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Office of Workers' Compensation Programs

Division of Coal Mine Workers' Compensation (DCMWC)

Notice to health care providers concerning disclosure of health care information to DOL/Division of Coal Mine Workers' Compensation

Regulations in effect governing the disclosure of health care information under the Health Insurance Portability and Accountability Act (HIPAA) do not restrict disclosure of health care information necessary for the administration and/or adjudication of a claim for workers' compensation benefits to a workers’ compensation administrative agency such as the Department of Labor’s Office of Workers’ Compensation Programs. 

The regulations provide, in regard to workers' compensation, that:

(l) Standard:  Disclosures for workers' compensation.  A covered entity may disclose protected health information as authorized by and to the extent necessary to comply with laws relating to workers' compensation or other similar programs, established by law, that provide benefits for work related injuries or illness without regard to fault. (45 CFR § 164.512(l)).

The Department of Health and Human Services, in issuing this regulation, explained that:

Under this provision, a covered entity may disclose protected health information regarding an individual to a party responsible for payment of workers' compensation benefits to the individual, and to an agency responsible for administering and/or adjudicating the individual's claim for workers' compensation benefits.  For purposes of this paragraph, workers' compensation benefits include benefits under programs such as the Black Lung Benefits Act, the Federal Employees’ Compensation Act, the Longshore and Harbor Workers’ Compensation Act, and the Energy Employees’ Occupational Illness Compensation Program Act.  (65 FR 82542 (Dec. 28, 2000)).

Although OWCP is not covered by the HIPAA regulations (because it is neither a health care provider nor a "covered entity" within the definitions of the rule), OWCP is committed to preserving the privacy of claimants’ medical information, as required by the Privacy Act.  Under that statute privacy protected information disclosures are strictly limited, and violations of the Act are punishable by criminal penalties.  OWCP may disclose health care or other information contained in a system of records maintained under unique individual identifiers, such as OWCP case files, only upon either the written authorization of the claimant, a court order, or a properly promulgated routine use.  Only authorized federal employees or contractors have access to medical records information.  In addition, all OWCP contractors with access to such information have written contract provisions that require them to comply with the Privacy Act.  Therefore, OWCP only discloses sensitive health care information to those permitted to receive such information under the Privacy Act, and only for purposes directly related to the mission of the agency.