Insurance carrier falsified Release of Medical Information...

by Anonymous

The employer's worker's comp insurance carrier submitted a falsified Authorization for Release of Protected Health Information to the medical center (personal primary care) and obtained my protected health information, which was non-industrial and not related to any current injury, and sent those records directly to a QME doctor.

The claims administrator literally took white tape and taped over the entire line of Provider Name and typed in the medical center. Then added 2 pages of Authorization Attachment stating they had access to the entire contents of all files (for all dates of injuries of illness) for any purpose, whether industrial or non-industrial, including all files, charts, reports, notes, forms, printouts, test results, lab results, and all correspondence and telephone conversation notes, including all email and computer notes from all sources.

I was not at any time notified of the existence or provided a copy of this falsified Authorization for Release of Protected Health Information, or the Authorization Attachments that were submitted to the medical center (in which they obtained my private health information, including lab results, prescriptions, diagnoses, etc.) and distributed it to a second Third Party QME doctor.

The QME reviewed and referenced the personal health information which included women's health, psychiatric, etc. but none of these issues related to the current work injury. I was also not sent any medical or non-medical information that the insurance carrier sent direct to the QME.

I have the original 1 page Authorization that I had signed and it does not have the Medical Center Name listed in the Provider Name Line. It did not have any of the added 2 pages of Authorization Attachments, either.

I believe my HIPAA rights and HIPAA laws were violated. I have just filed a HIPAA complaint with the OCR. What type of attorney would handle this issue? I am in the process of speaking with worker's comp attorneys also, as the insurance carrier has denied the worker's comp claim. I'd appreciate any information you can provide.

Visitor Question:
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ANSWER for "Insurance carrier falsified Release of Medical Information...":

Anonymous (CA):

While you can file a HIPAA complaint, you should know there is no right to recover for a private right of action. This means even if it is found your HIPAA rights were violated, you are not entitled to any compensation. HIPAA can levy substantial fines against your employer and/or the workers' compensation insurance company, but none of that money gets transferred to you.

You have every right though to pursue a workers' compensation claim. Because your claim has been denied, you would be best served by retaining one of the workers' compensation attorneys you've been speaking with.

The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from an attorney licensed in your state. Find a local attorney to give you a free case review here, or call (888) 647-2490.

Best of luck,

Judge Calisi

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