From the Hotline: HIPAA Release for Work-Related Injury

Question: Should we get a HIPAA release from an employee to review the medical information for a work-related injury?

Answer: You generally do not need a Health Insurance Portability and Accountability Act of 1996 (HIPAA) release from an employee in order to review medical information related to a workers’ compensation injury.

According to the U.S. Department of Health and Human Services:

covered entity is permitted to disclose an individual’s protected health information as necessary to comply with and to the full extent authorized by workers’ compensation law. See 45 CFR 164.512(l).

Individuals do not have a right under the Privacy Rule at 45 CFR 164.522(a) to request that a covered entity restrict a disclosure of protected health information about them for workers’ compensation purposes when that disclosure is required by law or authorized by, and necessary to comply with, a workers’ compensation or similar law. See 45 CFR 164.522(a) and 164.512(a) and (l).

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 (e.g. running a self-funded plan).

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. Generally, this health information is obtained from health care providers who treat these individuals and who may be covered by the Privacy Rule.

The Privacy Rule recognizes the legitimate need of insurers and other entities involved in the workers’ compensation systems to have access to individuals’ health information as authorized by state or other law. Due to the significant variability among such laws, the Privacy Rule permits disclosures of health information for workers’ compensation purposes in a number of different ways.

Source:

www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/workerscompensation.pdf

www.hhs.gov/ocr/privacy/hipaa/faq/workers_compensation/index.html