HIPAA and Workers Compensation: What You Need to Know

Another week, another workers compensation lesson from your trusty Massachusetts workers compensation provider! This week, we would like to discuss HIPAA and its relation to workers compensation.

Many employers mistakenly believe that HIPAA prevents medical personnel from discussing medical conditions related to workers compensation. This week, we are here to set the record straight. We would like to take the time to education employers that there exists an exception, specifically for workers compensation injuries.

First, you may wonder what the primary purpose of the HIPAA privacy rule is. Let’s start with that.

This rule protects from unauthorized disclosure of any personally identifiable health insurance that pertains to a consumer of health care services.

Now, when it comes to workers compensation, there is absolutely no problem with employers, physicians, workers compensation carriers, and others involved in the workers comp system sharing protected health info with one another. Of course, it must be in connection with the workers compensation claims and appeals. When it comes to exemptions, HIPAA allows three for workers comp matters (according to the U.S Department of Health and Human Services):

1. “As authorized by and to the extent necessary to comply with laws relating to workers’ compensation or similar programs established by law that provide benefits for work-related injuries or illness without regard to fault. See 45 CFR 164.512(l).

2. To the extent the disclosure is required by State or other law. The disclosure must comply with and be limited to what the law requires. See 45 CFR 164.512(a).

3. For purposes of obtaining payment for any health care provided to the injured or ill worker. See 45 CFR 164.502(a)(1)(ii) and the definition of “payment” at 45 CFR 164.501.”

As you can see, if health-related info is being exchanges in combination with a workers’ comp claim or appeal, the HIPAA privacy rule will NOT stand in the way. For further information on this, check out what HHS has to say, here.

At Wolpert Insurance, we feel that it is our duty to not only provide you with the proper Massachusetts workers compensation, but to educate and keep you “in the know.” We may be the insurance experts, but that does not mean that you cannot be, either. Continue to come back for more information and soon enough, you will be an expert, too! Do not miss next week’s post, where we will be discussing the dangers that employers have when an employee comes back to work full time after an injury.