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There Is No Workers’ Comp Without Medical Records

June 15, 2017 | 3 min read

There is nothing more critical to a workers’ compensation claim than the medical records of the injured employee. It not only provides proof that an injury took place, but it details the scope of the injury and explores the recommended treatment for the injury. Quite simply, without the injured employee’s medical records, there is no workers’ comp claim.

As such, Colorado’s workers’ compensation law states that “filing a claim for workers’ compensation is deemed to be a limited waiver of the doctor-patient privilege to persons who are necessary to resolve the case.” But that limited waiver is also restricted to the injury at the heart of the workers’ comp claim.

Medical Reports vs. Medical Records

Despite the fact that “report” and “record” are often used interchangeably when referring to workers’ compensation claims, Colorado law makes a distinction between the two.

“A medical report is a medical record, but a medical record is not necessarily a medical report,” according to the Colorado Department of Labor and Employment. “A medical report is generated either after examination of the claimant or based on a document review. A medical report in the workers’ compensation context refers to information regarding the work-related injury or disease at issue. Medical record is a broader term, and can include information not directly related to the injury or disease at issue.”

Conditions of Medical Releases

As a workers’ compensation claim makes its way through the state’s claims process, the injured employee’s medical provider is required to release the results of any examination related to the injury to the insurance company or the employer, if they are self-insured. The extent of that examination and any reports it generates often goes beyond the specific injury and may include otherwise protected health information, such as medical history, prior injuries or disabilities. By Colorado law, any information not related to the workplace injury should not be shared with any other party involved in the claim, such as the employer.

That does not stop insurance carriers from badgering injured employees to sign medical release forms. Injured workers are obligated to provide medical records going back five years, but carriers often attempt to secure records as far back as 10 years, trawling for previous treatments or conditions. Too often, injured workers are unaware of their rights, and are taken advantage of by insurance companies who know the law much better than they do.

As Burg Simpson workers’ comp attorney John M. Connell explains, it happens all the time.

“Often the releases don’t have anything to do with the injury they have. As an example, the claimant may have a shoulder injury and they’ll send you releases wanting to know about the leg injury you had three years ago,” John explains. “Really what they’re fishing for is to see if there are any reports that show you treated that shoulder that got injured.”

John adds that insurance companies frequently ask for more medical information than they’re entitled to. It’s just another reason why injured employees should not pursue complex workers’ compensation claim on their own. If you’ve been hurt while on the job, call a Colorado workers’ comp attorney at Burg Simpson at 303-792-5595 or take a moment to fill out our easy case evaluation form to speak with us for FREE before you sign anything.