Is a health care provider permitted to disclose medical information without patient consent to a private insurer?

California, United States of America


The following excerpt is from Heller v. Norcal Mutual Ins. Co., 32 Cal.Rptr.2d 200, 8 Cal.4th 30, 876 P.2d 999 (Cal. 1994):

[8 Cal.4th 39] Section 56.10(c)(4) provides that a health care provider may disclose medical information to "persons or organizations insuring, responsible for, or defending professional liability which a provider may incur, if the ... organizations, or persons are engaged in reviewing the competence ... of health care professionals or in reviewing health care services with respect to medical necessity, level of care, quality of care, or justification of charges." ( 56.10(c)(4).) This exception to the provisions of section 56.10 allows a provider of health care to disclose medical information without patient authorization "to persons or organizations which insure or are responsible for defending professional liability." Under our canons of construction, we look to the language of the statute itself to determine if the ordinary meaning is unambiguous; if so, the statutory language controls, and there is no need to look to legislative intent for construction or interpretation. (Lungren v. Deukmejian (1988) 45 Cal.3d 727, 735, 248 Cal.Rptr. 115, 755 P.2d 299.)

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