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Do HIPAA Laws Apply to Workers’ Compensation?

Do HIPAA Regulations Apply to Workers’ Compensation?

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) creates specific privacy guidelines that govern the disclosure and use of sensitive health information. It limits how it can be disbursed and employed in various situations, including workers’ compensation claims.

How HIPAA Laws Apply to Workers’ Compensation

To pursue workers’ compensation benefits, you must provide your employer’s workers’ compensation insurance case administrator with medical records related to your workplace injury. HIPAA laws govern these disclosures, including:

How Your Medical Records Can Be Disclosed

When your treating physician or emergency care provider submits records for your workers’ compensation claim, they must do so with caution. Any forms or records detailing your medical condition are considered highly confidential and cannot be released without your express written permission. For instance, they cannot send them through unencrypted email or a public fax.When you file a workers’ comp claim, your employer or workers’ compensation provider will probably ask you to sign a medical release of information form. Be sure that this form is filled out with no blank spaces. You should sign a different release form for each medical provider, and requests should pertain to records for your specific work-related injury.

Where Your Medical Records Can Be Stored

Since your medical records are considered sensitive and confidential, they must be stored in a secure location where authorized users can only access them. This paperwork includes workers’ compensation forms containing your private medical information. Your documents may be stored in a physical or digital file, but your employer and workers’ comp provider must strictly limit access.

Your company and the workers’ compensation insurance carrier must also have specific policies for disposing of protected health information (PHI) and medical records.

Who Can Access Your Medical Records

When you seek workers’ compensation benefits after a work-related illness or injury, the workers’ compensation insurance claims administrator can reasonably obtain medical records to prove your case. Since the employer is essentially paying for the treatment through their workers’ compensation insurance, they could also access the records.

Your employer should have a designated party, such as an HR administrator, who handles confidential documents of this nature. The only people who should have access to your records are those listed on the release form. If any other employees or managers have access to your medical records, they may be violating HIPAA laws

How Your Medical Records Can Be Used

Under HIPAA, your medical records are only disclosed for establishing and supporting your workers’ compensation claim. If your employer or another party accesses these records and uses them for another purpose, they may violate HIPAA laws. For example, if your employer changes your health insurance coverage or job duties based on information in your medical records, they are violating HIPAA policies.

Limits on Medical Record Disclosure

Your workers’ compensation claims administrator may only submit requests that relate to your workers’ comp claim. They cannot request your full medical file or history. This information goes only to those entities or individuals listed on a specific release form. If your employer or workers’ compensation provider obtains medical records unrelated to your workers’ compensation claim, both they and the medical care provider could be in violation of HIPAA laws.

Who Is Responsible for HIPAA Confidentiality in a Workers’ Comp Claim?

Any party who handles PHI must maintain confidentiality and HIPAA disclosure requirements. Responsible parties may include:

  • The doctor and medical staff treating your work-related injury
  • Your personal care provider and their nurses and staff
  • Any nurses, physician’s assistants, administrative staff, and other medical facility employees involved in your medical treatment and confidential record-keeping
  • Your employer, HR department, supervisor, or another person authorized to access PHI for your workers’ comp claim
  • Workers’ compensation insurance claims adjuster and other insurance personnel authorized to handle your workers’ comp case
  • Members of your state workers’ compensation board if they need to review the case on appeal
  • Independent medical evaluators (IME) or doctors providing a second opinion

Co-workers, supervisors, or unauthorized individuals who access PHI without express permission should notify HR or their supervisor of the breach and avoid accessing or sharing sensitive information. Misuse of confidential information can also be considered a HIPAA violation if access was not authorized.

What to Do If Your HIPAA Rights Are Violated

HIPAA is a critical protection that prevents you from suffering defamation, discrimination, or other mistreatment due to your medical history. If your private health information is incorrectly disclosed, stored, shared, or used, you could file a complaint through your state medical board. The responsible party may face fines and license restrictions.If they repeat HIPAA violations or if the violations are egregious or cause significant harm, you could file a lawsuit. Speak with a workers’ compensation lawyer with experience handling cases like yours. They can explain your HIPAA rights and discuss your legal options.

A Workers’ Compensation Lawyer Can Help Protect Your HIPAA Rights

Workers’ compensation claims are often complicated and require significant documentation of your medical condition. When someone fails to properly follow HIPAA guidelines for handling sensitive information, you can suffer losses, including:

  • Loss of work or income
  • Mental and emotional anguish
  • Pain and suffering
  • Damage to reputation

An attorney can help protect your HIPAA rights and seek justice for privacy violations. In addition, they can ensure that you have the information you need to pursue the compensation you deserve. If your case HIPAA violations compromised your case, they can help address the breach so it does not affect your workers’ comp benefits.

Our Workers’ Compensation Attorneys Can See How HIPPA Laws Apply to Your Case

At KJT Law Group, we have experience working with workers’ compensation clients like you. We are well-versed in HIPAA laws and can help you navigate the workers’ comp process while ensuring your sensitive medical information is adequately protected. Call us at (818) 507-8525 for a free consultation.

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