Throughout the course of your long-term disability claim, your insurer will likely ask you or your doctor to provide them with your medical records. For many people, this process is relatively simple: the insurance company asks your doctor, and they give them the records.
However, sometimes doctors or specialists will refuse to send your medical information. Why? Who knows. Sometimes this refusal comes from incompetency, overexertion or poor office systems. Regardless of the cause, however, the result is the same: the insurance company will terminate your claim or make your life more difficult until they receive the records.
This situation is extremely frustrating, we know. Luckily, however, there are a few things you can do. In this article, we are going to overview three steps you can take to get your doctor to send your medical records to your long-term disability insurer.
1. Ask your doctor a couple of times
This first step is obvious. However, it’s important to emphasize that you should ask your doctor a few times before doing anything drastic. In most cases, your doctor doesn’t have malicious intentions. They may just be busy or completely forgot to send in the forms. So, make sure to give them a few chances and explain the importance of the records.
2. File an official Freedom of Information (FOI) request
If your doctor still refuses to send your medical records after you’ve asked a couple of times and explained the severity of the situation, the next thing you can do is file an official Freedom of Information request. Depending on what province you live in, the process for filing may differ. However, generally, you send an access to information form directly to your doctor or the custodian of records, asking them to provide your records. Once you send the form, your doctor typically has 30 to 60 days to respond. If they don’t respond within that time frame or request an extension, then you can file a complaint. After your request and complaint have been made, the Office that oversees the privacy act in your province will begin writing letters to your doctor and delivering fines if need be.
The following is a breakdown of how to file a freedom of information request in each province:
Ontario
In Ontario, requests for medical records are governed by the Personal Health Information and Protection Act (PHIPA). You can request your medical file directly from your doctor using this form. If the doctor does not respond or provide the records within 30 days, then you can file a complaint with the Information and Privacy Commissioner of Ontario. You can file a complaint using this form.
Alberta
In Alberta, medical records are governed by the Health Information Act. You can request your medical file directly from your doctor using this form. If the doctor does not respond or provide the records within a reasonable amount of time (generally 30 to 60 days), then you can file a complaint with the Office of the Information and Privacy Commissioner of Alberta. You can file a complaint using this form.
British Columbia (B.C.)
In B.C., medical records are governed by the Personal Information Protection Act. You can request your medical file directly from your doctor using this form. If the doctor does not respond or provide the records within 30 days, then you can file a complaint with the Office of the Information and Privacy Commissioner for British Columbia. You can file a complaint using this form.
New Brunswick
In New Brunswick, medical records are governed by the Personal Health Information Privacy and Access Act. You can request your medical file directly from your doctor using this form. If the doctor does not respond or provide the records within 30 days, then you can file a complaint with the Office of the Ombudsman New Brunswick. You can file a complaint using this form.
Newfoundland
In Newfoundland, requests for medical records from doctors are governed by the Personal Health Information Act (NL). You can request your medical file directly from your doctor by citing sections 52 to 54 of the Personal Health Information Act. In the request, you will need to include your full name, birthdate, and healthcare number. And make it clear that you are requesting your medical records. This request must be written. (If you aren’t sure what to write in your request, please see the sample letter provided below).
If the doctor does not respond or provide the records within 60 days, then you can file a complaint with the Office of the Information and Privacy Commissioner of Newfoundland and Labrador. You can file a complaint using this form.
Sample letter/email to make your request (NL):
Dear Privacy Officer,
Under sections 52 to 54 of Newfoundland’s Personal Health Information Act (PHIA), I am requesting a copy of my personal information described below.
[Provide a detailed list of the personal information you are seeking. Providing a clear, narrow request (for example, relating to a specific topic or using date ranges) can result in a quicker response.]
In general, the PHIA requires organizations to provide individuals with access to their personal information at free or minimal cost within 60 days. For details about organizations’ responsibilities under the PHIA access provision, see the Office of the Privacy Commissioner’s website at: https://www.oipc.nl.ca.
If you do not normally handle these types of requests, please forward this letter to the person in your organization responsible for privacy compliance.
Please contact me at [your daytime phone number and/or your email address] if you require additional information from me before you proceed.
Here is information that may help you identify my records:
Full Name:
Address:
Account number [if applicable]:
Nova Scotia
In Nova Scotia, medical records are governed by the Personal Health Information Act. If you’d like to access your medical records, the first step is to make an official written request to your doctor. You can do that by stating you are making a request for medical records pursuant to section 71 of the Personal Health Information Act. You must also specify the subject matter of the record requested with sufficient particulars to enable the custodian to identify and locate the record. This means you have to tell them what years you’d like records for and include your full name, healthcare number, and birthdate. (If you aren’t sure how to write in your request, please see the sample letter provided below).
