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wc and privacy
#1
Question 
Does the w/c have the right to send my health records to a third party without my permission? What about HIPPA? The w/c insurance company hired a third party to go with me to my medical appointments and to speak to the doctor about my care. I was told that they would determine my care by discussing my injury with the doctor. Do I have any say in this matter, or is the insurance company allowed to exclude me from my care?
 
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#2
workers comp is not your health insurance.
it depends on the type of records.
the medical records involving the workers comp claim are theirs not yours.
in a litigated claim they are required to provide full documentation to the court on all issues.
Hipaa for the most part does not apply to workers comp.
you have the right to bar them from your examination, but they can speak to the doctor privately about your case.
workers comp rules are different in every state but within limits the employer controls the medical care.
in workers comp rights and responsibilities are shared/balanced between the one who pays and the one who receives.

Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#3
I have had my info sent to doctors I've never even seen and they give their opinion of my injury. There are time I can see a doctor only getting some files like your MRI so they can issue their view of what they see and if they could do anything with you.And these are times when one doctor is asking for this other doctor to look at them and not just a case manager wanting this other doctor to give their opinion which is normally based on the fact they know this doctor will write something in favor of what the manager wants. But in my cases they send them the files and they make a decision on what treatment you should or should not of had based only on the paper work. Even my doctor says you can not treat a person without examining them.
Now they do this because they have to look all over to find a doctor that will write what they want and since these doctors could be anywhere they don't want to have to spend the money to send you to this office for them to look at you. Now this would be better since this doctor did see you the problem is they used this doctor because he is going to write what they want so the fact that he saw you is not important and just a waste of money to them. Plus if the doctor did see you he might not issue the report they wanted because once he does see you he might decide he can't say the things the company wanted.
Remember if this doctors report ever comes under review he can always say I only had the paper work they sent me and did not see the patient.
 
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#4
(06-10-2014, 09:38 PM)diaimi Wrote: Does the w/c have the right to send my health records to a third party without my permission? What about HIPPA? The w/c insurance company hired a third party to go with me to my medical appointments and to speak to the doctor about my care. I was told that they would determine my care by discussing my injury with the doctor. Do I have any say in this matter, or is the insurance company allowed to exclude me from my care?

Do you have an attorney? Sometimes attorney's can be helpful in these situations.

You have the right to ask the nurse case manager not to be in the exam room with you and your doctor. You should be able to ask your doctor if you can be present when she is talking to him.

Work comp laws are state specific. In some states, an attorney can get rid of the nurse case manager.

The best thing to remember is nurse case managers work for the insurance company. They are there to protect the interests of the insurance company, which may not be in your best medical interests.


In my state there are limits to what records they can request, but it usually takes an attorney who is skilled to determine this, and who knows how to fight the issue.
I am not an attorney.Anything I write should not be considered legal advice.I am writing from my own personal experiences,which is not from any sort of legal background. You should consult with an attorney over legal issues. In California, if you cannot get an attorney you can consult with an I&A officer.
 
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#5
I live in VA, I have been interviewing attorneys over the past few days, I have one more today, I also have spoke with the insurance company about the case manager, I did inform them that if they want to send my records to another company then they need to inform me of this, the insurance company stated they did not have to get informed consent, and that if I refused the case manager for the MD visit, then I can be denied WC, at the same time, I requested my pay, I have not been paid since this started, the lady at the insurance company stated that she would not send me any money because I was being difficult and not letting the case manager go to my appt. I am so over this crap, hopefully my attorney will get some things straight. thanks for letting me vent.
 
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#6
You do need an attorney and it is good you are talking to several, this way you can find one you feel comfortable with. They love to threaten you and they hate it when you know the laws.
As for your records I'm not sure in your state but your lawyer will be able to help there. I'm guessing they can send them to anybody they want to review. It is sad with the laws on HIPPA that this can happen but then the laws in WC are written to help them and not us
 
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