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Full Version: HIPAA Authorization to Disclose form
BenefitsLink Message Boards > Health & Welfare Plans > Health Plans in General, Including COBRA and HIPAA
icu4whatur
If I am requesting FMLA or Medical Leave can the company I work for make me fill out a "HIPAA Autorization to Disclose form" that gives them (the Company), the Disability management company, it's affiliates, their disability consultants, health care professionals and staff permission to obtain the necessary information to adjudicate a claim for disability and/or leave of absense benefits. Before they process or grant either the FMLA or Medical Leave? This form wants us to sign and give the Company a date range that they can have the authorization then they want us to put a check next to each one of the following they are allowed to have: Complete Medical Records, Alcohol and or Substance Abuse, Psychiatric Evaluation and testing, hospitalization,confinement, AIDS/HIV Test information, other evaluations/assessments(specify).

If needed I can supply a copy of the form without the name of my employer.
Jacmo
If you refuse to sign the form, (which you can), then your employer might tell you that it is unable to process your claim within the confines of the law. Their hands will be tied concerning the transfer of private health information.

You could possibly justify (depending on the nature of or reason for, your leave) narrowing the list of "lookie-loos" by crossing out, for instance, the Disability management companies' affiliates; and checking off only those records needed for your situation.
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