If the doctor does not respond or provide the records within 30 days of your request, then you can file a complaint with the Office of the Information and Privacy Commissioner for Nova Scotia (OIPC). You can file a complaint using this form.
Sample letter/email to make your request (NS):
Dear Privacy Officer,
Under section 71 of Nova Scotia’s Personal Health Information Act (PHIA), I am requesting a copy of my personal information described below.
[Provide a detailed list of the personal information you are seeking. Providing a clear, narrow request (for example, relating to a specific topic or using date ranges) can result in a quicker response.]
In general, the PHIA requires organizations to provide individuals with access to their personal information at free or minimal cost within 30 days. For details about organizations’ responsibilities under PHIA’s access provision, see the Office of the Privacy Commissioner’s guidance at https://oipc.novascotia.ca under Tools for Health Custodians.
If you do not normally handle these types of requests, please forward this letter to the person in your organization responsible for privacy compliance.
Please contact me at [your daytime phone number and/or your email address] if you require additional information from me before you proceed.
Here is information that may help you identify my records:
Full Name:
Address:
Account number [if applicable]:
Saskatchewan, PEI and Manitoba
In Saskatchewan, PEI and Manitoba, Federal privacy legislation (i.e., the Personal Information Protection and Electronic Documents Act) covers information requests for health records from private doctor’s offices. If your doctor refuses to send records, you can request your medical records directly using the template below.
If the doctor does not respond or provide the records within 30 to 60 days, then you can file a complaint with the Office of the Privacy Commissioner of Canada using this form.
Sample letter/email to make your request (SK, MB, PE):
Dear Privacy Officer,
Under section 4.9 of Schedule 1 of Canada’s federal privacy legislation — The Personal Information Protection and Electronic Documents Act — I am requesting a copy of my personal information described below.
[Provide a detailed list of the personal information you are seeking. Providing a clear, narrow request (for example, relating to a specific topic, or using date ranges) can result in a quicker response.]
In general, PIPEDA requires organizations to provide individuals with access to their personal information at free or minimal cost within 30 days. For details about organizations’ responsibilities under PIPEDA’s access provision see the Office of the Privacy Commissioner’s guidance at priv.gc.ca: What businesses need to know.
If you do not normally handle these types of requests, please forward this letter to the person in your organization responsible for privacy compliance.
Please contact me at [your daytime phone number and/or your email address] if you require additional information from me before you proceed.
Here is information that may help you identify my records:
Full Name:
Address:
Account number [if applicable]:
3. Make a complaint to the College of Physicians & Surgeons in your province
In 99.9% of cases, a freedom of information request and/or complaint will motivate your doctor to send in your records. In our experience, once they start getting letters from the Privacy Office, they will do what they need to do to get you your information. However, what if it doesn’t work and your doctor still refuses to send your medical records?
If your complaint to the Privacy Office doesn’t pan out, then there is one more step you can take, which is submitting a complaint to the College of Physicians & Surgeons in your province. These organizations regulate the practice of medicine in each province. They also conduct investigations and monitor the quality of care provided by physicians.
But keep in mind, this is a step we do not recommend. You are better off leaving your doctor than making this kind of complaint. Why? Complaints to the College are very serious, and they can have devastating impacts on your relationship with your doctor and potentially other doctors.
The only time we recommend complaining to the College of Physicians & Surgeons, in the context of not sending in medical records, is when you have exhausted all other avenues and you believe your doctor is failing to provide your records because of problems with their practice.
For example, we had a person call in recently who told us her doctor wasn’t sending in their medical records because they didn’t have a receptionist. If this is the case, a complaint may be helpful because the College may advise the doctor on how to improve their practice or conduct.
With that said, these types of complaints should be taken very seriously. Please try the above steps first or consider leaving your doctor before even thinking about making a complaint to the College of Physicians & Surgeons in your province.
And, of course, you should always complain to the College if you have experienced any or all of the following:
- Concerns of inadequate care by your physician;
- Poor or unprofessional conduct by your physician; and/or
- Sexual abuse or inappropriate conduct by your physician.
Final Thoughts
When your doctor refuses to send medical records to your insurer, it can make you feel completely helpless. Hopefully, after reading this article, however, you feel a little more in control of the situation.
We hope this advice helps, and we wish you the best in your endeavours. And if you’d like to learn more about related topics, we encourage you to check out the following articles:
- What To Do if Your Doctor Won’t Fill Out Medical Report Forms
- Virtual Clinics That Fill Out Disability Medical Report Forms
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