HIPPA Regulations and Workers’ Compensation

• Dan T. Matrafajlo
• Mon Apr 2015
• Insurance,Workers Compensation,
• 0

If you have received medical treatment, you have most likely acknowledged receipt of documentation involving HIPAA regulations. What exactly does this mean? Additionally, are there different standards for HIPAA regulations and workers’ compensation claims?

What is HIPAA?

The acronym HIPAA stands for the Health Insurance Portability and Accountability Act of 1996. The purpose of the law is to ensure privacy and security regarding medical care. The act was also enacted to prevent fraud. In a general sense, HIPAA controls who may access your medical records or information. In most cases, individuals must sign medical releases to obtain copies of documentation involving someone’s medical treatment.

HIPAA is a federal act and falls under the scrutiny of the US Department of Health and Human Services, in their Office of Civil Rights. You may review further information about HIPAA here, as well the procedure for reporting your rights if they are violated.

Workers’ Compensation Carrier Can Access Your Records without a Release

There are some exceptions involving the need for a signed release for procurement of medical records. A medical release is a basic document signed by the person who received treatment and authorizing release of medical records. According to information obtained from the US Department of Health and Human Services, workers’ compensation insurance companies may need documentation to process claims. Therefore, they may request medical records with an explanation that they are responsible for an employee’s treatment and related expenses.

The extent of the records available without a medical release may be challenged by the workers’ compensation carrier or their attorney. They may attempt to secure past medical documentation. These records are NOT available without proper authorization.   In order to secure prior treatment documentation, the claimant may be asked to sign a medical release. Generally speaking, our office denies these requests unless they are related to the injuries suffered in the current accident.

Claimant Also Entitled to Medical Records

Although some physicians may try to deny claimants access to their medical records, this may be unlawful. According to N.J.S.A. 34:15-128.4, there are limited instances when a claimant may be denied access to records, regardless of the party who paid the medical bills. The only time this is acceptable is when the physician’s records are solely for the purpose of a permanency evaluation.

Contact Us

The Law Offices of Beninato and Matrafajlo interact with workers’ compensation carriers on a regular basis. We can help you determine the feasibility of pursuing a claim. Call us to arrange an appointment to discuss your case.