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  1. #1
    Join Date
    Feb 2017
    Posts
    1

    Default Pulling Unrelated Auto and Medical Claims

    My workers compensation claim was made in the State of: WA

    I've been working on this case mostly without a lawyer, though I just hired one after figuring out the self insured insurance company is trying to close my claim. I got my entire file - 500+ pages - and not only has there been constant threats to close my case if a dr doesn't fill out a form, but they've also pulled unrelated medical history by asserting hippaa does not apply. They also have pulled my entire auto insurance claim history.

    My attorney has never seen this before and now that I have an attorney I can't talk to anyone on my own because I have an attorney. The amount of personal information here is ridiculous and terrifying. It doesn't seem normal either.

    What can I do?

  2. #2
    Join Date
    Oct 1971
    Posts
    4,586

    Default Re: Pulling Unrelated Auto and Medical Claims

    shefallsdown
    I've been working on this case mostly without a lawyer, though I just hired one after figuring out the self insured insurance company is trying to close my claim.
    they've also pulled unrelated medical history by asserting hippaa does not apply. They also have pulled my entire auto insurance claim history.
    This is exactly why you don't wait until your case is destroyed to hire a lawyer.

    Just because you feel it's unrelated, doesn't make it so - they have a right to run a complete background check, including your auto insurance claim history.
    They also have a right to your entire medical history for the purpose of managing and adjudicating your claim.
    They are correct that HIPPA rules do not apply in Worker Compensation cases.

    Sounds like you have a history with the injury you're claiming, otherwise you wouldn't have an issue with this discovery.
    Go through and read the sources below, I highlighted a few sections that apply to your case.

    What Records Are Relevant?
    Workers’ compensation involves more than just the conditions covered on a claim.
    The entire medical record may be relevant and necessary to manage a workers’ compensation claim.
    http://www.lni.wa.gov/ClaimsIns/File...rdsRelease.pdf

    Disclosures for Workers' Compensation Purposes
    45 CFR 164.512(l)
    Background
    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.
    https://www.hhs.gov/hipaa/for-profes...ion/index.html

    HIPAA and L&I
    HIPAA Privacy Rule Exceptions and L&I
    Authorizations are not needed when patients are covered by workers' compensation
    HIPAA exempts workers' compensation programs from the Act’s Privacy Rule authorization requirement (45 CFR 164.512(l)).
    http://www.lni.wa.gov/CLAIMSINS/PROV...AA/DEFAULT.ASP

    The amount of personal information here is ridiculous and terrifying. It doesn't seem normal either.
    I have to say, I've never heard anyone speak of their past and medical history in these terms - If you think it's that bad, imagine what the carrier thinks.

    My attorney has never seen this before
    Sure he has - this is standard procedure, especially if they have reason to believe you're hiding something.

    What can I do?
    Pray that you haven't damaged your case beyond repair by waiting to hire a lawyer.

    Good Luck
    Tony
    Moderator Responses are based on my personal bias, experience and research - they may not be accepted in the legal community, always consult an attorney.

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