Who is Allowed Access to Workers’ Compensation Protected Health Information?

Understanding who can access your protected health information (PHI) in the context of workers’ compensation is essential for safeguarding your privacy rights. Workers’ compensation claims often require the sharing of medical information. But who is allowed to access this protected workers’ compensation protected health information? Here’s what to know.

Who Can Access Your PHI in Workers’ Compensation Cases?

Certain entities/people can legally access your information, including:

• Insurance Companies and Employers: When you file a workers’ compensation claim, your employer and the workers’ compensation insurance carrier have the right to access your relevant medical records. This access is necessary for them to verify the claim and determine the appropriate benefits. However, this access is limited to information directly related to your injury or illness.
• Healthcare Providers: The doctors and healthcare providers treating your work-related injury or illness will have access to your PHI. They share necessary medical information with the insurance company and your employer to facilitate the treatment and claims process.
• Legal Representatives: If you have an attorney representing you in a workers’ compensation claim, they will need access to your medical records to build your case. Similarly, the employer’s and insurance company’s attorneys will also have access to your PHI for defense purposes.
• Workers’ Compensation Boards and Agencies: State workers’ compensation boards or agencies overseeing your claim will have access to your medical information. They review your medical records to ensure that your claim is handled correctly and to resolve any disputes.

Limitations and Protections

The Health Insurance Portability and Accountability Act (HIPAA) typically governs the privacy of medical records, but it has specific exceptions for workers’ compensation cases. Under HIPAA, healthcare providers and other entities can disclose PHI without patient authorization when required by workers’ compensation laws. However, these disclosures must be limited to the minimum necessary information related to the claim.

Despite these exceptions, certain protections remain in place:

• Relevance: Only medical information pertinent to your workers’ compensation claim should be disclosed. Your unrelated health information should remain confidential.
• State laws: Some states have additional privacy protections for workers’ compensation claims. It’s important to be aware of the specific laws in your state.

Protecting Your Rights

If you believe your privacy or health privacy rights have been violated during a workers’ compensation claim, it’s crucial to take action:

• Request an Accounting: You have the right to request an accounting of disclosures from your healthcare provider to see who has accessed your PHI.
• File a Complaint: You can file a complaint with the Department of Health and Human Services’ Office for Civil Rights if you suspect a HIPAA violation.
• Consult an Attorney: Speaking to an attorney specializing in workers’ compensation or health privacy law is highly recommended. They can provide legal advice tailored to your situation and help protect your rights.

For more detailed information on HIPAA and workers’ compensation, visit the U.S. Department of Health and Human Services website.

Who Is Allowed Access to Your Workers Compensation Protected Health Information?

Knowing who can access your protected health information is vital for maintaining your privacy. While certain parties involved in the claims process need access to your PHI, these disclosures are regulated and limited. If you feel your privacy rights have been compromised, do not hesitate to seek legal counsel. Protecting your health information is not just a right but a critical aspect of managing your workers’ compensation claim effectively.

If you have questions or you’d like to discuss a concern about a violation of your medical privacy due to a workers’ compensation claim, contact Shugarman & Mehring.