Florida's workers' compensation system is designed to provide injured workers with benefits that cover medical expenses and lost wages due to work-related injuries. However, the insurance company typically has the authority to select the medical doctors that will provide treatment for your work injuries and insurance company representatives can speak to the medical provider regarding the injured worker’s diagnosis and plan for care. The insurance company can also investigate your medical history to determine whether a pre-existing condition is contributing to the need for medical care. This often presents the dilemma between permissible access to an injured workers' medical records and the worker’s right to privacy concerning his health.

As both employers and insurance companies often require access to these records, it's crucial to explore the balance between facilitating necessary treatment and protecting sensitive medical information. Under Florida law, the injured worker's medical records become a critical element in determining eligibility for benefits. Employers, their insurance carriers, and sometimes third-party administrators require access to these records to verify the extent of an injury and to monitor the treatment process. Their ability to get access to the injured workers medical information can certainly encroach upon an individual's right to privacy.

Legal Authority to Access Medical Information

The Health Insurance Portability and Accountability Act (HIPAA) establishes national standards for the protection of health information. Under HIPAA, medical providers can share relevant medical information with workers' compensation insurers without violating privacy regulations. However, the breadth of what is considered "relevant" can lead to disputes.

The Florida legislature has also given workers compensation insurance carriers and employers statutory authority to access a worker’s medical file. F.S. 440.13(4)(c) states the following:

It is the policy for the administration of the workers’ compensation system that there shall be reasonable access to medical information by all parties to facilitate the self-executing features of the law. An employee who reports an injury or illness alleged to be work-related waives any physician-patient privilege with respect to any condition or complaint reasonably related to the condition for which the employee claims compensation. Notwithstanding the limitations in s.456.057 and subject to the limitations in s. 381.004, upon the request of the employer, the carrier, an authorized qualified rehabilitation provider, or the attorney for the employer or carrier, the medical records, reports, and information of an injured employee relevant to the particular injury or illness for which compensation is sought must be furnished to those persons and the medical condition of the injured employee must be discussed with those persons, if the records and the discussions are restricted to conditions relating to the workplace injury. Release of medical information by the health care provider or other physician does not require the authorization of the injured employee. If medical records, reports, and information of an injured employee are sought from health care providers who are not subject to the jurisdiction of the state, the injured employee shall sign an authorization allowing for the employer or carrier to obtain the medical records, reports, or information. Any such discussions or release of information may be held before or after the filing of a claim or petition for benefits without the knowledge, consent, or presence of any other party or his or her agent or representative. A health care provider who willfully refuses to provide medical records or to discuss the medical condition of the injured employee, after a reasonable request is made for such information pursuant to this subsection, shall be subject by the department to one or more of the penalties set forth in paragraph (8)(b). The department may adopt rules to carry out this subsection.

Ex Parte Communications Regarding Your Medical Records

F.S. 440.13(4)(c) allows carriers, employers, and defense attorneys free contact with physicians regarding an injured worker—conveying the right hold ex parte communications with physicians and effectively reverses prior case law prohibiting such contact. Ex parte communication is a term used to describe one of these other persons speaking or corresponding with the doctor about the treatment of the injured worker without the injured worker’s knowledge. Claimants no longer have the right to be present during discussions between employers and carriers and their doctor.

Protect Your Privacy

Florida's workers' compensation system is a crucial safety net for injured workers, ensuring they receive necessary medical care and financial support. However, the intersection of medical records access and privacy presents significant challenges. It is essential to strike a balance that allows for the necessary flow of information while safeguarding the privacy rights of workers.

Doctor-patient confidentiality is one of the core concepts of a doctor-patient relationship. It requires health care providers to keep a patient’s personal health information private unless consent to release the information is provided by the patient. One significant concern is that many injured workers may not fully understand what they are consenting to. The potential for misuse of medical information is a significant concern in the context of workers' compensation. Injured workers may feel that their privacy is compromised, particularly when sensitive health details are shared without their explicit consent. For example, if an employer gains access to medical records that include mental health issues or previous injuries, they may make biased decisions regarding the worker's employment status or future job opportunities.

Given the concerns surrounding privacy, it is essential to advocate for stronger protections for injured workers. As Florida continues to refine its workers' compensation laws, prioritizing the privacy of injured workers should be at the forefront of reform efforts. By implementing better practices for informed consent, enhancing training, tightening regulations, and providing legal protections, the state can help protect the sensitive medical information of its workers while ensuring that they receive the benefits they deserve.

​​​​​​​If you have been injured in a work accident, you can contact your workers compensation attorneys, Juan Lucas Alvarez, P.A. for a free consultation wherein we will answer any questions you may have regarding your work injury claim including ways to protect release of your private medical information concerning medical diagnoses, and treatment that may be irrelevant to the work accident.