How does medical privacy affect my workers’ compensation claim in Georgia?
“HIPAA” refers to the Health Insurance Portable Accountability Act of 1996. This Act was designed to provide protection to an individual’s right to privacy regarding their medical information. Under HIPAA, personnel who aren’t authorized to obtain access to the medical information of others are prevented from doing so.
There is often confusion when it comes to HIPAA and workers’ compensation claims, however. In fact, many people wonder whether an injured worker is required to release their medical records to workers’ compensation insurance companies or their employers.
According to the U.S. Department of Health and Human Services:
“The HIPAA Privacy Rule does not apply to entities that are either workers’ compensation insurers, workers’ compensation administrative agencies, or employers, except to the extent they may otherwise be covered entities. However, these entities need access to the health information of individuals who are injured on the job or who have a work-related illness to process or adjudicate claims, or to coordinate care under workers’ compensation systems.”
Understanding the privacy rules under HIPAA
The rules for privacy regarding medical records are set out under HIPAA. Under this Act, there are multiple security layers and guidelines established for accessing healthcare information and transmitting and maintaining that information.
HIPAA regulates the way in which a variety of organizations and entities—including nursing homes, pharmacies, clinics and healthcare providers—are allowed to handle individual medical information. This Act also impacts the way in which HMOs, health insurance companies, government programs and company health plans process healthcare information.
Understanding workers’ compensation in Georgia
When an employee becomes ill or is injured on the job, a medical injury claim form must be completed by the employer. This form is then sent to the workers’ compensation insurance company, which is responsible for handling the claim. Ultimately, a file will be created that will contain medical information regarding the injury or illness.
In order to ensure the worker receives adequate medical treatment, the claims examiner will need to access all of the information in the file, including medical information. While the employer is entitled to receive access to information regarding the injury, there are limitations that apply to that access as established not only by HIPPA but also by workers’ compensation laws in individual states.
Not only does HIPAA regulate the way in which medical information is disclosed; it also determines how medical information is electronically and physically stored. In addition, there are regulations regarding who has access to the information and how it can be transmitted.
Under HIPAA, medical care providers are allowed to provide medical information to an employer, workers’ compensation insurance companies and state workers’ compensation administrators.
What rights and privacies do injured workers have?
Employees often have questions about their rights regarding HIPPA and the disclosure of their medical information. For instance, you be wondering:
“Do I have to sign a medical release form?”
The Workers’ Compensation Medical Records Disclosure Act specifically defines the information an employer is allowed to request.
Furthermore, any medical information regarding the occupational injury or workers’ compensation claim of an employee must be collected as well as maintained on a completely separate form. Additionally, that information must be maintained in a separate file along with any other information that must be maintained in a confidential manner.
That said, there are limitations to what information can be disclosed.
For instance, only the information that is needed to either pay for or treat an injured worker’s occupational injury or illness can be disclosed by a medical provider. Therefore, employers and workers’ compensation claims personnel don’t have the right to access a worker’s complete medical file or history.
Employees who are concerned about whether they are required to sign a workers’ compensation release form for their medical records should understand that under the Georgia Workers’ Compensation Act, they must provide a medical authorization when requested by an insurance company. Only certain medical records are covered under this authorization, however, under Form WC-207.
Injured workers shouldn’t sign a blank release form as they are only required to provide release of information related to the treatment of their condition, complaints or injury.
The form should contain the name of the medical provider to which the employee is signing a release of information. In most cases, the best course of action is for the employee to sign a separate release of information for each medical provider. By signing a blank release, it’s possible that the insurance provider might obtain medical records that should otherwise be kept confidential.
Whenever an injured worker submits a claim, the employee is considered as having waived any confidentiality regarding communications associated with that claim as well as treatment related to their injury.
When to consult a work injury attorney
Working with an experienced Georgia workers’ compensation attorney can help injured workers feel confident that their rights and privacy are completely protected, while also ensuring they receive the full compensation they deserve. Regardless of their industry, workers face numerous risks as they go about their day-to-day occupational activities.