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Medical record review is an important step in workers’ compensation claims processing. Employers are entitled to a copy of the medical records.
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The medical records of an injured employee are the most critical evidence in a workers’ compensation claim. This makes medical records services a very important requirement for insurance attorneys. Only the medical documentation can provide proof that an injury occurred, and it also gives details regarding the scope of the injury and the recommended treatment. In a workers’ compensation claim, claimants receive notices from their employer/insurer requesting that they provide copies of their medical records or fill up a medical records release form that would allow the employer/insurer to request the medical records on their own. Why Employers Need Access to Workers’ Medical Records The medical records are requested to ensure that the claimant is receiving the necessary treatment, and that they are not abusing the privilege of receiving free medical treatment. The copies of medical records are also needed when the employer or insurer schedules the claimant for an independent medical evaluation, so that the medical examiner has a detailed medical history of the injury to provide optimal rating for permanent partial disability. Employers need to access relevant medical information to ensure prompt, accurate claims processing; to provide safety programs to lessen recurring injuries that are similar in nature; to reduce the chances of fraudulent claims; and to ensure they can prepare an adequate claims defense. In the absence of employer oversight of insurance carriers and the capability to prepare an apt claims defense, the premium pricing structure could lead to increased workers’ compensation costs and other employee entitlements. The employer/insurer is entitled to a claimant’s medical records. Points to Note
The medical records requested must be immediately relevant to the work-related injury.
According to the Rules of the Workers’ Compensation Commission, each party is required to provide the opposing party with copies of all medical documentation that is currently in their possession or is subsequently received by them.
The duty to disclose medical records exists throughout the claim processing period and is reciprocal. That is, the claimant can request copies of medical information in the possession of the employer/insurer and vice versa.
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Either party can also issue a subpoena duces tecum (a subpoena for production of evidence) to a physician that will require the physician to supply the party with copies of the medical records that are requested.
The opposing party has 30 days to note an objection to the subpoena.
In case there is no objection, the subpoena will be sent to the medical provider and the provider must comply with the subpoena.
The claimant on his or her part must be sure to inform every doctor that is treating the injury that the injury is a work-related one. Any changes in the nature of the injury, pain, discomfort and so on must be communicated to the doctor so that the claimant’s medical history of the work-related injury is well documented. The employer or insurance company cannot ask the claimant to sign a release immediately after an injury. The claimant has the right to speak to his/her lawyer first and have the lawyer review the medical release request. The ideal thing is to have the lawyer prepare the medical release form.
When performing a medical record review, the employer/insurer will be looking for evidence whether the injury is due to non-work-related causes or pre-existing conditions. With regard to a case wherein the injury was caused by a pre-existing condition, the worker can always insist that the workplace accident worsened their condition or that the new pain is purely due to the new injury. The insurer would also stay alert when examining the medical records to see whether the worker at any time told the doctor that he/she has not been hurt that bad.
Regulations such as the HIPAA, the Drug Abuse Treatment and rehabilitation Act, and the Comprehensive Alcohol and Alcoholism Prevention, Treatment and Rehabilitation Act protect employee privacy associated with substance abuse treatment. Employees must be constantly aware that their employers’ access to their medical records is vital to validate their claim, and that medical chart reviews are indispensable when getting a claim approved. An experienced workers’ compensation attorney would ensure that their clients are informed about all relevant facts, and work to maximize their client’s benefits.
www.mosmedicalrecordreview.com
918-221-7791