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Healthcare – HIPAA – Workers’ Compensation

By: Meredith Ullman | 9/10/2012 | Category: Workers Compensation-HIPAA
Are you an employer in Ohio who provides your employees with healthcare insurance?  If so, are you helping your employees with their medical bills or any personal medical information in your capacity as the healthcare plan administrator?

What happens if an employee files a workers’ compensation claim and you know that the employee has had problems with the same shoulder for years?  You know this information because you have been collecting that employee’s medical bills as an intermediary for your insurance company in order to determine when the employer portion of the deductible takes effect.  Of course, when you learn that the employee has filed a claim for the exact same injury you are indignant and feel it is your right to pass that information along to your workers’ compensation representative.  Can you do this?  Quite simply, no.  Not without running afoul of HIPAA, that is.

For those of you who are not familiar with HIPAA, it stands for The Health Insurance Portability and Accountability Act and was enacted in 1996.  HIPAA was established to protect health information and addresses the use and disclosure of an individual’s health information by organizations subject to the rule, called “covered entities.”

Generally speaking, HIPAA does not apply to workers’ compensation claims and the medical information necessary to defend a claim; however, if you are an employer who provides healthcare insurance, you are a “covered entity.”  A “covered entity” is generally a health plan, healthcare clearinghouse or healthcare provider.  As an employer, you might not think you fall into one of these categories, but if you provide healthcare insurance to your employees, you are a “covered entity” and any medical information you learn in that capacity is covered under HIPAA.

Any information you learn, for example, through collecting bills, which may be relevant to defending a workers’ compensation claim, cannot be disclosed to your workers’ compensation representative.  That’s not to say that your representative cannot discover the information independently, as any good representative should.  Disclosure of the medical information could result in criminal penalties.  So, while it may be tempting to disclose medical information discovered while administering your company’s healthcare plan in order to defend a workers’ compensation claim, it could result in a hefty criminal penalty.

From a practical standpoint, it is not a good idea to act as an intermediary for employee insurance issues.  Not only is information discovered during the process protected by HIPAA, but a host of other HIPAA regulations may come into play.  RBS always recommends that all workers’ compensation records and/or documents (especially medical records and reports) be kept in a file separate and distinct from an employee’s personnel file.  Furthermore, any information collected in administering a healthcare plan should be kept separate from both the employee’s personnel and workers’ compensation files.  For more information regarding the interplay of healthcare programs, HIPAA and workers’ compensation, please do not hesitate to contact Meredith Ullman or any of the experienced workers’ compensation attorneys at RBS.

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