Do I Have to Release My Medical Records for a Workers’ Compensation Claim?

Being hurt while on the clock is a frustrating and painful experience. Not only are you injured, but now you may be facing lost wages because you cannot work. Missing work, however, does not necessarily mean missing out on being paid for days you would have worked. Workers’ compensation is a no-fault system that provides wage loss and medical benefits to injured workers throughout Pennsylvania.

But in order to receive those benefits, you will be asked to release your medical records. For many workers, this seems like a breach of privacy. Today, we want to talk about what you are legally obligated to provide, and when, in a workers’ compensation claim.

Who can ask for your medical records?

You, your employer, and your employer’s insurance company can request access to your medical records to evaluate and/or investigate your injury. This may include not only the records related to your injury, but the records of your primary care physician and other doctors you may have treated with in the few years prior to your injury.  Your employer and the insurance company have a right to review these records to see if you have any pre-existing conditions or prior similar complaints that may raise questions about whether you sustained a work injury.  If you do have a pre-existing condition or prior similar complaints, this alone does not justify a denial of your claim.  If, however, you refuse to allow your employer and the insurance carrier access to these records, your claim will be denied on the basis that you did not give them an opportunity to properly investigate it.

Why does my employer need my medical records?

Ostensibly, your medical records are required to ensure you receive the proper treatment for your injuries. However, your employer’s insurance company may also be seeking a way to deny your claim. Workers’ compensation insurers, like all insurers, want to keep the money they receive. As such, if they can use your medical records to show a pre-existing injury, they may use it to deny your claim.

The good news is that preexisting conditions are not automatic grounds for denial. For example, say you broke your leg years ago in a sports-related accident. If you break that same leg in a forklift accident, you cannot be denied workers’ compensation simply because that leg was broken before. Likewise, if you have a medical condition like asthma or COPD, and you develop a respiratory illness related to your working conditions, your claim should not be denied. Your pre-existing conditions may not have been work-related, but the new illness exacerbated those conditions, and that should be covered under workers’ compensation.

Does HIPAA protect my privacy in workers’ compensation claims?

Confidentiality is perhaps most important on your mind when you know that someone will be having access to your medical records, we know. If your records are released or accessed without your consent, it may be a violation of the Health Insurance Portability and Accountability Act (HIPAA), and such a violation can be met with legal consequences. HIPAA “is a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge.”

HIPAA is there to protect your rights to confidentiality, but it does make exclusions for medical records in workers’ compensation claims. Simply requesting the records is not a violation of HIPAA.

What if I don’t sign the medical release?

If you do not sign the release, your workers’ compensation claim can be denied – and in all likelihood, it will be. What you can do, however, is review the request to ensure that only the right information is released. You can speak with your primary doctor or one of our attorneys about this review if you are unsure about the language in the authorization form.

Note that you do not have to release your medical records to a case manager. Often, insurance companies will hire nurses or other professionals to help them review claims, handle doctors’ appointments, and more. You do not have to agree to work with a case manager, nor do you have to submit your records to a case manager. If you or your doctor is being pressured by a case manager, call us right away.

What happens after I sign the authorization form?

Once you sign the form authorizing the release of your medical records, your employer’s insurance company may ask you to attend an independent medical examination, or IME.

You should know, though, that these doctors have been chosen by the insurance company, and are likely to side with the insurance company when it comes to your claim. As such, it is in your best interest to also seek a consultation with your own doctor. This additional consultation may prove to be a critical part of your claim if the insurance company’s doctor says you are not injured after a 10-15 minute consultation, but your own doctor’s more thorough consultation shows that you are injured. We also want you to know that just because the IME doctor recommends a course of treatment, you do not have to follow it. You can use your own doctor when it comes to treating your injuries.

What benefits will I receive for my work injury in Pennsylvania?

There are certain benefits provided under workers’ compensation. They include:

• Payments for lost wages: This applies to every sort of employee, including full time, part time, or someone who works in a limited capacity. Paying for lost wages helps the employee with such things as their bills and food while they are incapacitated or healing from the injury.
• Specific loss benefits: These benefits are for employees who were hurt significantly on the job, and suffered an injury such as an amputation, the loss of hearing or sight, or disfigurement of the head, face or neck. These require special benefits to help them deal with the life-time change to their life.
• Medical care: Even if the employee does not need to take time off work for their injury, workers’ compensation will still cover the medical costs it took to tend to and treat the injury. This includes all medical bills. The employer must cover any out of pocket costs as well.
• Death benefits: In cases of fatal worksite accidents, the benefits may then apply to the spouse who was living with, or financially dependent on the employee’s wages. This can also apply to any dependents under the age of 18, or under 23 years of age if a full time student. How long these benefits last depends on a number of factors such as if/when the spouse remarries, and how old the dependent is. Included in death benefits is a one-time lump payment for funeral costs.

If you want to file a workers’ compensation claim, you need to submit your medical records to your employer’s insurance company. There are rules governing what they can request. At KBG Injury Law, our York, PA workers’ compensation lawyers can help ensure you secure the proper compensation to which you are entitled, for as long as you are entitled to receive it. Call 717-848-3838 to schedule an appointment at our York, Lancaster, Hanover, Harrisburg, and Gettysburg, PA locations. Or use our contact form, and we can make sure you get the help you need.