Frequently Asked Questions

I’m trying to return my patient to work. Do I need to state that the claimant can or cannot return to work on the patient record? How should I let all parties involved know that I want my patient to return to work?
Do not document that the claimant can or cannot return to work. As the claimant’s treating provider you should always document the patient’s limitations, not whether they should return to work. It is the employer’s responsibility to determine if there is work for injured workers that does not physically put them at risk. Documenting the patient’s limitations in your clinical note should let all parties involved know of your concerns. No additional communication is necessary. If employers contact you directly, you should take the time to answer any of their concerns.
State law says I may disclose records relating to my treatment of an injured worker to a workers' compensation insurer trying to determine the amount of or entitlement to payment under the workers' compensation system. Am I allowed to share this information under the HIPAA Privacy Rule?
Yes. A covered entity is permitted to disclose an individual’s health information as necessary to comply with and to the full extent authorized by workers’ compensation law. See 45 CFR 164.512(a).
State law says I may provide information regarding an injured workers' previous condition, which is not directly related to the claim for compensation, to an employer or insurer if I obtain the workers' written release. Am I permitted to make this disclosure under the HIPAA Privacy Rule?
Yes. A covered entity may disclose protected health information where the individual’s written authorization has been obtained, consistent with the Privacy Rule’s requirements at 45 CFR 164.508. A covered entity would be permitted to make the above disclosure if the individual signed such an authorization.
I am a health-care provider and my state law requires I provide a workers’ compensation insurer, upon request, with an injured worker’s records that relate to treatment or hospitalization for which compensation is being sought. Am I permitted to disclose the information?
Yes. The HIPAA Privacy Rule permits a covered entity to disclose protected health information as necessary to comply with state law. See 45 CFR 164.512(a). and 164.502(b) (2) (iv).
Does an individual have a right under the HIPAA Privacy Rule to restrict the protected health information that his or her health-care provider discloses for workers’ compensation purposes?
No. Individuals do not have a right under the Privacy Rule at 45 CFR 164.512(a). to request that a covered entity restrict disclosure of protected health information about them for workers’ compensation purposes if the disclosure is required or authorized by a workers’ compensation law. See 45 CFR 164.522(a).