English 
Spanish Yes, your employer and the workers’ compensation insurance company need your medical records to investigate your workers’ compensation claim. They need this information to validate your claim and determine the cost to pay for your benefits. If you do not release your medical records, they will likely deny your claim.
However, you do not have to release all of your medical records. They only need prior medical history, treatments, and claims that are directly relevant to your work injury. In this article, we’ll explore how insurance companies use your medical records when investigating workers’ compensation claims, how these records are requested, and the ways a workers’ compensation lawyer can protect you from bad faith practices.
Why Do They Need My Medical Records for a Workers’ Compensation Claim?
The insurance company handling your workers’ compensation claim will use the medical records on your current injury to better understand its extent and severity, your treatment options, and how your injury occurred. They may also use the records to ensure you get the treatment you need to recover after your work-related injury.
However, the insurance company is also looking for holes in your story and reasons to deny your claim if they can. They’re also trying to determine how soon you may be able to return to work, identify modifications and alternative work arrangements, and calculate the costs of treatment to offer a meager settlement.
They will likely want to see past medical records, too. This information can help them understand whether you had any pre-existing conditions that are related to your work-related injury or illness. They’ll want to determine whether your injury or illness was caused by your work and not something else. They may also investigate how your work has made the existing injury or illness worse, which can be validated in a claim as well.
Types of Medical Records and Information Insurance Companies Can Request
You do not need to release all of your medical records to insurance companies. On the HIPAA medical records release form, you can agree to let them view all medical records they request. However, it’s best to only reveal relevant records to protect your personal information. You have the right to choose which types of medical history they can access.
Some medical information they may request includes:
- Previous medical doctors
- Test results
- Emergency room visits
- Prior hospital and outpatient center stays
- Mental health and psychiatric care records
- Alcohol and substance use information
- Previous insurance claims
If you don’t agree to send the records they need, they are likely to deny your workers’ compensation claim because they could not fully investigate your case.
You can get advice on which records to release and how to protect your personal information by working with a workers’ compensation lawyer from our team. We can help you fill out the HIPAA release form and identify which records are relevant to your case. This can make the records release process less stressful and help protect your information so you feel more secure.
How Medical Records Are Requested in a Workers’ Compensation Case
When you file paperwork for your workers’ compensation claim, you’ll need to fill out the HIPAA medical records release form, which is Form 16-1 in California law (the Spanish version is 16-1S). Then, the insurance company may request or subpoena records they need from a healthcare provider, health insurance company, or medical facility. In the subpoena, they must provide a reason for requesting those specific records.
You will typically be notified of which records are requested before the insurance company accesses them, and you may deny any requests that you want. A workers’ compensation lawyer can help you determine which requests are relevant so you can keep your information safe.
Can I Stop the Medical Records Request?
Yes, you can object to certain records being obtained. For instance, you may want to have the request revised so that certain parts of your records are redacted or removed. You can also prevent the records request altogether.
If you or your legal team don’t believe that the records the insurance company is requesting are relevant to your workers’ compensation claim, you can file a motion to stop or modify the request, according to Cal Code Civ Proc § 1985.3(g). You may also revoke your HIPAA release at any time.
Will My Medical Records Be Made Public?
No, much of the personal medical record data used in your workers’ compensation case will not be visible. However, some information may be. A workers compensation lawyer Los Angeles can help you understand what information may become accessible and how to avoid unnecessary releases.
Can a Lawyer Help Me With My Medical Records During a Workers’ Compensation Claim?
Yes, a workers’ compensation lawyer can do a lot to safeguard your private medical information while ensuring the insurance company is getting the information they need to investigate your claim. We can:
- Make sure you fill out the release carefully, only allowing the most relevant records to get to the people who need them
- Protect you from HIPAA violations, such as the insurance company obtaining your medical records without your authorization or without notifying you first
- Keep an eye on the records requests and advise you at every step
Let KJT Law Group Protect Your Medical Records in Your Workers’ Comp Case
If you’re filing a workers’ compensation claim, KJT Law Group can help. Our team of workers’ compensation lawyers can oversee your entire claims process. We can gather evidence of your injury, file thorough and accurate claims, communicate with the insurance company, and handle all appeals and hearings on your behalf. Call our office at (818) 507-8525 for a free consultation to discuss what medical records are necessary for your workers’ compensation claim.
