Workers' Compensation Newsletter

Physician's Report for Worker Illness and Injury

Many states have laws that require health care providers to complete numerous forms in order to document treatment provided to patients and their subsequent progress. In Workers’ Compensation law, physicians are often required to complete such reports to assist government claims administrators in determining the eligibility and extent of available benefits. Many states require the primary treating physician to complete an “Attending Physician’s Report” (APR), sometimes called the “treating” physician’s report, to satisfy such requirements. In addition, the federal government requires physicians who treat federal employees to complete such forms. Generally, before an employee may begin to receive disability benefits, the APR must be completed and filed with the appropriate government office.

Determinations of an Attending Physician

Completed reports reveal the treating health care provider’s opinions regarding the injury. Such information is often helpful to determine if the injury is truly work-related and may provide insight to employers on how to place employees in a more accommodating work environment. While APR requirements vary among states, they generally include the following information:

  • Description of the illness or injury
  • Evidence of a preexisting condition similar to the claimed ailment
  • Physical limitations
  • Recommendations regarding the employee’s work availability

The completion of such reports also serves to limit fraud by certifying that such information is accurate and that the physician understands that any deliberate misrepresentation or concealment of important facts may subject the physician to criminal penalties.

Medical Confidentiality

Since medical records are confidential, physicians may generally not disclose such information without the patient’s consent. However, under certain circumstances, in Workers’ Compensation law, physicians may disclose otherwise confidential information. In 2002, the American College of Occupational and Environmental Medicine (ACOEM), an organization of over 6000 health care providers devoted to specializing in occupational and environmental medicine, issued a consensus opinion statement that listed some of these exceptions.

The ACOEM notes that as a general rule, physicians should not disclose patient information to employers absent the patient’s express authorization, preferably in writing. In addition, physicians should tailor the report to the ultimate reader. For instance, for reports that will be given to employers, physicians are generally permitted to address the employee’s ability to work. However, for reports that will be submitted directly to an insurance claims administrator, physicians may generally provide “diagnostic and treatment information reasonably necessary to adjudicate the claim.” In this instance, however, the physician should obtain a release from the patient.

The ACOEM also noted that most states allow for a “partial waiver” regarding the protection of medical information. However, state laws differ, and in some instances, the provisions of the federal Health Insurance Portability and Accountability Act (HIPAA) may preempt such laws. For instance, under HIPAA, in Workers’ Compensation law, “covered entities” may disclose confidential medical information in order to comply with Workers’ Compensation laws and other programs that provide benefits for injuries or illnesses considered work related.

When Confidentiality Conflicts With the Law

Other confidentiality issues that all health care providers must consider include issues that may pit the physician’s obligation to maintain confidences against facing criminal penalties. Among other circumstances, HIPAA lists 12 instances, considered public interest and benefit activities, that allow the use or disclosure of protected health information without the patient’s authorization or permission. The common underlying policy behind allowing the 12 types of disclosures is that in each instance, the importance of allowing disclosure is independent of the health care context. Notable instances include the following:

  • Victims of abuse, neglect or domestic violence: This category includes disclosure to government authorities in connection with such illegal activities.
  • Law enforcement purposes: As defined by HIPAA, including, but not limited to, where such medical information constitutes evidence of a crime or is required by law (such as a court order or subpoena.)
  • Serious threat to health or safety: Where disclosure is made to prevent or lessen a serious and imminent threat of harm to a person or the public, when such disclosure is made to a person or entity able to prevent or lessen the threat, including the intended target or law enforcement.
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