AND INFORMATION REQUESTS
149.43, 1347.12, 1347.15, 2317.02, 3701.243, 4123.27, 4123.88, 4732.19.
4123-15-03, 4123-16-01, 4123-16-08.
Insurance Portability and Accountability Act (HIPAA) of 1996 (specifically 45
Resources and Legal memos that relate to confidentiality, information requests
Chief of Operational Policy, Analytics and Compliance (Signature on file)
Rev. 09/17/14; 12/12/14
The purpose of
this policy is to ensure BWC protects the information of injured workers and
employers that is legally defined as confidential and not public record.
BWC only discloses information to an entity legally entitled to receive
applies to BWC Field Operations.
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. This includes, but is not
limited to, medical information, Insurance Services Office (ISO) reports or
information regarding whether the person has a workers’ compensation claim.
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, results of
clinical tests and summaries of the following items: diagnosis, functional
status, the treatment plan, symptoms, prognosis and progress to date.
Party to the
injured worker, employer, injured worker authorized representative or employer authorized
Peace 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).
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.
Public: for purposes of this
policy, any person not a party to the claim, including a spouse or relative to
the injured worker.
Public 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,
received 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.
Redact: to obscure or remove
(text) from a document prior to publication or release.
1. It is the policy of BWC to
ensure staff complies with applicable state and federal statutes, rules, policies
and directives related to accessing and releasing confidential information.
2. Confidential information that
is not public record is not releasable to a requester without first determining
that the person or entity requesting the information is legally authorized to
receive the information.
3. Confidential information
contained within a larger document that is releasable shall be redacted when it
is subject to a public record request.
4. 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.
Managed 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 BWC.
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 BWC.
b. Information determined to be
confidential pursuant to this policy shall not be:
Viewed in the claim;
Released to anyone,
including the parties to the claim.
5. It is the policy of BWC to
require staff to comply with the applicable BWC Human Resource policies and
procedures on confidentiality, information requests and sensitive data.
In addition, BWC shall maintain confidentiality regarding:
a. Psychiatric information if
the psychiatric condition is not allowed or not being requested in the claim.
b. BWC shall redact references
to psychiatric condition(s) if the condition(s) is not allowed in the claim and
shall house the original unredacted document(s) in the “CONFIDENTIAL” folder.
c. Psychiatric information in
the following situations, even if the psychiatric condition is allowed or being
requested in the claim:
When a physician,
psychiatrist or psychologist determines that psychiatric information is
detrimental to the injured worker, BWC shall not release information to the injured
worker. BWC may release the information to a physician, psychiatrist or
psychologist who is designated by the injured worker or by his/her legal guardian.
a) Neither Ohio law nor rule
defines mental health notes; however, the Health Insurance Portability and
Accountability Act (HIPAA) created standards when dealing with the privacy of
health information, which helps to prevent the improper use of one’s medical record.
b) BWC policy shall reference
mental health notes as psychotherapy or non-psychotherapy.
c) Psychotherapy notes remain
confidential, and HIPAA requires a separate specific release for psychotherapy notes.
d) Psychotherapy notes are not:
Viewable in the
Releasable to anyone,
including a party to the claim.
iii) Exception: if a party
to the claim submits psychotherapy notes that were directly obtained from the
treating physician pursuant to a signed release from the injured worker, in support
of (or in opposition to) a motion, then the psychotherapy notes may be viewable.
d. Human immunodeficiency virus
(HIV)/Acquired immune deficiency syndrome (AIDS);
Medical records that
contain information regarding HIV/AIDS testing/conditions that are not allowed
in a claim and have not been requested to be allowed are confidential.
BWC shall redact
references to HIV/AIDS if the condition(s) is not allowed in the claim and shall
house the original unredacted document(s) in the “CONFIDENTIAL” folder.
iii. BWC shall redact references
to HIV/AIDS in copies of documents released in response to public record
e. Occupations statutorily not
subject to release
BWC shall not release
the residential and familial information of:
a) peace officers as defined in
b) Peace 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 (BCCI) as defined in R.C. 149.43 (A)(1)(p).
BWC shall not release
to anyone, other than a party to the claim or a provider attached to the claim,
any information that discloses any of the following in respect to an injured
worker whose occupation is statutorily not subject to release identified in
section IV.A.5.d.i. without a specific release for this information:
a) Address, except for the state
or political subdivision;
b) Information pertaining to
referral or participation in an employee assistance program;
c) Telephone number (including
emergency phone number);
d) Social security number;
e) Financial or credit
employment benefits (from any source);
g) The identity and amount of
any charitable or employment benefit deduction by the employer from the
employee’s compensation (unless the amount of the deduction is required by state
or federal law);
h) Name of family members;
iii. BWC shall not release to
anyone, other than a party to the claim or a provider attached to the claim, the
following information in respect to the spouse, former spouse, or the child
of an injured worker whose occupation is statutorily not subject to release
identified in section IV.A.5.d.i. without a specific release for this
b) Telephone number (including
emergency phone number);
c) Social security number;
d) Employment information;
e) Financial or credit
iv. BWC shall not release
information pertaining to the injured worker’s spouse, former spouse and
children if an injured worker dies and his/her occupation is statutorily not
subject to release identified in section IV.A.5.c.i.
v. If an injured worker is
identified in a claim whose occupation is statutorily not subject to release
identified in section IV.A.5.d.i. and the injured worker has any other
claims, BWC must protect information regarding the injured worker, spouse, former
spouse, and children of the injured worker in all of the injured
B. Information requests for
1. It is the policy of BWC that
a member of the public, including a person listed as designee on
www.bwc.ohio.gov, shall not review claim information without signed written
consent from a party to the claim.
a. If a person has a signed
consent from a party to the claim, the person is entitled to obtain or review
information in a claim.
b. If a person does not have a
signed consent from a party to the claim, the person is not entitled to any
information in a claim, including whether or not a claim exists.
c. 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.
d. Exception: if the
injured worker is unable to communicate, BWC may talk with a family member without
2. When a party to the claim
requests information, BWC shall verify the individual is a party to the claim.
Validation includes three or more of the following:
a. Claim number;
b. Date of injury;
c. Authorized representative’s
identification number (if appropriate);
d. Employer’s Federal Tax
Identification number (if appropriate);
e. Injured Worker’s
Date of birth; and
iii. Last four digits of social
3. BWC Human Resources has
specific policies and procedures for staff regarding public records, journalists
and bloggers requests.
4. BWC shall make a claim
available for inspection at a time during regular business hours.
5. BWC shall only honor
authorizations executed within a year of the request for information.
6. It is the policy of BWC to
require staff to comply with the agency public records policy.
7. If an injured worker has
multiple claims, BWC may share information amongst those claims if those claims
may have an impact on the claim at issue.
8. BWC, during the investigation
of a claim, may request information that is necessary to the processing of 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.
BWC staff may refer to the
corresponding procedure for this policy entitled “Procedure for CLAIM CONFIDENTIALITY
AND INFORMATION REQUESTS” for further guidance.