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HIPAA Restrictions and Medical Records


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

Under the Privacy Rule, the Workers' Compensation Board, workers' compensation insurers and employers are not considered 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 workers' compensation proceedings, from HIPAA restrictions concerning use and disclosure of protected health information. Therefore, health care providers may continue to provide the Board and insurers with reports of treatment (CMS-1500 form) and testify at hearings and depositions.

Important: This guideline reflects the Board's understanding of HIPAA and its application to the New York workers' compensation system. However, HIPAA is federal legislation. Therefore, the New York State Workers' Compensation Board has no authority over the method and manner in which HIPAA and the Privacy Rule is implemented. For a binding interpretation of the law, you must contact the regulating federal agency, the U.S. Department of Health and Human Services' 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 providerís obligation 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 insurers are permitted to continue to have claimants evaluated by independent medical examiners in order to obtain information concerning a work-related injury. The independent medical examiner may continue to share their opinion with the Board and the employer/insurer in the customary manner.