HIPPA Regulations and Workers’ Compensation
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.
Dan T. Matrafajlo, Esq. is the Managing Member and Lead Partner at Beninato & Matrafajlo, Attorneys at Law, LLC, a New Jersey-based personal injury law firm with offices in Elizabeth and East Brunswick. With over two decades of experience representing clients in complex matters—including motor vehicle accidents, workers’ compensation, and wrongful death cases—he has recovered over $100 million on behalf of his clients and is known for securing significant results. He has also helped shape New Jersey personal injury law through notable Appellate Division decisions such as Hardison v. King and Frenklakh v. Lojek, with his litigation work featured in the New Jersey Law Journal, underscoring his authority in the field.
Mr. Matrafajlo was recognized as a Super Lawyers® Rising Stars honoree from 2012 to 2017 and is a member of the Million Dollar Advocates Forum—an honor reserved for attorneys who have achieved multi-million-dollar verdicts and settlements. Combining deep legal expertise with a client-focused approach, he provides strategic, results-driven representation while guiding clients through every stage of the legal process. He earned his Juris Doctor from the University of Miami School of Law and is admitted to practice in both New Jersey and New York.
