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HIPAA RESTRICTIONS AND MEDICAL RECORDS


WORKERS' COMPENSATION GUIDELINES

On April 14, 2003 the Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 went into effect. The Privacy Rule changes the way that “protected health information” may be used and disclosed by covered entities.

Under HIPAA’s Privacy Rule, the Workers' Compensation Board, workers' compensation carriers and employers are not covered entities and therefore may continue to use medical information concerning claimants in their customary manner.

If you are a “covered entity,” such as a health care provider, the Privacy Rule specifically exempts health information that is required as part of a lawful process, including a workers' compensation proceeding, from HIPAA restrictions concerning use and disclosure of protected health information. Therefore, health care providers may continue to provide the Board and carriers with reports of treatment (C-4s) and health care providers may continue to testify at hearings and depositions.

Important: This guideline reflects the Board's understanding of HIPAA and its application to New York's workers' compensation process. However, HIPAA and the Privacy Rule are federal legislation. Therefore, the New York State Workers' Compensation Board has no authority over the method and manner in which the new legislation and regulations will be implemented. For a binding interpretation of the law, you must contact the regulating federal agency, the Office of Civil Rights.

The following are some guidelines regarding health care providers' continuing obligation to provide medical records to the Board:

In short, all parties must be aware that a health care provider's obligations under HIPAA does not relieve the provider or the parties of their obligations under the Workers' Compensation Law and accompanying regulations. Claims will not be established, awards to claimants will not be made, and medical bills will not be paid without the submission of required medical information.

Independent Medical Examinations: Employers and carriers are permitted to continue to have claimant's evaluated by independent medical examiners in order to obtain information concerning a work-related injury. The independent medical examiner may continue to share his/her opinion with the Board and the employer/carrier in the customary manner.