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Q&A: Workers compensation

HIPAA Weekly Advisor, June 15, 2009

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Q. An employee health nurse for a hospital is authorized to access patient medical records and related PHI. The employee health nurse is responsible for workers’ compensation case management. If the nurse is notified that the hospital’s emergency department has evaluated and treated a hospital employee for a work-related incident, is the nurse allowed to access the employee’s medical records related to the injury? The hospital is a self-insured facility for workers’ compensation purposes.

A. If the nurse is acting in the capacity of what amounts to the workers’ compensation carrier, a review of the employee’s medical record only as it relates to the injury and potential preexisting conditions is permissible, but needs to be “walled off” from other hospital operations.

Also, the nurse, as with an external workers’ compensation carrier, cannot access the medical records of the employee without the employee initiating a workers’ compensation claim. If the employee elects not to file a claim, the nurse would be violating the privacy of the employee-patient and violating HIPAA because, in that case, access would not be related to treatment, payment, or healthcare operations, nor would it meet the criteria allowing such medical record access to workers’ compensation carriers.

Editor's note: Chris Apgar, president of Portland, OR-based Apgar & Associates, LLC, answered this question. This is not legal advice. Consult your attorney regarding legal matters.

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