions can be useful in further proving the need for compensation.
  • Prescriptions: Depending on the injury, you may need to take painkillers, anti-inflammatories, or other prescriptions. Records of these prescriptions can show the severity of the condition. They are also proof of the costs needed.
  • Diagnostic tests: Records from X-rays, MRIs, and other tests are also important in establishing the severity and existence of injuries.
  • Rehabilitation and physical therapy: If you attend physical therapy or other rehabilitative sessions, you should obtain records of these sessions. These again are expenses that the opposing party will need to pay back.
  • Photographs of injuries: Photographs of the injuries can be persuasive in proving the extent of the injuries. This can be especially useful if they are from the scene of the accident.
  • Injury journals: In some cases, a victim may be able to use their own records as evidence. A personal injury journal may recall detailed descriptions of the accident and subsequent

While medical records are essential to any personal injury cases, they can be especially necessary for medical malpractice claims. This may require additional documentation. A personal injury law firm can guide you through the needed records that will depend on the circumstances surrounding your accident.

personal injury claim orange county

How Do I Obtain My Medical Records for a Personal Injury Claim?

If you are the victim of a personal injury accident, you have the right to request your own medical records. The Health Information Portability and Accountability Act (HIPAA) grants patients the right to receive copies of their own patient records. California Health & Safety Code section 123100 et seq further enforces this.

Under HIPAA, parents or legal guardians can obtain the medical records of minor children unless otherwise specified. In wrongful death claims, it may be possible for loved ones to obtain medical records as well, though it will depend on the specifics of the case.

Obtaining medical records can be overwhelming, but an Orange County personal injury attorney can help with the process. It is advised that you grant your lawyer legal authorization to access these records. California evidence code section 1158 allows attorneys to obtain records with written consent from the patient or the legal guardian/conservator of the patient.

An Orange County personal injury attorney can also request images and police records to further strengthen the case.

Importance of Medical Records

Medical records can significantly strengthen your personal injury claim. Having these files can help increase compensation by proving the existence and severity of the injuries.


The opposing party may try to undermine the existence of your injuries, especially if they are not physically noticeable. For example, say you suffer a traumatic brain injury from a drunk driver. Brain injuries are not physically noticeable in the way a broken bone or laceration might be. Thus, having medical records can prove the accident resulted in an injury.


Another argument by the opposing side may be the lack of relation between the injury and the accident itself. For example, the opposing party may argue elderly individuals have pre-existing conditions. Orange County personal injury lawyers will use your medical records to prove causation.


Not all injuries are equal, and thus, compensation should take this factor into consideration. A catastrophic injury should receive a higher payout than a broken finger due to the extent of suffering. Similarly, documented mental anguish can also be a cause for compensation.

An Orange County personal injury lawyer will use medical records to negotiate a settlement with the opposing party. Financial compensation should reflect your physical and mental pain and suffering. If the settlement doesn’t reflect this, it may be worth moving forward to trial.


As mentioned above, medical records will ultimately impact the damages awarded. Showing receipts of expenses related to the injury will help you receive your compensation.

This is especially important in serious cases where the victim will need to account for ongoing expenses and care. For example, an individual with a spinal injury may need to consider the future expenses needed to live a comfortable life. This is especially important if their injury will continue to escalate in severity.

Personal injury lawyers in Orange County can help calculate past and future expenses to get maximum financial compensation.

Personal Injury Attorney– Orange County, CA

If you are suffering from a personal injury, the last thing you want to worry about is dealing with insurance companies. Our Orange County personal injury attorneys will be by your side every step of the way.

Our Orange County personal injury lawyers will work directly with insurance companies and other representatives to secure the highest settlement possible. And, if needed, we are not afraid to take cases to trial to ensure you get the best deal. John Perlstein is among Super Lawyers‘ rankings of top trial lawyers in Southern California.

For a free consultation with an Orange County personal injury attorney, fill out our contact form today.

Los Angeles Personal Injury Victim or Surviving Loved One of a Los Angeles Wrongful Death Victim?

It’s vital to take action now. Call (213) 252-1070 today or fill out the form below for a FREE consultation with a personal injury and wrongful death attorney (Los Angeles and the surrounding Southern California area).

Fill out the form below to set up a free consultation on your personal injury case: