This is one of the official Workers' Compensation forms for the state of New Hampshire.
New Hampshire Workers' Compensation Medical Form
Category:
State:
New Hampshire
Control #:
NH-75A-WC
Format:
Word;
PDF;
Rich Text
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Description
How to fill out New Hampshire Workers' Compensation Medical Form?
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FAQ
A medical-only claim is any claim involving medical attention, but no time lost from work beyond the state-mandated waiting period and does not include any permanency of injury.
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.
Medical only workers' comp claims are those that involve an injury where the employee only receives medical care and treatment, or the wage loss is confined to the waiting period under a workers' compensation act.
Workplaces must prioritise your health and safety. They must facilitate your return to work. They must balance this against your privacy rights. This means that access to medical records may be necessary, but your employer has an obligation to request and access only the information required and nothing more.
As a general rule of thumb, you should never discuss anything except the basic facts of the accident, including where it occurred, the date and time it occurred, what type of accident it was, and which body parts were injured.
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.
Yes, you are required to release your medical records if requested when you file a workers' compensation claim after a workplace injury.
Workers' comp insurance provides coverage to help your employee pay for medical expenses related to a work-related injury or illness. This can include emergency room visits, necessary surgeries and prescriptions.