Policy and Procedure Name:
and Information Requests
R.C. 109.71, 149.43, 1347.12,
4123-15-03, 4123-16-01, 4123-16-08.
The Health Insurance Portability and Accountability Act
(HIPAA) of 1996 (specifically 45 CFR 164.501).
BWC Human Resources and Legal memos that relate to
confidentiality, information requests and subpoenas.
Ann M. Shannon, Chief of Claims Policy & Support
Policy CP-03-03, effective 05/16/19 and Procedure CP-03-03.PR1 effective 05/16/19
Previous versions of this policy are available upon
Table of Contents
I. POLICY PURPOSE
Party to the claim
A. Claim Confidentiality
and Information Requests: General Policy
B. Information Requests
for Claim Documents
C. Claim Confidentiality
Regarding Certain Psychological or Psyciatric Conditions and Human
Immunodeficiency Virus (HIV) or Acquired Immune Deficiency Syndrome (AIDS)
D. Occupations Statutorily
Not Subject to Release
A. General Claim Note
B. Information Requests
E. Imaging Psychiatric
The purpose of this policy is to ensure that
BWC protects confidential injured worker (IW) and employer information, and
properly handles the accessing and release of confidential information and that
which is public record.
This policy applies to BWC claims services staff.
Information: Legally protected information relating to data, such as
any injured worker data that contains a name or any other identifier and which
describes anything about, done by or done to a person.
notes: For purposes of this policy and as defined by HIPAA, this is
the information HIPAA excludes from psychotherapy notes. It includes
information about medication prescription and monitoring, counseling session
start and stop times, the modalities and frequencies of treatment furnished,
result of clinical tests and summaries of the following items: diagnosis,
functional status, the treatment plan, symptoms, prognosis and progress to
Party to the claim:
Injured worker, employer, injured worker authorized representative or employer
Officer: For purposes of this policy, an individual legally vested
with enforcement rights who generally works for a city, county or state public
employer and can be either “traditional” (e.g., police officer) or
“non-traditional” (e.g., certain park rangers, tax agents or liquor agents).
notes: For purposes of this policy and as defined by HIPAA, these
are notes recorded (in any medium) by a health care provider who is a mental
health professional documenting or analyzing the contents of conversation
during a private counseling session or a group, joint or family counseling
session and that are separated from the rest of the individual’s medical
record. HIPAA has created standards that strictly limit access to psychotherapy
notes so as to prevent the improper use of a person’s medical records.
For purposes of this policy, any person not a party to the claim, including a
spouse or relative of the injured worker.
Record: Any document, device, or item, regardless of its physical or
electronic form or characteristic (i.e., paper, documents, photocopies, maps,
drawings, photographs, email, computer disks, audio, and video tape recordings)
that is created by a public office or coming under the jurisdiction of a public
office. A public record serves to document the organization, functions,
policies, decisions, procedures, operations, or other activities of the office
and is kept by the public office. The law provides many exceptions that exempt
certain types of records from public disclosure.
To obscure or remove (text) from a document prior to publication or release.
1. It is the
policy of BWC to require staff to comply with the applicable BWC Human
Resources policies and procedures on:
requests (including public record, journalist, and blogger requests); and
a. It is the
policy of BWC to treat claim information as confidential and not as a public
b. It is the
policy of BWC to release claim information only to a requester who is legally
authorized to receive it.
3. It is the
policy of BWC that:
a. A party to the claim may see all information in
the claim, unless otherwise specified in this policy.
services staff shall not require consent to release information for
interpreters with whom the IW has agreed to use.
Care Organizations (MCOs) associated with the claim may receive information in
the claim and are bound to preserve the confidentiality of the information and
comply with BWC’s sensitive data transmission policies when communicating with
associated with the claim may receive information in the claim and are bound to
preserve the confidentiality of the information and comply with BWC’s sensitive
data transmission policy when communicating with BWC.
4. If an IW
has other claims that have an impact on the claim in question, BWC may share
information between those claims.
5. During the
investigation of a claim, BWC may request information that is necessary for
processing the claim or contact a non-party to the claim for additional
information. BWC shall use discretion and sound judgment in discussing claim
issues, so as not to disclose confidential information.
