This is one of the official workers' compensation forms for the the state of Missouri
Missouri Authorization to Release Information for Workers' Compensation
Category:
State:
Missouri
Control #:
MO-126-WC
Format:
Word;
PDF;
Rich Text
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Description
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Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.
Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.
If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
We protect your documents and personal data by following strict security and privacy standards.
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FAQ
What RTW / workers' comp information IS confidential? While relevant, recent, work-related medical information is usually not confidential, other medical informationsuch as the individual's medical historyis confidential.
What RTW / workers' comp information IS confidential? While relevant, recent, work-related medical information is usually not confidential, other medical informationsuch as the individual's medical historyis confidential.
Will a Workers' Compensation Case Affect My Future Employment? As long as you do not badmouth your former employer, a previous workers' compensation claim should not impact your chances of being hired in the future.
The EEOC says An employer may ask questions about an applicant's prior workers' compensation claims or occupational injuries after it has made a conditional offer of employment, but before employment has begun, as long as it asks the same questions of all entering employees in the same job category.
A prospective employer has no right to ask whether you have had a previous workers' compensation claim. However, a prospective employer does have the right to know if you have an injury or medical condition that will impact on your ability to perform your work duties.
Yes, you are required to release your medical records if requested when you file a workers' compensation claim after a workplace injury.
No, you should not sign the HIPAA authorization for the release of your medical records. Often, the insurance company will act as though they cannot begin to decide how much money to offer you until they have all of your medical records.
The HIPAA Privacy Rule does not apply to entities that are either workers' compensation insurers, workers' compensation administrative agencies, or employers, except to the extent they may otherwise be covered entities.
Many insurance companies use generic forms that are broad in scope and grant blanket access to all of your medical records. The Medical Authorization form may even give the claims adjuster or insurance defense attorney permission to speak with your doctors and nurses without you present.
