Does HIPAA Apply to Workers’ Compensation Claims

Workers’ compensation claims are a crucial aspect of employee benefits, providing financial support and medical care to workers for on-the-job accidents and illnesses regardless of fault.

However, many employees are concerned about privacy when sharing their medical information with employers and workers’ compensation providers. 

The Health Insurance Portability and Accountability Act (HIPAA) safeguards your healthcare information. So, does HIPAA apply to workers’ comp? Generally, no.

Employers and insurers can access your medical information relevant to your claim, but there are restrictions to this access.

Here, we will explore HIPAA and workers’ comp, including your rights and the responsibilities of employers and healthcare providers.

What Is the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule?

The HIPAA Privacy Rule governs the use and disclosure of individually identifiable health information, known as protected health information (PHI).

The rule prohibits using or disclosing PHI unless the patient has signed an authorization.

The rule applies to “covered entities,” which include healthcare providers, health plans, and healthcare clearinghouses and their business associates who handle PHI on their behalf. But how does HIPAA apply to workers’ compensation claims?  

Can My Employer Contact My Doctor Without My Consent?

A common concern for individuals pursuing a workers’ compensation claim is whether their employer can contact their doctor without their consent.

The short answer is, yes, they can. However, the health information they can access is limited.   

The HIPAA Privacy Rule does not apply to employers, workers’ compensation insurers, or administrative agencies, except to the extent they may otherwise be covered entities.

If an employee suffers a work-related injury or illness, these entities need to access employees’ health information to process claims, coordinate healthcare, and arrange compensation.

The privacy rule recognizes this need. So, it allows healthcare providers to disclose health information in the following ways.

Disclosures without Authorization

The HIPAA Privacy Rule permits covered entities to share health information without authorization to employers, workers’ compensation insurers, state administrators, and other workers’ compensation entities in the following instances: 

  • When workers’ compensation laws or other similar programs that provide benefits for work-related injuries require them to do so; 
  • When disclosure is required by state or other law; or
  • To obtain payment for the healthcare of the injured or ill worker. 

This information typically includes details about your injury, diagnosis, treatment, and work-related restrictions. 

Disclosures with Authorization

Healthcare providers can share PHI with workers’ compensation entities with written authorization from the individual. This authorization must meet certain requirements.

It is important to note that you have the right to review and approve the types of information that can be disclosed and the purposes for which it will be used.

Be cautious when granting authorization and ensure you understand your consent. An experienced attorney can provide guidance on medical authorizations.   

Minimum Necessary Requirement 

HIPAA’s “minimum necessary” requirement stipulates that covered entities should only disclose the minimum amount of PHI necessary to accomplish the workers’ compensation purpose.

Employers and healthcare providers must make a reasonable effort to limit sharing your medical information to what is essential for your workers’ compensation case. 

Contact an Attorney Today 

Understanding how HIPAA applies to your workers’ compensation claim is crucial for safeguarding your privacy while ensuring you receive the benefits and medical care you deserve.

While employers have access to some of your medical information for legitimate purposes, they must adhere to HIPAA’s principle of minimum necessary disclosure. You should consult an attorney if you have concerns about your privacy rights in a workers’ compensation case.

The Cottrell Law Office specializes in workers’ compensation cases and serves clients in Arkansas, Missouri, Kansas, and Oklahoma.

Our attorneys understand the complex legal system and are prepared to zealously advocate for your rights and the compensation you deserve. Contact us today for your free consultation.

Frequently Asked Questions (FAQs) 

Q: Can my employer contact my doctor without my consent?

A: Yes, when your employer needs medical records for a workers’ compensation claim, federal law allows healthcare providers to release this information without your authorization. 

Q: What health information is available to my employer when they request it?

A: Workers’ compensation entities are entitled to health information necessary to handle the claim and pay the workers’ bills.

Many healthcare providers have standard policies and procedures for handling these requests for information.

Q: What health information is confidential? 

A: The involved workers’ comp entities only need information about your present claim. They don’t have a right to request access to information irrelevant to your claim.

For example, if you had a procedure years before your work-related injury, they do not have the right to access the medical records related to that procedure. 

Q: Should I sign a health information release form? 

A: It depends. Do not sign a blank release form or a release that allows access to medical records unrelated to the treatment of your work injury.

You should consult an attorney if you have questions about signing a health information release form.

Author Photo

Wesley Cottrell

Wes Cottrell earned his B.A. from Pittsburg State University in 1981 and his J.D. from the Washburn University School of Law in Topeka, Kansas in 1985. He was admitted to practice law in Kansas in 1986, in Missouri in 1987, in Arkansas in 1989, and Oklahoma in 1993. He is licensed to practice law in the United States District Court for the District of Kansas, eastern Arkansas, western Arkansas, and western Missouri. He was Deputy Prosecuting Attorney in Crawford County, Kansas from 1987-1989.

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