between HIPAA and Workers' Compensation Disclosure Requirements. Workers'
compensation insurers, employers and the Utah Labor Commission need access to
health information of individuals who are injured on the job or who have a
work-related illness in order to process or adjudicate claims, or to coordinate
care under Utah's workers' compensation system. Generally, this health
information is obtained from health care providers who treat these individuals
and who may be covered by federal "HIPAA" privacy rules.
The HIPAA Privacy Rule specifically recognizes the legitimate
need of the workers' compensation system to have access to individuals' health
information to the extent authorized by State law. See
CFR 164.512(1). The Privacy
Rule also recognizes the importance of permitting disclosures required by other
CFR 164.512(a). Therefore,
disclosures permitted by this rule for workers' compensation purposes or
otherwise required by this rule do not conflict with and are not prohibited by
the HIPAA Privacy Rule.
Disclosures Permitted Without Authorization. A medical provider, without
authorization from the injured worker
For purposes of substantiating a bill
submitted for payment or filing required Labor Commission forms, such as the
's Initial Report of Injury/Illness" or the "Restorative Services
Authorization," disclose medical records necessary to substantiate the billing,
including drug and alcohol testing, to:
employer's workers' compensation insurance carrier or third party
b. A self-insured
employer who administers its own workers' claims.
c. The Uninsured Employers' Fund;
d. The Employers' Reinsurance Fund;
e. The Labor Commission as
required by Labor Commission rules.
2. Disclose medical records pertaining to
treatment of an injured worker who makes a claim for workers' compensation
benefits, to another physician for specialized treatment, to a new treating
physician chosen by the claimant, or for a consultation regarding the claimed
work related injury or illness.
Disclosures Requiring Authorization.
Except as limited in C(3), a medical
provider, whose medical records are relevant to a worker's compensation claim,
shall, upon receipt of a Labor Commission medical records release form, or an
authorization form that conforms to HIPAA requirements, disclose his/her
medical records to:
a. An employer's insurance
carrier or third party administrator;
b. A self-insured employer who administers
its own workers' compensation claims;
c. An agent of an entity listed in B(1)(a
through e), which includes, but is not limited to a case manager or reviewing
d. The Uninsured
e. The Employers'
f. The Labor
g. The injured
h. An injured workers'
attorney representing any of the entities listed above in an industrial injury
or occupational disease claim.
Medical records are relevant to a workers'
compensation claim if:
a. The records were
created after the reported date of the accident or onset of the illness for
which workers' compensation benefits have been claimed; or
the records were created in the past ten
years (15 years if permanent total disability is claimed) and:
i. There is a specific reason to suspect that
the medical condition existed prior to the reported date of the claimed work
related injury or illness or;
The claim is being adjudicated by the Labor Commission.
3. Medical records related to care
provided by a psychiatrist, psychologist, obstetrician, or care related to the
reproductive organs may not be disclosed by a medical provider unless a claim
has been made for a mental condition, a condition related to the reproductive
organs, or the claimant has signed a separate, specific release for these
Regarding Return to Work. A medical provider, who has treated an injured worker
for a work related injury or illness, shall disclose information to an injured
workers' employer as to when and what restrictions an injured worker may return
E. Additional Disclosures
Requiring Specific Approval. Requests for medical records beyond what
subsections B, C, and D permit require a signed approval by the director, the
medical director, a designated person(s) within the Industrial Accidents
Division or an administrative law judge if the claim is being
F. Appeals. A party
affected by the decision made by a person in subsection E may appeal that
decision to the Adjudication Division of the Labor Commission.
G. Injured Worker's Duty to Disclose Medical
Treatment and Providers. Upon receipt and within the scope of this rule, an
injured worker shall provide those entities or persons listed in C(1) the
names, address, and dates of medical treatment (if known) of the medical
providers who have provided medical care within the past 10 years (15 years for
permanent total disability claim) except for those medical providers names in
C(3). Labor Commission form number 307 "Medical Treatment Provider List" must
be used for this purpose. Parties listed in C(1) of this rule must provide each
medical provider identified on form 307 with a signed authorization for access
to medical records. A copy of the signed authorization may be sent to the
medical providers listed on form 307.
H. Injured Worker's Right to Contest Requests
for Pre-Injury Medical Records. An injured worker may contest, for good reason,
a request for medical records created prior to the reported date of the
accident or illness for which the injured worker has made a claim for benefits
by filing a complaint with the Labor Commission. Good reason is defined as the
request has gone beyond the scope of this rule or sensitive medical information
is contained in a particular medical record.
Limitations on Use and Re-disclosure of
1. Any party obtaining
medical records under authority of this rule may not disclose those medical
records, without a valid authorization, except as required by law.
An employer may only use medical records
obtained under the authority of this rule to:
a. Pay or adjudicate workers' compensation
claims if the employer is self-insured;
b. To assess and facilitate an injured
workers' return to work;
otherwise authorized by the injured worker.
3. An employer obtaining medical records
under authority of this rule must maintain the medical records separately from
the employee's personnel file.
Any medical records obtained under the authority of this rule to make a
determination regarding the acceptance of liability or for treatment of a
condition related to a workers' compensation claim shall only be used for
workers' compensation purposes and shall not be released, without a signed
release by the injured worker or his/her personal representative, to any other
party. An employer shall make decisions related only to the workers'
compensation claim based on any medical information received under this
Fees for Providing Medical Records. When any medical provider provides copies
of medical records, other than the records required when submitting a bill for
payment or as required by the Labor Commission rules, the following charges are
1. A search fee of $15
payable in advance of the search;
2. Copies at $.50 per page, including copies
of microfilm, payable after the records have been prepared and
3. Actual costs of postage payable after the
records have been prepared and sent. Actual cost of postage is deemed to be the
cost of regular mail unless the requesting party has requested the delivery of
the records by special mail or method.
4. The Labor Commission will release its
records per the above charges to parties/entities with a signed and notarized
release from the injured worker unless the information is classified and
controlled under the Government Records Access and Management Act
5. No fee shall be charged
when the RBRVS or the Commission's Medical Fee Guidelines require specific
documentation for a procedure or when medical providers are required to report
by statute or rule.
or his/her personal representative may obtain one copy of each of the
following records related to the industrial injury or occupational disease
claim, at no cost, when the injured worker
or his/her personal representative
have signed a form by the Industrial Accidents Division to substantiate his/her
industrial injury/illness claim;
b. Operative reports
c. Hospital discharge
d. Emergency room
f. Specialized test
g. Physician SOAP
notes, progress notes, or specialized reports.
h. Alternatively, a summary of the patients
records may be made available to the injured worker or his/her personal
representative at the discretion of the physician.