1. BWC shall
make a claim available for inspection at a time during regular business hours.
to Release Claim Information
a. BWC will
not release an IW’s claim information unless the IW (or their legal guardian,
authorized representative, or executor, if applicable) submits a Consent to
Release Information (C-72) form or a written request containing
equivalent information. The C-72:
communicate information about the IW’s claim to the specific person named on
the C-72; or
documentation regarding the IW’s claim to the specific person/organization
named on the C-72.
valid for up to one year (or an earlier date identified by the IW on the C-72);
iii. Can be
revoked at any time at the written request of the IW.
b. No member
of the public, including a person listed as a designee
in the claim, is entitled to obtain or review claim information
(including whether or not a claim exists), without a signed C-72, with the
following exceptions: If a non-party to the claim has a durable power of
attorney (POA) or proof of guardianship granted by the courts, a copy is
required to be on file prior to disclosing any information. Refer to Custody,
Guardianship, Power of Attorney and Incapacitation policy and
procedures for more information.
a. If the IW
is unable to communicate when the claim is initially filed, BWC may speak
with a family member without an authorization/release on a temporary basis.
limited telephone conversations, BWC may accept verbal authorization from the
IW to speak to another person during the same telephone conversation regarding
their claim information. However, if the IW intends for the permission to be
ongoing, the IW must submit a C-72.
1. BWC shall either
redact or place the following information into the claim file where it is not
viewable by the parties:
information if the psychiatric condition is not allowed or not being requested
in the claim.
information in the following situations, even if the psychiatric condition is
allowed or being requested in the claim:
a physician, psychiatrist or psychologist determines that psychiatric
information is detrimental to the IW, BWC shall not release information to the IW.
BWC may release the information to a physician, psychiatrist or psychologist
who is designated by the IW or by their legal guardian.
records that contain information regarding an IW’s HIV or AIDS status or
testing when the condition has not been requested for allowance in the claim.
2. Psychotherapy notes
d. It is the
policy of BWC that psychotherapy notes shall not be released to the parties to
the claim without a HIPAA compliant release.
e. It is the
policy of BWC that psychotherapy notes shall not be viewable in the claim,
unless a party to the claim submits psychotherapy notes obtained from the
treating physician pursuant to a signed release from the IW, and in support of,
or in opposition to, a motion.
3. When claim
information as described above is submitted to the claim and redaction is
impractical, it is the policy of BWC to change the document type to “CONFID”.
This document type is only viewable internally and is accessed by clicking on
the “CONFID” tab.
D. Occupations Statutorily
Not Subject to Release
1. BWC shall
not release the residential and familial information of:
officers as defined in R.C. 109.71;
officers, parole officers, probation officers, bailiffs, prosecuting attorneys,
assistant prosecuting attorneys, correctional employees, community-based
correctional facility employees, youth services employees, firefighters,
emergency medical technicians (EMT), or investigators of the Bureau of Criminal
Identification and Investigation (BCI) as defined in R.C. 149.43(A)(1)(p).
2. When an
IW’s occupation is one of those described above:
a. BWC shall
not release any of the following information about the IW:
except for the state or political subdivision;
pertaining to referral or participation in an employee assistance program;
number (including emergency phone number);
iv. Social security
or credit information;
vi. Beneficiaries of
employment benefits (from and source);
vii. The identity and
amount of any charitable or employment benefit deduction by the employer from
the employee’s compensation (unless the amount is required by state or federal
viii. Names of family members; or
b. BWC shall
also not release any of the following information about the IW’s spouse, former
spouse, or any of the IW’s children:
number (including emergency phone number);
or credit information.
The information described above may be released:
a party to the claim or provider attached to the claim; or
an IW’s written consent specifically granting BWC permission to do so.
3. Upon the
death of an IW whose occupation is one of those described above, BWC shall
continue to protect information pertaining to the IW’s spouse, former spouse,
4. When an
IW’s occupation is one of those described above, BWC shall protect information
regarding the IW, spouse, former spouse, and children in all of the IW’s
1. BWC staff
shall refer to the Standard
Claim File Documentation and Altered Documents policy and procedure for
claim note and documentation requirements; and
follow any other specific instructions for claim notes and documentation
included in this procedure.
services staff shall comply with all applicable BWC Human Resources policies
and procedures, including, but not limited to the following:
Record requests – staff shall refer to the BWC Human Resources Employee
Handbook Memo 4.33 Public Records Review Policy and Procedure.
or bloggers – staff shall refer to the BWC Human Resources Employee Handbook
Memo 4.15 Relations with News Media.
