HIPAA Privacy Rule and Workers’ Comp

Q. Under the HIPAA Privacy Rule, can my office send supporting documentation (medical records) with our bills to a workers’ compensation insurance carrier without special authorization from the injured employee who is our patient?

A. Yes. The HIPAA Privacy Rule does not apply when you disclose protected health information (PHI) to workers’ compensation insurers, workers’ compensation administrative agencies, or employers as required by state law for workers’ compensation system purposes.

The Privacy Rule recognizes the legitimate need for insurers and other entities involved in the workers’ compensation system to have access to an injured worker’s PHI as authorized by state or other law.

For more information, read Texas Department of Insurance  Advisory 2003-05.

Updated Jan. 24, 2013

NOTICE: The Texas Medical Association provides this information with the express understanding that 1) no attorney-client relationship exists, 2) neither TMA nor its attorneys are engaged in providing legal advice and 3) that the information is of a general character. This is not a substitute for the advice of an attorney. While every effort is made to ensure that content is complete, accurate and timely, TMA cannot guarantee the accuracy and totality of the information contained in this publication and assumes no legal responsibility for loss or damages resulting from the use of this content. You should not rely on this information when dealing with personal legal matters; rather legal advice from retained legal counsel should be sought.

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