Won’t the HIPAA Privacy Rule’s minimum necessary standard impede the ability of workers’ compensation insurers, State administrative agencies, and employers to obtain the health information needed to pay injured or ill workers the benefits guaranteed them under the State workers’ compensation system?
Does an individual have a right under the HIPAA Privacy Rule to restrict the protected health information his or her health care provider discloses for workers’ compensation purposes?
Does the HIPAA Privacy Rule permit a health care provider to disclose an injured or ill worker’s protected health information without his or her authorization when requested for purposes of adjudicating the individual’s workers’ compensation claim?
I am a health care provider and my State law says I have to provide a workers’ compensation insurer, upon request, with an injured workers’ records that relate to treatment or hospitalization for which compensation is being sought. Am I permitted to disclose the information required by my State law?
My State law says I may disclose records, relating to the treatment I provided to an injured worker, to a workers’ compensation insurer for purposes of determining the amount of or entitlement to payment under the workers’ compensation system. Am I allowed to share this information under the HIPAA Privacy Rule?
My 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?
Q: Won’t the HIPAA Privacy Rule’s minimum necessary standard impede the ability of workers’ compensation insurers, State administrative agencies, and employers to obtain the health information needed to pay injured or ill workers the benefits guaranteed them under the State workers’ compensation system?
A: No. The Privacy Rule is not intended to impede the flow of health information to those who need it to process or adjudicate claims, or coordinate care, for injured or ill workers under workers’ compensation systems. The minimum necessary standard generally requires covered entities to make reasonable efforts to limit uses and disclosures of, as well as requests for, protected health information to the minimum necessary to accomplish the intended purpose. For disclosures of protected health information made for workers’ compensation purposes under 45 CFR 164.512(l), the minimum necessary standard permits covered entities to disclose information to the full extent authorized by State or other law. In addition, where protected health information is requested by a State workers’ compensation or other public official for such purposes, covered entities are permitted reasonably to rely on the official’s representations that the information requested is the minimum necessary for the intended purpose. See 45 CFR 164.514(d)(3)(iii)(A).
For disclosures of protected health information for payment purposes, covered entities may disclose the type and amount of information necessary to receive payment for any health care provided to an injured or ill worker.
The minimum necessary standard does not apply to disclosures that are required by State or other law or made pursuant to the individual’s authorization.
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Q: Does an individual have a right under the HIPAA Privacy Rule to restrict the protected health information his or her health care provider discloses for workers’ compensation purposes?
A: Individuals do not have a right under the Privacy Rule at 45 CFR 164.522(a) to request that a covered entity restrict a disclosure of protected health information about them for workers’ compensation purposes when that disclosure is required by law or authorized by, and necessary to comply with, a workers’ compensation or similar law. See 45 CFR 164.522(a) and 164.512(a) and (l).
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Q: Does the HIPAA Privacy Rule permit a health care provider to disclose an injured or ill worker’s protected health information without his or her authorization when requested for purposes of adjudicating the individual’s workers’ compensation claim?
A: Covered entities are permitted to disclose protected health information for such purposes as authorized by, and to the extent necessary to comply with, workers’ compensation law. See 45 CFR 164.512(l). In addition, the Privacy Rule generally permits covered entities to disclose protected health information in the course of any judicial or administrative proceeding in response to a court order, subpoena, or other lawful process. See 45 CFR 164.512(e).
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Q: I am a health care provider and my State law says I have to provide a workers’ compensation insurer, upon request, with an injured workers’ records that relate to treatment or hospitalization for which compensation is being sought. Am I permitted to disclose the information required by my State law?
A: Yes. The HIPAA Privacy Rule permits a covered entity to disclose protected health information as necessary to comply with State law. No minimum necessary determination is required. See 45 CFR 164.512(a) and 164.502(b).
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Q: My State law says I may disclose records, relating to the treatment I provided to an injured worker, to a workers’ compensation insurer for purposes of determining the amount of or entitlement to payment under the workers’ compensation system. Am I allowed to share this information under the HIPAA Privacy Rule?
A: Yes. A covered entity is permitted to disclose an individual’s protected health information as necessary to comply with and to the full extent authorized by workers’ compensation law. See 45 CFR 164.512(l).
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Q: My 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?
A: 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. Thus, a covered entity would be permitted to make the above disclosure if the individual signed such an authorization.
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