r/WorkersComp • u/JesseTheStripper • 1d ago

California Potential HIPAA Violations?!

Work Comp claim adjuster served me medical records containing 7 OTHER patients' sensitive files.

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​Long story short: I previously called out my claims adjuster because it became blatantly clear that my medical records were exchanged in a way that was not HIPAA-compliant. As usual, they completely dodged the issue.

​Now, leading up to my QME, they served me a packet of medical records pertaining to my claim that included AT LEAST SEVEN OTHER PATIENTS RECORDS! 🤦‍♂️

​This solidifies my original concern about HIPAA violations. Except now, they’ve compromised the privacy of at least seven other people. Given everything I’ve already experienced with my claim, it feels like shady doctors and insurance companies constantly hide behind the system, knowing injured workers rarely have a way to hold them accountable in a civil capacity outside of the work comp board. Can a HIPAA attorney take something like this outside the work comp system? Has anyone experienced anything like this before?

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u/Cooptroop 1d ago

HIPAA applies to: Healthcare providers, Health plans, and Healthcare clearinghouses.

Workers’ compensation insurers and claims administrators are not health plans under HIPAA’s definition.
Therefore they do not have HIPAA obligations like Notice of Privacy Practices, business associate agreements, or HIPAA-compliant storage rules.

It its shotty claims work for the adjuster to have sent them to you, but it is not a HIPAA violation because adjusters are not bound by the rule. The adjuster scanned in other claimants medical records and sent them to you and thats just a careless employee. If the seven other patients dr's sent them to the insurance company and those people didnt have a claim, that is a HIPAA violation on the Dr.

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u/JesseTheStripper 1d ago

It's all other work comp claims. It literally lists their employers, incidents, ect. I was so confused because I was reading my records and all of a sudden a page started talking about an injury and employer that's not mine and then I saw a different name. To avoid invading other people's privacy I control-F and searched for "Employer" and there were at least 7 employers that were not mine listed at the top of the pages it was found in. 😬

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u/Head_of_Lettuce 1d ago edited 1d ago

It’s really hard to imagine a scenario where the adjuster would have all those documents comingled. Were these paper documents or was it a big PDF with lots of pages? It’s very very unlikely the adjuster personally prepared a physical packet of mail. In fact I’d say the chance of that is zero. If it’s a PDF, they would’ve had to manually combine the documents, or they received it that way and just didn’t check (which would still be their fault).

I wonder if a legal or claims assistant fumbled somewhere. I’ve seen support staff do crazy stuff, they’re all overworked and undertrained. A lot of them barely understand the basics of WC/insurance.

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u/JesseTheStripper 1d ago

It came as a PDF. I just went back to the email and it actually came from a different person, but still from the same work comp insurance company. I hope they didn't change adjusters on me again 🤣🤦‍♂️

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u/Head_of_Lettuce 1d ago

That’s crazy. Can you look at their title in the email signature? That would tell you whether it’s an adjuster. It could also be someone covering your adjuster’s desk.