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What Is the Workers’ Compensation Medical Disclosure Act?

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Workers’ compensation insurance is there to benefit workers injured on the job, but it can be complex and difficult to understand. This is especially true when your employer’s insurance company denies your claim. The intent of workers’ compensation laws is to support workers, but the job of an insurance company claims adjuster is to protect their company’s interests. They thoroughly investigate claims to ensure they are legitimate.

However, gathering the information needed to investigate your claim can feel like an invasion of privacy. Claims adjusters and employers may legally access some, but not all, of a claimant’s medical records without consent. Several federal acts are in force to protect your rights. While you may need to disclose some information to file your claim, it is important to be aware of your rights to privacy. 

What Is the Workers Compensation Medical Disclosure Act?

The workers compensation medical disclosure act defines what information it requires and what information it allows an employer to ask for. It defines relevant medical information as the following:

  • Information regarding the nature of injury for which an employee claims a benefit
  • Information pertaining to diagnosis, costs, and the nature of treatment of the injury which the employee claims benefits.
  • Records regarding the injury for which an employee claims a benefit that is necessary for the employer to have in order to modify the employee’s work duties and other accommodations.
  • Information that is necessary for the employer to defend itself in adjudicated cases.

The act also allows employers to access this information with or without express consent of the employee. Typically, the insurance providers or administrators provide these documents. However, the act still protects rights of the employees. An employer may not request or gain access to infractions that are not directly related to the workers’ compensation claim. Lastly, employers may not divulge this information to any other persons or entities.

Do I Have to Allow My Employer Access to Medical Records?

Even under the workers’ compensation medical disclosure act, an employee must release their medical records for a workers’ compensation claim. Although this may seem like an invasion of privacy, without medical records there is no way to validate a workers’ compensation claim. Employers may request medical information related to your claim, but they may not request any other sensitive medical records. They also may not use force or coercion against an employee to disclose their information. Fortunately, there are several federal laws in place to protect your privacy.

Federal Protection of Medical Records

Federal protections are in place to protect your medical records. When it comes to workers’ compensation claims it is challenging to decide what information to disclose. Disclosing the wrong information may lead to the denial of your claim. On the other hand, you may have information you would prefer your employer and others not know. Two federal provisions that protect your rights are the Health Insurance Portability and Accountability Act and the Drug Abuse Treatment and Rehabilitation Act.

Health Insurance Portability and Accountability Act (HIPPAA)

This federal law protects an employee’s privacy. HIPAA exists in various places, such as hospitals and physical therapy practices, and restricts the sharing of medical records. The HIPAA Privacy Rule permits the disclosure of health information for workers’ compensation purposes without individual authorization, but it does require that information must be within the employer’s direct purpose or interest.

The Drug Abuse Treatment and Rehabilitation Act and the Comprehensive Alcohol and Alcoholism Prevention, Treatment and Rehabilitation Act

These federal laws protect employee privacy concerning information related to substance and alcohol abuse treatment.

If you have recently filed a workers’ compensation claim, it is useful to understand the basic information regarding medical records and privacy and protect your rights. Hiring an experienced Orange County workers’ comp attorney can help you with your claim. Contact DiMarco | Araujo | Montevideo today to schedule a free consultation.