Cost Containment Strategies for the Beginning of the Workers’ Compensation Claim: Medical Records/Medical Information (Part 6 of 10)

This segment in the Cost Containment Strategies Blog Series will focus on the third initial investigation cost containment strategy- tips for securing relevant Medical Records/Medical Information.

Medical Records/Medical Information

Pursuant to the June 26, 2011, North Carolina Workers’ Compensation Legislative Reform, defendants are entitled to have reasonable access to all relevant medical information.  N.C.G.S. § 97-25.6 addresses balancing the protection of the claimant’s right to a confidential physician-patient relationship, while allowing the parties to have reasonable access to all relevant medical information.

The key is “relevant medical information.” Relevant information includes medical records, reports and information necessary to the fair and swift administration and resolution of workers’ compensation claims, while limiting unnecessary communications with healthcare providers.  Relevant medical information includes the following:

• Diagnoses of claimant’s condition;
• Appropriate course of medical treatment;
• Anticipated time claimant will be out of work;
• Causal relationship between condition and employment;
• Work restrictions related to the condition;
• Kind of work for which the claimant may be eligible;
• Anticipated time claimant will be restricted;
• Permanent partial disability.

As a result, the employer and/or claims adjuster can write the authorized health care provider directly, with a simultaneous copy to the claimant or claimant’s attorney if he/she is represented, to inquire about relevant medical information without first securing approval from the claimant/claimant’s attorney.  The employer or adjuster may provide a copy of the job description for approval to the authorized treating physician.  The employer and/or claims adjuster does NOT need to secure permission or “pre-approval” of this correspondence from the claimant or claimant’s attorney.  The employer or claims adjuster must provide a simultaneous copy of the correspondence to the claimant/claimant’s attorney AND a copy of the health care provider’s response to the claimant within 10 business days of receipt.

Questions?  Please contact Jennifer directly at (919) 863-8846 or jjones@cshlaw.com.