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The medical provider's failure to provide the URO with the password to access encrypted medical records does not satisfy the requirement of section 127.464 to provide the URO with the claimant's medical records.

July 1, 2010
Shaw v. WCAB (Melgrath Casket Co.), 1871 C.D. 2009; filed April 21, 2010; by Judge Cohn Jubelirer

The Commonwealth Court affirmed a decision of the Workers' Compensation Appeal Board that a medical provider's mailing of a CD-ROM with the claimant's complete records, whose contents were inaccessible to the URO due to an encrypted password that was not provided to the URO, fails to satisfy the requirement of Section 127.464 of the Bureau regulations that the medical provider under review supply the medical records of the claimant. The medical provider sent the CD-ROM to the URO in a timely fashion but failed to include the password that would permit the records to be reviewed. The URO called the doctor's office twice to report that the CD could not be downloaded and that the doctor had to provide paper medical records. The doctor failed to respond to the call. The URO returned the unviewed CD-ROM to the doctor but made no further attempts to call the doctor. Without the claimant's medical records, the URO issued a determination under Section 127.464(a) that the healthcare was unreasonable and unnecessary because the doctor failed to supply the requested records. On appeal, the claimant argued that the medical provider satisfied the requirement to supply the claimant's medical records within 30 days of the request and that it was the URO's failure to request the password to the records that precluded their review. The court noted that the regulations clearly imply that the medical provider must supply medical records in a useable format that allows the URO to engage the review process. The purpose of the regulations is thwarted if a medical provider fails to send useable and readable records to the URO. The doctor was found to have acted unreasonably in failing to inform the URO of the password and in not returning the calls about the encrypted records.

Case Law Alert, 3rd Qtr 2010

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Francis X. Wickersham
Shareholder
(610) 354-8263
fxwickersham@mdwcg.com
G. Jay Habas
Managing Attorney, Erie, PA Office
(814) 480-7802
gjhabas@mdwcg.com

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