Here are some thoughts on disability claims, the onus on providers to release the medical records for review, and the related legal aspects.

1. Disability Claims, Medical Record Release, and the Law
Here are some thoughts on disability claims, the onus on providers to release the
medical records for review, and the related legal aspects.
Medical records are indispensable to prove disability and obtain the due benefits from
the Social Security Administration (SSA) and the Department of Veterans Affairs
(VA). This recent news highlighted the plight of a 59-year old Cohoes woman,
Candas Woodard, who desperately needs her medical records to claim increased
disability payments from the Department of Veterans Affairs. Apart from
disabilities connected to military service, she has other disabilities as well, and lives
on disability payments she receives from the VA and SSA. The issue here is that Ms.
Woodard’s doctor is withholding her records on the grounds that she has not paid her
bill.
Review of Pertinent Medical Records Vital to Prove Disability
Candace Woodard had a botched C-section in 1979 during her three-year tenure at
Maxwell Air Force Base, Alabama, for which she is hoping to obtain increased
disability insurance from the VA. She has been arguing with the VA for an increase
for ten long years, and it is only last week that the VA acknowledged that her
condition warrants a higher rating on the VA benefits scale. However, the problem
now is that she has to produce the relevant medical records for review so that the
concerned authorities can proceed with the case and possibly take a decision in her
favor. For this she needs the above mentioned doctor who performed a laparoscopy
on her to release her healthcare records. She had gone outside the VA system and
the free medical care it provides to obtain the laparoscopy test because her VA
doctor would not do this test. Now she requires her laparoscopy records as well as a
statement from the doctor.
The Legal Angle
Let us consider the legal angle here. The HIPAA (Health Insurance Portability and
Accountability Act) Privacy Rule gives patients, with a few exceptions, the right to
inspect, review and receive a copy of their medical records and billing records held

2. by covered entities such as health plans and healthcare providers. Healthcare
providers cannot deny patients a copy of their records because they have an unpaid
bill. A patient who has not been given access to his/her medical records can file a
HIPAA Privacy Rule Complaint with the U.S. Department of Health and Human
Services (HHS) Office of Civil Rights, at
http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html.
New York State law requires providers to give patients an opportunity to see their
healthcare records within 10 days of placing a request. Providers and facilities can
charge the patient for photocopying costs, but cannot deny access if the patient
cannot pay for copies. The law also allows the provider to withhold certain items
such as the provider’s own observations, confidential information that was entrusted,
substance abuse records and mental health records.
Attorneys with experience and expertise in the field would advise providers to
release medical records to patients who request them. Failure to do so may land
them in legal hassles, apart from having to incur loss of revenue from unpaid bills.