Requests from a party to the claim
services staff shall not release any information without the verification of
the identity of the individual requesting the information regardless of whether
the request is verbal or electronic (email).
the person is identified as a party to the claim, staff may share claim
information verbally, electronically/digitally, or by hard copy.
the person is not a party to the claim, refer to Section 3 below.
from a non-party to the claim
services staff shall not release any claim information (including whether or
not a claim exists) to anyone who is not a party to the claim (including an
individual listed in the claim as a designee) without the IW’s written or
temporary verbal consent.
b. Consent to
review or obtain information in a claim
an IW has a signed C-72 or equivalent, claims services staff shall release the
information to the requesting individual and update the consent in the claims
management system under the:
Listing, and enter;
iii) Current date;
iv) Expiration date
one year from the date of the consent.
ii. If a
C-72 or equivalent is submitted by an IW granting or revoking authorization to
speak to someone regarding the IW’s claim on the IW’s behalf, claims services
staff shall save the document in the document management system in all claims for
which the authorization has been granted.
telephone calls with the IW, if the IW gives BWC verbal consent to speak to
another person during that same call regarding their claim information, claims
services staff shall:
in claim notes the name of the person the IW has given permission to speak with
as well as their relationship to the IW; and
b) Inform the
IW that if they would like to give ongoing consent for BWC to release
information to another party, they must submit the consent to BWC in writing by
completing a C-72 or equivalent.
claims services staff is contacted by a family member or any other non-party to
the claim who has a durable Power of Attorney (POA), prior to releasing any
information, claims services staff shall:
a copy of the durable POA; and
with a BWC attorney regarding whether the durable POA entitles the requester to
questions arise regarding whether or not a medical record or documentation in
the claim may be released, claims services staff shall review these issues with
a BWC attorney. The BWC attorney may assist claims services staff in
determining whether a document is:
by a party to the claim;
b. Able to be
services staff shall not release to anyone, including parties to the claim,
claim information that is not releasable.
3. In the
event of an information request, claims services staff shall not release documents
placed in the “CONFIDENTIAL” file to anyone, including a party to the claim.
When someone requests a document , and there is a signed C-72 with
specific consent to release the information to the requester, no redactions are
2. When a
document subject to a records request is releaseable and it contains references
to a psychiatric condition or HIV/AIDS status not allowed in the claim, claims
services staff shall redact any information regarding these conditions, unless
a signed C-72 or equivalent specifically gives consent to release this
information to the requestor.
3. When a
document subject to a records request is releaseable and it contains claim
information for an IW whose occupation is statutorily not subject to release as
described in this policy, claims services staff shall redact all residential
and familial information unless a signed C-72 or equivalent specifically gives
consent to release this information to the requestor.
When claims services staff receives psychiatric information from the
provider, claims services staff shall review it to determine if it is:
notes related to a psychiatric condition allowed or requested in the claim.
These are generally viewable by the parties, and are pertinent medical
information for the management of the claim. Exception: If a provider
documents that a review of the information by the IW will be detrimental to the
IW, then the non-psychotherapy notes may not be viewable.
notes are generally not viewable by the parties in the claim, even if the
psychiatric condition is allowed in the claim.
If a party to the claim submits psychotherapy notes that were directly obtained
from the treating physician pursuant to a signed release from the IW, and in
support of (or in opposition to) a motion, then the psychotherapy notes may be
services staff shall save non-viewable psychiatric information such as
psychotherapy notes as well as non-psychotherapy notes deemed detrimental to
the IW in the Confidential folder of the claims
services staff shall contact the provider to clarify the nature of the
psychiatric information if there is doubt as to whether or not it constitutes
services staff shall contact the treating physician to determine how to handle
claims with psychiatric information deemed to be detrimental to the IW. The
treating physician is responsible for discussing reports with the IW as well as
informing them of the intent to provide the information to BWC.
documentation pertaining to a psychiatric condition not allowed and not
requested in a claim shouldn’t be viewable to the parties in the claim. This
information shall be redacted and left in the imaged documents, or if redaction
is impractical, placed in its entirety in the Confidential folder of the claims
management system. However, if at some point in the future the psychiatric
condition becomes allowed or is requested, the information may be removed from
the Confidential folder of the claims management system or the unredacted
version may be restored to the imaged documents of the claim.
4. Requesting mental health
services staff shall not request psychotherapy notes from the provider.
service staff may request non-psychotherapy notes needed to support periods of
disability or for the management of the claim. Claims services staff may use
the Mental Health Notes Summary
(MEDCO-16) form to request non-psychotherapy notes.