English 
Spanish Your medical records play a crucial role in your workers’ compensation case. It helps prove that you need benefits and helps to determine the severity of your disabling injury. Without medical records, you don’t have a case.
Why Does the Insurance Company Need My Medical Records for a Workers’ Compensation Claim?
The insurance company handling your workers’ compensation claim will use your medical records to better understand the extent and severity of your injury or illness, your treatment options, and how your injury or illness occurred. It may also use the records to ensure you get the treatment you need to recover after your work-related injury.
However, there is a flipside to this that can jeopardize your case. The insurance company is also looking for holes in your story and reasons to deny your claim if it can. It’s 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.
It will likely want to see your past medical records, too. This information can help it understand whether you had any pre-existing conditions that are related to your work-related injury or illness. This could give the insurer the opportunity to claim that your symptoms are related to your pre-existing condition. This could allow it to get out of paying you the benefits you need.
Do I Need to Release My Medical Records in My Workers’ Comp Case?
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 of paying for your benefits. If you refuse to release your records, the workers’ comp insurer will most likely deny your claim.
However, it’s important to note that the insurer is likely going to request all of your medical records. You only need to give it medical history, treatment, and previous claims that are related to your work injury or illness.
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.
Medical records play a critical role in your case, but they can also jeopardize the benefits you need.
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 the insurer view only relevant records to protect your personal information. Remember, you always have the right to choose which types of medical history the insurance company can access.
Some medical information the insurer 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
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.
We can also help you fight for the benefits you need if the insurer is giving you a hard time.
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 (the Spanish version is 16-1S). Then, the insurance company may request or subpoena records it needs from your healthcare provider, health insurance company, or medical facility. In the subpoena, the insurer 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. However, remember that if you don’t turn over some of your records, your employer’s workers’ compensation insurer will likely deny your claim.
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?
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 attorney in 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 it needs 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 today for a free consultation to discuss what medical records are necessary for your workers’ compensation claim.
