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HIPAA and the Release of Workers’ Compensation Records

June 2012

Corporate News

By definition, The Health Insurance Portability and Accountability Act (HIPPA) of 1996 Privacy and Security Rules provide federal protections for personal health information. However, medical providers are frequently confused by the requirements when it comes to the exchange of medical records for workers’ compensation treatment.

The pertinent part of Federal Regulation 65 Fed. Reg. 82,818 (Dec. 28, 2000) §164.512(i) states:

(1) Standard: Disclosures for workers’ compensation. A covered entity may disclose protected health information as authorized by and to the extent necessary to comply with laws relating to workers’ compensation or other similar programs, established by law, that provide benefits for work-related injuries or illness without regard to fault.

Colorado law, Colo. Rev. Stat. §8-47-203, further explains:

Access to files, records, and orders. (1) Notwithstanding the provisions of section 8-47-202, the filing of a claim for compensation is deemed to be a limited waiver of the doctor-patient privilege to persons who are necessary to resolve the claim.

A medical provider is not required to obtain a medical release in order to provide medical information related to the workers’ compensation claim to persons who are necessary to resolve the claim. In general, the persons necessary to resolve the claim and to whom medical records should be released when requested are:

The Colorado Division of Workers’ Compensation Form WC-164 was specifically developed to collect related information in a concise format. When sending treatment notes as required by the Participation Guidelines, a medical provider should always ensure that only information related to the claim is provided. Should an Electronic Medical Records (EMR) system automatically include other non-related information, that information should be redacted prior to sending the WC-164 to Pinnacol Assurance and only provided with presentation of a medical release. Please remember, however, that “non-related workers’ compensation information” can easily become part of the claim at the point a condition or medications begins to affect the treatment for the work-related injury.

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