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The role of HIPAA in Workers’ Compensation

The Health Insurance Portability & Accountability Act (HIPAA) is a federal law that has a stated purpose to protect the privacy of health records for individual citizens. Information from an individual’s health record should not be disclosed without his or her expressed permission. This information is classified as protected health information or PHI. The nature of workers’ compensation cases is to utilize information to determine the scope of an individual’s injuries. There are special rules for HIPAA when applied to workers’ compensation cases.

During a workers’ compensation investigation, certain entities are immune from HIPAA privacy rules. Entities such as administrative agencies, insurers and employers are exempt from privacy restrictions. The reason the HIPAA rules do not apply in these instances is because the information found in the injured worker’s medical record is needed to adjudicate or decide the workers’ compensation case.

Generally, patients must give their consent before medical information is disclosed to a third party. Certain exemptions allow specially classified entities to access medical records without the patient’s consent. Special programs like those that benefit federal employees, black lung victims, longshoremen and energy workers also have exemptions from consent rues.

Any disclosures during the course of an investigation must comply with the law. An individual’s medical record should only be accessed to the extent needed to resolve the workers’ compensation case. In addition, a medical record may be accessed without the consent of the patient for the purpose of pursuing moneys owed for health care services provided to the injured employee.

Source: Mississippi Workers Compensation Commission, ” Health Insurance Portability & Accountability Act (HIPAA) and Workers Compensation,” last visited March 16, 2015

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