Health Insurance Portability and Accountability Act (HIPAA) and Workers' Compensation


TO: Commissioners, District Administrators, Self-Insureds, Insurance Carriers, Attorneys, Unions, Medical Practitioners, and Advisory Board Members
FROM: John A. Mastropietro, Chairman
DATE: June 30, 2003
RE: Health Insurance Portability and Accountability Act (HIPAA) and Workers' Compensation


As many of you know, HIPAA is a new federal law that governs the sharing of information among providers, insurance carriers and others involved with the care and treatment of patients. This legislation specifically excludes all matters concerning workers' compensation. Therefore, the various obligations under HIPAA related to special authorizations, access, and protection of confidential information does not apply to the treatment, care, benefits or processing of any workers' compensation claim. However, all of the present federal and Connecticut statutes and regulations protecting confidentiality in workers' compensation and other matters still apply and must be followed by all involved in the workers' compensation process.

There has been some confusion and certain providers have denied access to workers' compensation related medical information due to a concern about HIPAA. As you all know, the workers' compensation system relies on the timely exchange of medical and other claim information in accordance with the various workers' compensation related statutes, regulations and directives of the Commission. All involved in the workers' compensation process must abide by these rules. Those who do not comply with the rules, and fail to share and protect information in accordance with these rules, could suffer severe penalties and, in certain cases, have their privileges to treat employees under workers' compensation withdrawn or have their status as a workers' compensation self-insured employer or carrier revoked.

To avoid further confusion, I recommend that anyone requesting medical information in a workers' compensation case or processing a workers' compensation claim be certain to boldly note on any such request that the request relates to a "WORKERS' COMPENSATION" matter.

The present situation in which a medical release is required will continue without any obligation to change the release to meet the requirements of HIPAA. As to providers, it is important that you continue to meet your obligations of providing timely progress reports to carriers and/or employers as well as copying all the appropriate parties on any written report that is drafted, including the employee or his representative.

As some of you may know, HIPAA has a minimum necessary "rule" on the disclosure of medical information. However, HIPAA's policy as to limitations on disclosure must coexist with the Connecticut Workers' Compensation Commission's long standing policy encouraging open disclosure of medical information pertinent to a Workers' Compensation claim subject to medical privacy limitations in Connecticut's own body of statutes. In situations where it seems HIPAA's authorization for disclosure rules conflict with our body of law, we remind you that HIPAA excludes information relating to Workers' Compensation.

We hope this memorandum helps to clarify the issue so that the system can continue to function smoothly. I thank you for all your efforts to comply with the spirit of this law in exempting the workers' compensation system. However, if there are any specific questions with regards to your obligation under the workers' compensation system as it relates to confidentiality and the sharing of information, please do not hesitate to contact this office.