Injured workers are not required to sign an unrestricted medical release form to proceed with their workers’ compensation claims, according to a case released last week. I should start this post with a qualification (as I so often do-it’s the lawyer in me): this case dealt with an application for permanent total disability compensation. Your mileage might vary depending upon the circumstances of the claim. First of all, however, let’s start with some background.
What are the rules regarding release of medical records in connection with a workers’ compensation claim?
Ohio law provides that the Bureau of Workers’ Compensation (“BWC”) or the employer can require that an injured worker provide, upon request, a “current signed release of [medical] information.” See O.R.C. 4123.651(B).
What happens if an injured worker refuses to sign a medical release form?
If “without good cause” an injured worker refuses to execute a release of information, the employer can ask the Industrial Commission to suspend the claim. If the Industrial Commission grants the request to suspend the claim, the injured worker is not entitled to receive any compensation or medical benefits until a medical release is provided. A claim may also be suspended if the injured worker refuses to submit to a medical examination. See O.R.C. 4123.651(C). I’ve posted about this issue in the past: Yes, Your Claim Can Be Suspended for Failing to Undergo a Psychological Test.
Is the injured worker required to submit any particular type of medical release?
The statute references a form prepared by the Ohio Bureau of Workers’ Compensation. That form is the C-101 medical release. In practice, however, many providers are rejecting the BWC’s medical release form on the grounds that it is not compliant with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). According to the U.S. Department of Health and Human Services website, the core elements of a valid authorization under HIPAA include:
- A meaningful description of the information to be disclosed;
- The name of the individual or the name of the person authorized to make the requested disclosure;
- The name or other identification of the recipient of the information;
- A description of each purpose of the disclosure;
- An expiration date or an expiration event that relates to the individual;
- A signature of the individual or their personal representative (someone authorized to make health care decisions on behalf of the individual) and the date.
For more about the elements necessary to make a release HIPPA compliant, see this link to the HHS website.
The Ohio Department of Medicaid also prepared a new release form which effective February 3, 2019 all Ohio providers must honor. A copy of that standard authorization form can be found here. The release is not Medicaid specific, and pursuant to Ohio Administrative Code Section 5160-1-32.1 the standard authorization form “shall be accepted by any person or governmental entity in this state as a valid authorization for the use or disclosure of …. protected health information.” For more information, see Does Ohio’s New Standard Medical Release Form Apply to Workers’ Compensation Claims?
What can the medical release form cover?
Not all medical records, at least according to the 10th Appellate District. The Court addressed this question last week in State ex rel. Costco Wholesale Corp. v. Howard, 2019-Ohio-1460.
In Costco, the injured worker filed an application for permanent total disability compensation. The employer requested a suspension of the claim because the injured worker refused to provide a medical release permitting disclosure of all medical records from any physician.
The Industrial Commission refused to require the injured worker to provide an unrestricted medical release. Instead, the injured worker was directed to provide a C-101 Medical Release and a release for a specific hospital group. The releases were limited to treatment for the conditions allowed in the claim for a limited time period. The employer disagreed, and filed a writ of mandamus to have the claim suspended.
The 10th Appellate District refused to order the Industrial Commission to suspend the claim. As the Court put it:
“there is no Ohio case, statute, or rule that required claimant to sign the unrestrictive release…. [T]he records required to be released in a particular case are fact dependent, not lending itself to blanket rules….. The SHO resolved that Costco’s request for all medical records was over broad and unsupported by Ohio law. This resolution of the issue was reasonable and not inconsistent with any case, statute, or rule governing discovery relating to a PTD compensation application.”
What’s the takeaway for employers?
Going forward, employers need to be clear in drafting their medical release form. Make sure that the form is specific to records for treatment to the body parts at issue in the claim, or any conditions that might be pertinent to the requested conditions. The 10th Appellate District did find that the Industrial Commission “may, based on a reasonably limited information request, exercise its discretion and decide that a release of records relating to particular non-allowed conditions is appropriate.” However, based upon the Court’s language, it seems like a request for an unrestricted medical release is no longer going to fly, so to speak.
Another employer tip, check out Jon Hyman’s Ohio Employer Law Blog. Jon gives great daily posts about a whole host of legal issues relevant to Ohio employers, and his blog was the inspiration for me to start mine. His weekly roundup always includes a number of articles on a variety of topics, and last week he was kind enough to include one of my posts.