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OhioBWC - Basics: (Policy library) - File

Policy Name:

CLAIM CONFIDENTIALITY AND INFORMATION REQUESTS

Policy #:

CP-03-03

Code/Rule Reference:

R.C. 109.71, 149.43, 1347.12, 1347.15, 2317.02, 3701.243, 4123.27, 4123.88, 4732.19.

O.A.C. 4123-3-22, 4123-15-03, 4123-16-01, 4123-16-08.

Other Resources:

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.

Effective Date:

12/12/14

Approved:

Rick Percy, Chief of Operational Policy, Analytics and Compliance (Signature on file)

Origin:

Claims Policy (CP)

Supersedes:

09/17/14; 07/30/14

History:

New 07/30/14; Rev. 09/17/14; 12/12/14

 

 

I. POLICY PURPOSE

 

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 it.

 

II. APPLICABILITY

 

This policy applies to BWC Field Operations.

 

III. DEFINITIONS

 

Confidential 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.  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.

 

Non-psychotherapy 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, 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 claim:  injured worker, employer, injured worker authorized representative or employer authorized representative.

 

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).

 

Psychotherapy 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.

 

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.

 

 

 

IV. POLICY

A.    Confidentiality

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.

i.      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.

ii.     Providers 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.

b.    Information determined to be confidential pursuant to this policy shall not be:

i.      Viewed in the claim; or

ii.     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:

i.      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.

ii.     Psychotherapy notes

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:

i)      Viewable in the claim; or

ii)     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);

i.      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.

ii.     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 requests.

e.    Occupations statutorily not subject to release

i.      BWC shall not release the residential and familial information of:

a)    peace officers as defined in R.C. 109.71;

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).

ii.     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 information;

f)     Beneficiaries of 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;

i)      Medical information.

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 information:

a)    Address;

b)    Telephone number (including emergency phone number);

c)    Social security number;

d)    Employment information;

e)    Financial or credit information.

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 worker’s claims.

 

B.    Information requests for claim documents

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 an authorization/release.

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

i.      Current address; and

ii.     Date of birth; and

iii.    Last four digits of social security number.

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.


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