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  1. #1
    Join Date
    Oct 2010
    Posts
    3

    Default Does the Work Comp Insurance Company Have a Right to All My Medical Records

    I was injured at work on 5/11/10 and have been going through PT since and am now having surgery on 11/5/10. When I received a copy of the IME report that denies my injury stating it #1, didn't happen at work and #2, aggrevated a pre-existing injury (I had surgery on the same should 5 yrs ago w/ NO problems since until this). When reading over the IME report, I realized they had full records from my Neurosurgeon who did a discectomy on me in 2008. I called their office and asked for a copy of the authorization they received from the insurance company as I had signed all of them with a note "ONLY on records from 5/11/10 and pertaining to a right shoulder injury are to be remitted. This authorization expires 5/11/11". Well, I received the Neurosurgeon's copy and it's just a basic letter that the insurance company sent them demanding ALL of my medical records and saying they were entitled to them?? I put this same note on my family doctor's authorization & the chiropractors authorization but let them have all records from same ortho who did prior surgery and is doing this one. Are they entitled to ALL of my records when the actual authorization that I'd signed & returned to them had this note and they decided to try and get my records this way; which they were given??

  2. #2
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Does the Work Comp Insurance Company Have a Right to All My Medical Records

    Yup, they are entitled to medical records, and HIPAA is expressly exempt from WC.
    So regardless of what you put on the release of information form, they are required to submit per the request. If not, a comp court judge and issue an order to compel.
    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. 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.

    http://www.hhs.gov/ocr/privacy/hipaa...rkerscomp.html
    #2, aggrevated a pre-existing injury
    That's not really a valid reason for denying a claim. Even though the CA/s and IME's try it every day.
    Your ER take you "as is" when you are hired. Aggreviation to a pre existing injury/condition is generally a compensable claim, the ER/IC is fully liable for the medical care, and/or wage loss due to the injury.

    As you have been denied, it's probably time to consult with an attorney or two.

  3. #3
    Join Date
    Oct 2010
    Posts
    3

    Default Re: Does the Work Comp Insurance Company Have a Right to All My Medical Records

    I have spoken with an attorney. I was advised to call after my surgery next Friday once the doctor fixes everything that is going on in there and after I speak with him and he agrees that it's work related; which I'm sure he will. They also think I have a tear in my bicep, which IS new. So, I'll call him to get the ball rolling likely the week after surgery. The report said the "injury was not consistent with pulling a box"...he apparently didn't listen to me as I pulled the box out part way to grab the handle on the back side and when I lifted it, that's when it happened, so he actually looks foolish with what he says with what I told him happened directly above that in his report.

  4. #4
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Does the Work Comp Insurance Company Have a Right to All My Medical Records

    ... so he actually looks foolish with what he says with what I told him happened directly above that in his report.
    Don't think it really matters to the IME how "foolish" he may appear... thats his opinion, you have yours.
    There isn't anything an atty can do until there is denial/delay. You have to provide the medical evidence to support your claim for WC benefits. A doctor has to do that, you have on that has, they have one that says otherwise. Now you need a judge to decide.

  5. #5
    Join Date
    Oct 2010
    Posts
    3

    Default Re: Does the Work Comp Insurance Company Have a Right to All My Medical Records

    Quote Quoting BvIA View Post
    Don't think it really matters to the IME how "foolish" he may appear... thats his opinion, you have yours.
    There isn't anything an atty can do until there is denial/delay. You have to provide the medical evidence to support your claim for WC benefits. A doctor has to do that, you have on that has, they have one that says otherwise. Now you need a judge to decide.
    I mean, he'll look foolish if they find other things in there that he said was somthing else. I have large lumps in my bicep and noticable spot with deep groove running from my shoulder to the inside of my elbow; he said it was a lipoma which is a small fatty tissue that is very soft to the touch and does not cause pain; he's a dork as mine is a hard lump that appears to be part of my actual bicep and moved over to cause the large lump and groove; hence why they think it may be a bicep tear. He diagnosed my friend w/ a strained shoulder and AFTER they fixed her torn rotator cuff, he then said he misdiagnosed her but it happened years ago, not with the incident she says happened. I know they're paid big bucks to go with the wc company but I also know what happened and WHERE it happened and will fight them...

  6. #6
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,011

    Default Re: Does the Work Comp Insurance Company Have a Right to All My Medical Records

    I know they're paid big bucks to go with the wc company...
    Common misconception among most IW.
    When the IME reports are not favorable, and not all are, the assumption is the Dr is paid 'big bucks" to be ER/IC friendly.
    Most states have OMFS/Official Medical Fee Schedules, all providers are paid the same, based on the IDC codes.
    IME or 'medical/legal' evaluations carry different fee schedules. Higher, but still not the 'big bucks' as presumed.

    Regardless of the prior situation with your friend, that has nothing to do with your injury/claim... no state can legislate opinion, and that's all this IME has offered.

    There are ways to dispute a opinion you are not accepting...that's why there are WC courts and judges, and the need to litigate a claim.
    WC atty is in your best interests.

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