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I do med mal defense and I encounter this issue frequently. Fortunately, I have good paralegals who are on top of following up to get the imaging for CT scans, X-rays, etc. I always am proactive in making sure the paralegals know to follow up to get imaging.
We point out in the cover letter that the request includes films, bold and underlined. However, you also have to learn how each provider works. One hospital requires a separate request to their "film library" and another needs the request faxed to their radiology department. As in the other response, paralegal followup is key, and the paralegal should keep a record of how each provider wants the film request.
We use Magna or Lexitas, but still most of our rad films come via CD or within huge compressed zip files that we then have uploaded to our system. Our legal assistants usually get them put into an appropriate format for review and then pass them over to the paralegal. Different firms do it different ways, but I just make sure we have the records ordered and follow up, as they usually come in last.
It's difficult but you need a good records team to keep following up.