What Role Does Medical History Play in Workers’ Compensation Claims?


Most individuals enjoy a certain level of privacy regarding their medical history.  Most employees are weary about sharing intimate details about their medical history with the employer/insurer; however, pursuant to O.C.G.A. 34-9-207, the employer/insurer may be entitled to this information.

In a Georgia workers’ compensation claim, an employee’s personal health information can be used by the employer/insurer to assess the compensability of a claim.   Medical records are of interest to the employer/insurer because these records reveal whether an injured worker has previous injuries to the body part injured in the work accident at issue or pre-existing conditions (such as diabetes or high blood pressure).  It is critical to investigate previous injuries because the employer/insurer may not be liable for payment of medical treatment for an injury which occurred before the accident at issue and/or did not occur in the course and scope of the employee’s employment.  Additionally, if an injured worker is a diabetic or suffers from high blood pressure, these pre-existing conditions can slow down an injured worker’s recuperation or cause complications in healing.

For example, if an injured worker sustains a broken ankle and is also suffering from type 2 diabetes, but is non-compliant with her diabetes treatment plan, he or she may experience delays in her recuperation due to poor circulation or possible nerve damage in the lower extremities.  In the aforementioned example, the repercussion of non-compliance with her diabetes treatment plan can lead to serious complications, which may prevent the employee from returning to work and may sever the employer/insurer’s liability for continued medical treatment for the broken ankle.  The employer/insurer will point to this fact to deny future benefits.  Obviously, this will be a medical question for the administrative law judge.

The medical records are also a tool the employer/insurer can utilize to gather information about injured worker’s conversations with his or her medical providers.  Ordinarily, a patient’s conversation with his or her physician is confidential, however, when an injured worker files a workers’ compensation claim and seeks medical treatment for work-related injuries, the patient-physician conversations are no longer considered confidential.

Pursuant to O.C.G.A § 34-9-207, when an employee files a workers’ compensation claim, the employee waives

“…any privilege or confidentiality concerning any communications related to the claim or history or treatment of injury arising from the incident that the employee has had with any physician… .”

Employees should not be discouraged from filing a claim due to privacy concerns. The release of workers’ compensation information to non-parties is generally prohibited under the workers’ compensation code.  Employees must keep in mind that in order to receive the best medical care, the doctors must have access to his or her medical history to create an effective treatment plan.  The mutual goal of all parties is to return the injured worker back to normal duty if possible.  However, it is important to realize that this may never happen depending on the severity of the injury.  If the goal of “normal duty work status” is not reachable, then the injured worker should still strive to reach maximum medical improvement.