In New Jersey, if a worker is injured in a work-related accident or incident, the…
Workers Compensation Monmouth County
Do claimants in workers’ compensation cases have a right to request their treating medical records from the insurance carrier, third party administrator, or the authorized treating physician to whom they are assigned for treatment?. The answer to this question comes from both the New Jersey Workers’ Compensation Act and from the rules of the New Jersey Medical Society.
N.J.S.A. 34:15-128.4 provides that it is unlawful for an employer, the carrier or the treating physician, or a third party in the case or their agents “to withhold from the individual any medical information they have regarding that individual which is requested by the individual, and if an individual requests the medical information, the individual shall not be charged fees in excess of the cost of providing copies of the information.” In other words, a claimant has a right to medical information from any party to a workers’ compensation case. That includes the treating medical provider.
Authorized workers’ compensation physicians owe the same obligation to a treating claimant as they would to a private patient. The mere fact that the employer has designated the treating doctor and pays for the care in no way changes the doctor-patient relationship in a workers’ compensation case.
The rules of the New Jersey Medical Society are similar. Under N.J.A.C. 13:35-6.5, the treating medical provider must provide patient records no later than 30 days from the receipt of a request from the patient or an authorized representative. The records must include objective data such as test results and x-ray results. The rules go on to say that when a patient has requested the release of medical records to a specified individual or entity, the physician shall secure a written medical authorization to protect the privacy interests of the patient.
The Board of Medical Examiners also provides that the cost of reproducing such records shall not be greater than $1.00 per page or $100 for the entire records, whichever is less. If the records are less than 10 pages, the medical provider may charge $10 to cover postage and associated costs related to the retrieval of such records. Medical providers shall not charge for a copy of the patient’s records when the physician has effectively terminated a patient from practice in accordance with the requirements of N.J.A.C. 13:35-6.22.
It is important to understand the difference between a treating physician and a medical examiner retained by the workers compensation carrier or employer to provide an evaluation of the claimant. Because there is no physician-patient relationship in a situation involving such a medical examination, a physician who is performing the examination does not have to provide a copy of such a report to the person being examined. That report is sent to the party which requested it, usually the insurance carrier, third party administrator or counsel.
The rule regarding disclosure of treating medical records between counsel is contained in N.J.A.C. 12:235-3.8 (c), which states that either party must furnish medical information to the other within 30 days of the receipt of a demand for such records. Usually the employer or its insurance carrier/third party administrator has the treating records, and in that case those records must be made available to petitioner’s counsel or petitioner on request. If the claimant has obtained treatment on his or her own, then the same obligation rests on claimant to provide such records to the employer on request. If a party is not responding timely to a request for medical information in a litigated case, the appropriate step is to file a motion in the Division of Workers’ Compensation.