If you filed a Wisconsin worker’s compensation claim, you may be shocked when the insurance company starts asking for medical records that seem unrelated to your injury. For example, you may have injured your knee at work, but the insurance company wants records about your back, hip, ankle, or prior surgery. We understand why this feels invasive, unfair, and frustrating. Unfortunately, Wisconsin’s worker’s compensation system gives insurance companies broad rights to investigate and defend against claims, including the right to have their own IME doctor review physical medical records that may be “reasonably related” to the injury. The insurance company may argue that it cannot know whether other physical conditions are related until its doctor reviews the records. For example, even in a knee case, the IME doctor may try to claim that an old back injury or spinal surgery caused nerve symptoms that explain the knee pain, rather than the work injury. These IME doctors are paid by the insurance company, and their opinions are often used to deny meritorious claims. But the system gives insurers the right to make those arguments, and judges will often allow the records to be released to the insurance company’s doctor so the doctor can give an opinion about causation.
That does not mean the insurance company gets every private record from your life. One of the biggest limits is mental health records. If your injury is purely physical—such as a shoulder, knee, back, or hand injury—the insurance company generally cannot demand unrelated mental health or therapy records just because you filed a worker’s compensation claim. Physical medical records are treated differently because insurers may argue that other physical conditions could affect the same body part, symptoms, disability, or need for treatment. Mental health records are far more sensitive, and if the worker’s compensation claim is only for a physical injury, those records are usually outside the proper scope. But if the claim itself involves a mental health condition—such as work-related PTSD, depression, anxiety, or another psychological injury—the rule changes. In that situation, the insurer generally has access to your mental health records because they may relate to diagnosis, causation, disability, and treatment. We can object when an insurer truly overreaches, but contesting these requests often leads to a short hearing where the insurer asks a judge to order the records released. The insurer will usually argue that its doctor must see the records before deciding what is related, and judges commonly accept that argument. Fortunately, our law firm is experienced in challenging inaccurate IME reports, exposing the flaws in paid-for opinions, and showing judges why those opinions should not be relied on.
If you suffered a work injury in Wisconsin and the insurance company denied your claim, please contact one of Hawks Quindel S.C.’s experienced worker’s compensation attorneys for a free consultation. We serve clients throughout the Midwest and are ready to help you secure the benefits you deserve