Understanding Work Related Injuries By Debbra Murphy Axia College of University of Phoenix “Worker’s compensation is a social insurance program that provides medical care, cash benefits, and rehabilitation services to workers who are disabled fro a job related accident of disease. ” (anglefire. com) Worker’s compensation started in the 1800’s in Germany, when it was seen that workers injured while working for a company needed to be taken care of so they did not suffer physically or financially as a result of working for that company.
Worker’s compensation became common in the United States in the 1930’s and 1940’s and today is in all 50 states and territories. Worker’s compensation rules are basically the same in all 50 states. When worker’s compensation was first proposed there was a compromise between the employers and the employees that the employer would accept full responsibility for carrying worker’s compensation insurance, and the employees gave up the right to sue the employer for damages resulting from a job related injuries. Lectric Law Library, 1995) Once an employee is injured on the job they must report the injury to their employer, usually in writing, within a certain period of time. Once the employer is notified they must report the injury to the state worker’s compensation office, and the insurance carrier which is also within a certain time period. In most cases the injured employee must be seen by a physician that has been chosen by the employer, or their insurance carrier.
If the employee does not see the doctor that is recommended then benefits may not be covered and the employee would have to pay for his or her care. (Chapter 13, p. 429) The responsibility of the employee is to report the injury in writing if possible to the employer, and see the physician that is recommended by the employer, and/or the insurance carrier. The responsibility of the physician is to treat the injury, determine a percentage of disability, and a return to work date they must also file a progress report with any significant changes to the disability to the insurance carrier.
The responsibility of the employer is to either file themselves or have the physician of record file the “First Report of Injury” form within the allotted amount of time which normally ranges from 24 hours to ten days depending on the state. The responsibility of the insurance carrier is to assign the case a claim number, determines whether or not the claim is eligible for worker’s compensation, and notifies the employer.
The notice they send is either an Admission of Liability which states that the employer is responsible for the injury, or a Notice of Contest, this is a denial of liability. If the employer is liable then the insurance carrier will send checks for lost wages directly to the employee without withholding income taxes. If the insurance carrier denies the claim then any responsibility for medical bills would be the employees and could be submitted to their normal insurance carrier for payment. Chapter 13, p. 429) Worker’s compensation is one of the few times that the HIPPA privacy rules do not apply in the healthcare situation. With worker’s compensation the provider may disclose a patient’s protected health information to an employer without the patient’s permission. The worker’s compensation claim information is not subject to the same confidentiality as other medical records. In many states claims adjusters and employers have unrestricted access to the worker’s compensation files.
Also at the federal level the HIPPA privacy rules permit disclosures of protected health information for worker’s compensation purposes without the permission of the patient. (Chapter 13, p. 428) The implications of unrestricted access to a patient’s medical records that allowing a third party to use medical records for worker’s compensation or research runs the risk of the inadvertent release of personal medical information to a persons family or friends that the patient may want to keep private.
This information could cost the patient their employment, a friend, or even cause problems with family members. Since people have a property interest in their medical information, forcing individuals to divulge medical information without their consent violates the Fifth Amendment. The federal medical privacy regulation has eroded our constitutional privacy rights by giving government agencies, as well as state favored special interests, an even greater ability to access our personal medical information without our consent. Paul, 2004) With the rules of worker’s compensation individuals do not have the right under the privacy rule to request that a physician restrict disclosure of their protected health information for worker’s compensation purposes when that information is required by law or necessary to comply with a worker’s compensation or similar law. However a physician cannot disclose information that is not directly related to that particular claim to an employer, insurer, or anyone else without the written authorization from the patient. (Chapter 13, p. 28-429) References: Angelfire (nd) What is Worker’s Compensation? Retrieved August 21, 2010 from http://anglefire. com/biz7/workerscomp/What. html Lectric Law. com (1995) What is Workers’ Compensation? Retrieved August 21, 2010 from http://www. lectlaw. com/files/emp37. htm Paul, R. (nd) A Free Market Approach to Medical Privacy Retrieved August 22, 2010 from http://www. jpands. org/vol9no1/paul. pdf Valerius, J. , Bayes, N. , Newby, C. , & Seggern, J. (2008) Medical insurance: An integrated claims process approach (3rd ed. ). Boston: McGraw-Hill