Who gets to look at claims?

[Guest Damien]

My TPA employer has received a request for health claim copies (in relation to a member involved in an accident) from an attorney representing a state attorney general's office. Does the member's standard consent to release of information (for payment/treatment purposes) extend to

cover something like this?

I used to work for a large national insurer that would not even consider such a request without a subpoena for the info in question. We don't want to run afoul of any regs on privacy or confidentiality. Would it make any difference if this attorney was strictly in private practice vs working for an agency?

Please help! Thanks.

[jeanine]

I see you are registered in NJ. I don't know about NJ case law, but in Ohio even a subpoena is insufficient to turn over confidential information in a civil case. We would insist on a court order. However, your post states the atty general is requesting info. Is this a criminal investigation? There are generally different standards of proof and/or evidence in criminal cases vs. civil cases, so a short answer would be yes, there probably is a difference between the atty general's office request and a private atty. I must give you my standard advice--run it by an atty, especially one licensed in NJ if that is the office this is coming from.

[Guest Damien]

A little more background may help:

Our plan member lives in NY, and the request is from the NY State Attorney General's Office. This all apparently stems from a bad car accident. As for why this AG office is involved, I can only guess there may be a product liabity suit in the works. We asked the office to subpoena the records, but they said (on the phone)that the standard subrogation letter that the plan memeber has signed is sufficient. We are still reluctant to release info, especially photocopies of actual claims, under these circumstsances. We plan to speak with an attorney, but I would still appreciate any input.