Synopsis: Understanding the HIPAA Battlefield in Work Comp.

Editor’s comment: I read a great blog from a Chicago-area Claimant attorney on what he asserts are the rights and rules relating to HIPAA in WC claims. To paraphrase, he indicates under workers’ compensation law, your employer or their insurance company has a “right” to medical records related to your injury. As a result, it’s very common after a worker gets hurt for them to get a letter that asks the worker to sign [and return] a “medical release form” that authorizes them to have access to your medical records.

The blogger indicates these medical release forms are written by insurance companies [and me, one of their lawyers] in a way that favors insurance companies. If insurance carriers/TPA’s could, they’d see every medical record of the worker’s life since they were a baby. Counsel claimed it’s a “fishing expedition” for insurance carriers/TPA’s to look for something that might possibly give them a reason to deny a given case.

The good news is counsel admits insurance carriers and TPA’s are entitled to medical records that relate to work injuries, he then asserts we have “no right” to look at any and all medical records from the injured worker’s life. So, he recommends if a worker want your insurance carrier/TPA to know the worker had cancer or was bi-polar or see what happened when the worker was pregnant, under HIPAA, the worker and/or counsel can restrict insurance carriers and TPA’s from seeing such records.

What is the HIPAA Battlefield?

Counsel confirms when his firm gets these requests, they strike out any language that says “any and all medical records” and their staff replace it with language that limits a medical record request to the accident and treatment that relates to the same body part. He asserts insurance carriers/TPA’s have a “right” to see records from a car accident where a worker hurt their back five years ago if they are claiming back pain now. Counsel also indicates insurance carriers/TPA’s don’t have a right to records from a car accident that hurt your back if you are now claiming carpal tunnel.

My only issue with the great blogger is the continued insistence on asserting there are “rights” or “no rights” on access to medical records following an injury. The advice from the defense team at KCB&A is get all the medical records you can get and try to figure out what is “relevant” in defense of the claim and what is not. A great example of this is a simple rotator cuff tear. Obviously, all records relating to shoulder, arm and hand care would be relevant. Would medical records for treatment for cancer? In my view, it would be critical evidence, as the health of your body is illustrative In managing one WC claim.

The defense team at KCB&A has a great and expansive HIPAA release for your use and consideration. This release has been used across the country for over a decade by numerous insurance carriers/TPA’s and self-insured employers. If you want a free copy, send a reply.


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Synopsis: Sedgwick to acquire York Risk Services Group

Editor’s comment: Sedgwick has signed an agreement to acquire York Risk Services Group. The transaction is subject to customary conditions and regulatory approvals and expected to close in the latter part of 2019.

York is a premier provider of risk management, claims administration, managed care and absence management solutions. They serve a variety of clients, including corporations, the insurance industry and public entities. The company has nearly 5,000 employees in more than 60 offices across the U.S., as well as a strong international presence. York offers customized claims solutions and has specialized experience to handle even the most complex claims across all liability lines. Their offerings notably complement Sedgwick’s existing market capabilities.

Joining forces with York marks another milestone in Sedgwick’s storied 50-year history of growth and enhances their industry position as a leading global provider of innovative risk, benefits and integrated business solutions. Bringing together the expertise and capabilities of Sedgwick and York will allow them to serve more customers in more places. After the close of this acquisition, the Sedgwick family will be nearly 27,000 colleagues strong!

Until the close of the transaction, York will continue conducting business as usual.

The defense team at KCB&A provides defense work for both York and Sedgwick and all major U.S. TPA’s. We salute them as they grow and thrive.