HIPAA and Disability

During our recent webinar for members of the American Psychological Association, someone asked “How does HIPAA apply if one becomes disabled, moves, or retires?” We thought that was a great question and knew at least one other person might be wondering the same thing.

In many instances, the answer depends upon the specifics of each situation. But we can clarify a few things, especially regarding HIPAA and disability, short- and long-term.

HIPAA and Disability – The Rules

If your healthcare provider files claims electronically with an insurance company, they must follow HIPAA Rules and Regulations. That means a doctor can share medical information about you with another healthcare provider for treatment purposes without your consent, or with your health insurance company for billing purposes without your consent.

However, if you are trying to purchase life insurance, disability insurance, or long-term care insurance as an individual, it’s a virtual certainty that you have signed a consent form that permits your doctor to send your PHI (protected health information) to that company. Signing the consent form waives your rights under HIPAA. Not signing the consent form means you wont get insurance.

FYI, it’s likely the information you authorize to be shared with the life insurance company will also be sent to a company like MIB, Inc. (formerly known as Medical Information Bureau) which is one of the largest underwriting organizations in the U.S.. They perform risk assessment services for many major insurers, and they keep those records for seven years. Remember that you consented to it when you applied for the individual policy.

Make Sure You’re HIPAA Compliant

Knowing when HIPAA does and does not apply is confusing.

We can help take the guesswork out of HIPAA!

HIPAA and Disability – The Exceptions

There is an entire class of insurance products that are specifically exempted from HIPAA. Often called secondary insurance, these plans include:

  • Coverage only for accident, or disability income insurance, or any combination thereof.
  • Coverage issued as a supplement to liability insurance.
  • Liability insurance, including general liability insurance and automobile liability insurance.
  • Workers’ compensation or similar insurance.
  • Automobile medical payment insurance.
  • Credit-only insurance.
  • Coverage for on-site medical clinics.
  • Other similar insurance coverage, specified in regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.

For example, if you break your leg while working, the cost of treatment generally does not come from your health insurance company. Instead, every state except Texas requires employers to have workers’ compensation coverage to provide for employees injured while performing assigned work duties.

Worker compensation insurers, administrative agencies, or employers can request your medical records as long as the law permits it without violating the HIPAA Privacy Rule.

HIPAA and Disability – Moving or Retiring

Moving or retiring should have no impact on the requirements to be HIPAA compliant. In fact, some states have their own version of HIPAA that demands a higher level of compliance than federal law.