Must I sign an authorization to release medical records to the insurance company if I've suffered a work injury in Pennsylvania?

Under Pennsylvania law, injured workers have an obligation to help the insurance company investigate their claims, which means that you must provide the insurance company with medical records proving you are disabled due to a work injury. Although the Health Insurance Portability and Accountability Act (HIPAA) ordinarily protects the privacy of medical records, it does not apply to medical records sent to an insurance company regarding a work injury.

Because it is in your interest to ensure that the insurance company has medical proof that you suffered a disabling work-related injury, you need to do everything you can to get medical records supporting your claim to the insurance company as quickly as possible. This may mean that you are better off signing a medical records authorization.

You should, however, take a careful look at the authorization.  The authorization may give the insurer or the insurer's representative the right to speak directly with your medical providers.  This is not a wise idea.  The authorization may grant the insurance company the right to send a vocational nurse to your medical evaluations.  You should avoid signing a document that allows them to do so.  

The most common problem that we see in medical records authorizations issued by workers' compensation insurance companies in Pennsylvania is their wide scope. For example, many authorizations permit the insurance company to obtain copies of HIV/AIDS, drug and alcohol abuse, and psychological treatment records.

We always tell people not to authorize the insurance company to obtain such records.  If necessary, you should cross out the portions of the authorization that permit the recovery of such records, initialing the sections that you crossed off.  When your psychological condition is not at issue, requests to obtain copies of your psychological records are particularly reprehensible.  Any information contained in the records the insurance company obtains will be used against you.  The last thing you want to do is permit the insurance company to obtain records that document a sexual affair, alcoholism, drug use, history of psychological problems, or personal difficulties in your life.

On the other hand, you do not want to make the authorization too narrow.  If you do not care about the production of medical records, it makes little sense to get into a dispute with the insurance company over these records.  Furthermore, the insurance company is entitled to, at least some extent, determine whether you are disabled for reasons unrelated to the work injury. Finally, the insurance company is legally entitled to know about your past medical history as it pertains to the work injury that you suffered.

When signing a medical records authorization, use your common sense.

Greg Boles
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