Making a claim for an on the job injury involves more than telling the boss you were hurt. It often requires documentation of the injury itself and the resulting follow-up medical care.
And while the employer and their Workers’ Compensation insurance carrier is entitled to review certain medical records, there are limits to what can be expected.
Should I Sign a Medical Authorization and Release?It sounds simple enough, right? They already have your medical records, don’t they? Why would it matter if you signed an authorization for release of medical records?
We’ve all gotten a bit used to sharing personal information. A lot of that comes from social media and cell phones.
It seems everyone is sharing everything about themselves nowadays. There are so many “data breaches” in the news it can seem like it doesn’t even matter.
There is a big difference between posting a picture of the family vacation on Instagram and giving someone access to what federal law deems confidential, protected medical information.
You may have heard of something called HIPAA. It’s a healthcare law that’s been on the books since 1996 and stands for the, “Heath Insurance Portability and Accountability Act.”
Doctors and their offices take HIPAA seriously, so should you.
As named, it can be a bit hard to tell whether HIPAA even applies to medical records or not. It appears to focus on insurance and whether you can get insurance after leaving a job.
There is an important part under the United States Code (the federal law) concerning Protected Health Information that applies to more than just what treatment you received when visiting a doctor.
For insurance adjustors, there is a treasure-trove of information included in medical records. Think about it. Don’t doctors make you fill out a new personal information forms about every time you see them?
What information is included? Is there anything in there not related to medical care that an insurance company could use to snoop around into your personal affairs?
HIPAA and the PHI (Personal Health Information) clause under HIPAA protects you from the improper disclosure of things like your:
With that information, you can find out just about anything you want about a person. You can set up fake identities.
While those records be helpful to your doctor to confirm payment, insurance coverage, and even to review prior medical issues with other medical service providers, that information would normally remain private in most instances.
As such, it’s imperative you realize that the insurance company for your employer is not the same thing as your employer. They do not have access to much of your personal information.
They are not your friend. They are not looking out for your best interests.
Your employer isn’t allowed to automatically share all your personal information either. It’s against the law for them to share that information without your permission.
So, to answer the prior question, no they do not have all your records. We firmly believe, based on years of practical legal experience, giving them access to that material, without some form of limitation, is a really bad idea.
Because they ordinarily do not have access to your confidential medical records and other highly sensitive personal information, that’s why they often seek an authorization for release of medical records.
They want you to help them snoop on you.
It’s not a violation of HIPAA or the PHI laws if you voluntarily turn over your personal information. Indeed, you are never required to provide a full Medical Release as part of the Workmens Compensation claim in North Carolina.
Providing documentation of a workplace injury and resulting medical care is not the same thing as a providing FULL RELEASE of all your records, irrespective if they have absolutely nothing to do with your claim for damages / injuries.
We strongly recommend you speak with an experienced Work Comp lawyer before doing anything and signing away your rights.
Once an insurance company has your records, they have them forever.
They are not asking for that material to help you. They are generally looking for a way to deny a claim and/or limit their exposure for legal liability, assuming that’s possible.
What is a “Previously Existing Medical Condition?”Your prior history of medical treatments, doctor visits, and even past accidents may play a role in any claim for compensation under the NC Workmans Compensation laws.
That can be particularly important if causality is determined to be an issue. It’s also true if the nature and extent of the damages comes to play.
As plaintiff’s lawyers, part of our job is to anticipate defenses to claims.
Insurance companies look for ways to avoid paying claims. Make no mistake they’re not on your side.
They’re concerned about protecting their shareholders and the employer, not you.
If they can find a way to deny a claim, especially legitimate claims that should be paid, that’s pure profit. That works to take money from your pocket.
Not paying a claim that should be paid is profitable for insurance companies. If your employer is self-insured, that’s profitable for them as well. The person that pays for that profit is you.
One way to avoid paying a claim is to assert a “pre-existing medical condition.” Essentially, the carrier asserts that you weren’t hurt on the job.
While they may not dispute the fact that you’re hurt, they could challenge how you were hurt or how badly you were injured. That’s a common defense employed in cases involving repetitive motion injuries.
So even if you think a prior shoulder injury is irrelevant to a claim involving a slipped disk in your back, it’s often important to provide the medical documentation regarding the shoulder.
That can be both good and bad.
Employers and insurance companies take their employees as they come. Medical professionals regularly see a correlation in injuries.
For example, if you hurt your back in the past, that can affect how you hold your body in the future.
In any event, there are two general rules we like to follow at our law office:
Do NOT provide a full medical authorization and release to the insurance company. We can help assess and provide relevant medical documentation to the carrier; and, If medical records are to be provided, it’s better to be inclusive in nature. Hiding materials, especially those relevant to causality and treatment, can result in the denial of a claim and problems in the future. Related Legal Issues Involving NC Worker Compensation ClaimsKevin Jones is a local.
After attending college at Chapel Hill, Kevin graduated from the Campbell University Law School in Buies Creek, North Carolina.
Kevin has spent his entire career focusing on helping people hurt at work and in car accidents. He has more than 30 years of practical trial experience, litigating matters before the Industrial Commission and NC Courts.
He is a Board-Certified Specialist in Workers’ Compensation Law in North Carolina, as recognized by the North Carolina State Bar.
All legal consultations at our law firm are free of charge. We don’t send you a bill. There are no hourly rates or true retainers.
We earn legal fees upon success in settling your matter or achieving a verdict / award at trial. That means if we are unable to achieve a recovery, there are no legal fees.
That’s what lawyers refer to as a contingency fee or contingent legal fee basis for legal representation.
Everything you tell us, even in consultation, is kept confidential.
We understand there are times when people just want to get information and decide not to proceed forward with a legal claim.
That’s OK. Part of making a good decision about what is best for you and your family should involve gathering information.
We also understand some clients are concerned about bringing a claim for a workplace injury, fearing reprisals by an employer.
Unfortunately, that does happen on occasion, even though it’s not supposed to. And because of that, we want to make the decision-making process easy on you.
Call us. Ask questions. Sit down with an attorney.
If we think we can help, we’ll let you know. If you decide to go in another direction, we will not pressure you to move forward.
You may reach Kevin Jones directly by email at Kevin@DodgeJones.com