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Worker's Compensation Claims Process Essay

862 words - 4 pages

Worker's Compensation Claims Process
“In order for an injury to be covered under a workers’ compensation plan it must be in result in personal injury or death, occur by accident, arise out of employment, and/or occur during the course of employment. Workers’ compensation insurance pays an employee’s medical bills that result from a job-related injury; disability compensation programs do not pay medical expenses. Workers’ compensation insurance provides coverage for illnesses and injuries that are job-related. Most disability compensation programs provide benefits for injuries or illnesses that are not work-related.” (Valerius, J., Bayes, N., Newby, C., & Seggern, J. (2008). Medical ...view middle of the document...

The employee will receive worker’s compensation for lost wages, unless the claim denied the employee must pay all medical bills and will be submitted to his/her individual insurance carrier.
“Workers’ compensation cases are one of the few situations in which a health care provider may disclose a patient’s protected health information (PHI) to an employer without the patient’s authorization. Workers’ compensation claim information is not subject to the same confidentiality rules as other medical records. The HIPAA Privacy Rule permits disclosures of PHI for workers’ compensation purposes without the patient’s authorization.” (Valerius, J., Bayes, N., Newby, C., & Seggern, J. (2008). Medical insurance: An integrated claims process approach (3rd ed.). Boston, MA: McGraw-Hill) Under the Privacy Rule individuals do not have the right to request that a physician restrict a disclosure of their PHI for workers’ compensation purposes when the disclosure is required by law or authorized by, and necessary to comply with, a workers’ compensation or similar law. “The federal Health Insurance Portability and Accountability Act (HIPAA) sets a national standard for privacy of health information. It was implemented in 2003, but HIPAA only applies to medical records maintained by health care providers, health plans, and health clearinghouses – and only if the facility maintains and transmits records in electronic form.” (www.privacyrights.org) Medical information may be shared with people in the health care industry to people who are not in the medical industry. “In order for someone to have access to your medical records you must agree to let them see, but in some cases you do not have the choice to consent to obtain care or qualify...

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