16VAC30-50-50. Rule 3 4. Filing documents. , medical records, and copying charges.

1. Agreements. All agreements as to payment of compensation shall be reduced to writing by the employer and promptly filed with the commission. If the claim is denied the employer shall notify the employee and the commission promptly in writing.

2. Medical reports; filing; and copying charges.

A. Definitions.

The following words and phrases when used in this subsection shall have the following meanings unless the context clearly indicates otherwise:

"Health care provider" means those entities listed in the definition of "health care provider" in §32.1-127.1:03 of the Code of Virginia.

"Medical records" means all health records, related to an injured body part or disease at issue, as defined by §32.1-127.1:03 and shall include Attending Physician's Report, or Commission Form 6, or equivalent; treating health care provider's notes, reports, and response to a questionnaire; emergency room reports, operative notes, hospital admission and discharge summaries, cumulative progress notes, and return to work or disability slips.

"Party" means the claimant, injured employee, employer, insurer, Uninsured Employer's Fund and their attorneys.

"Treating health care provider" means any health care provider that furnishes health services or renders an opinion about the injury or disease at issue after the date of accident.

B. Filing records.

1. The original or a legible copy of all medical reports records received by an employer or an employee a party relating to a claim shall be filed immediately with the commission. A party shall not file medical records unrelated to an injured body part or disease at issue.

2. A copy of all reports medical records filed with the commission shall be furnished sent to the opposing party. Unless otherwise agreed to by the opposing party, medical records shall be mailed, postage prepaid, to the opposing party.

3. All medical reports records relevant to a claim shall be required reports subject to provisions of §65.2-902 of the Code of Virginia. Failure by a party to file a medical report record shall be grounds for imposing sanctions. Required reports shall also include:

4. Medical care providers attending an injured employee shall, upon request from a party, furnish a copy of all medical records relating to the injured employee.

5. Copies shall be mailed or, if agreed to by the requestor, made available for pick-up, within 20 days after receipt of a request. Medical care providers may not require prepayment of copying charges.

6. A treating health care provider shall provide a party, upon request, an Attending Physician's Report, or Commission Form 6, or equivalent, without charge.

7. A medical care provider may not require a customized authorization.

8. Medical reports relating to workers' compensation claims are not subject to The Health Insurance Portability and Accountability Act or HIPPA.

A. Commission Form 6 or equivalent;

B. Attending physician''s notes and reports;

C. Emergency room reports;

D. Operative notes;

E. Hospital admission and discharge summaries;

F. Cumulative progress notes; and

G. Return to work or disability slips.

A medical care provider attending an injured employee shall, upon request from an employer or an employee, furnish a copy of required reports, at no cost except for a nominal copying charge.

A medical care provider is entitled to a reasonable fee for preparation of a narrative report written in response to a request from a party if the report requires significant professional research or preparation.

C. Copying charges.

1. Copying charges for non-treating health care providers shall be in accordance with §8.01-413 of the Code of Virginia.

2. A treating health care provider may charge a copying charge of not more than $.10 per page for the first 50 pages and $.05 for each page thereafter.

3. A treating health care provider may charge $.25 for each page if the record was microfilmed or imaged.

4. A treating health care provider may not charge for copies of medical records or other documentation submitted by the health care provider to a party for the purposes of obtaining payment of medical bills by that party.

5. If the medical records are mailed to the requestor, a treating health care provider also may charge for the actual cost of mailing the medical records.

6. In addition to the above fees, a treating health care provider may charge the actual cost of reproducing an x-ray, electrocardiogram, or other special graphic medical record, provided such fee shall not exceed $8.00 per film.

Statutory Authority

§65.2-210 of the Code of Virginia.

Historical Notes

Derived from VR405-01-06, Rule 4, eff. January 1, 1994.