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Obtain Medical Records To Support Workers Compensation Claims

Workers Compensation Claims

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Direct Billing For Medical Records Retrieval

Insurance carriers, Self-Insured’s and Municipalities often establish direct billing relationships with Ontellus and instruct their attorneys to utilize Ontellus for records retrieval.

Workers' compensation involves wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue their employer for the tort of negligence.

Plans differ among jurisdictions, provision can be made for weekly payments in place of wages (functioning in this case as a form of disability insurance), compensation for economic loss (past and future), reimbursement or payment of medical and like expenses (functioning in this case as a form of health insurance), and benefits payable to the dependents of workers killed during employment.

General damage for pain and suffering, and punitive damages for employer negligence, are generally not available in workers' compensation plans, and negligence is generally not an issue in the case. In most states, workers compensation claims are handled by administrative law judges, who often act as triers of fact. 

As in other personal injury claims, medical record review is an important part of workers’ compensation litigation. The work-related injury must be well-documented in the claimant’s medical records. It is of utmost importance that every time a claimant sees a doctor and the doctor knows that he/she is treating a work-related injury.

Once the treatment for the work-related injury is completed, an independent medical examiner (IME) will examine the claimant to determine whether there is any permanent partial disability due to the injury. The medical examiner examines and interviews the claimant and reviews the relevant medical records.

The disclosure of medical information can vary from state to state, and in some states do not allow medical release/authorization whereas in others do. The Privacy Rule for Workers’ Compensation is designed to provide the minimal necessary information needed to manage a claim. State laws allow for subpoenas to obtain full medical records when needed.

Ontellus’ longtime experience in states like California, following the Confidentially of Medical Information Act (CMIA) and deep knowledge of the nuances of the privacy rules and Worker’s Compensation Act’s within each state ensures that records are obtained legally and timely.  We track the rules of each Worker’s Compensation board and ensure that custodians abide by both the respective record release periods and copy costs set forth under the rules.