State v. Ellingsworth
In State v. Ellingsworth, 966 P.2d 1220 (Utah Ct. App. 1998), a state workers' compensation fund claims adjuster gained access to defendant's medical records in connection with processing a workers' compensation claim.
The records, and other information uncovered by the adjuster, led eventually to the prosecution of defendant for workers' compensation fraud, and defendant sought to suppress the records as the product of an illegal search.
The Ellingsworth court determined that the proper standard is "whether an actor's 'intent and purpose in conducting the search . . . is in the person's own interest or to further law enforcement,' . . . and it equally applies to private individuals or non-law enforcement government agents." Id. at 1225.
In sum, a workers' compensation adjuster employed by a quasi-government corporation obtained and examined the defendant's medical records while reviewing her claim for benefits.
Eventually, the defendant was prosecuted for insurance fraud after a workers' compensation investigator forwarded the defendant's case history to the attorney general's office pursuant to a statute requiring insurance agents to release information related to suspected fraud.
The defendant argued that the use of her medical records in the criminal trial violated her Fourth Amendment rights. The appellate court rejected this argument, holding that the Fourth Amendment did not apply because the adjuster "was acting like any other private insurer" in reviewing the defendant's claim for benefits to protect its own interests unrelated to law enforcement. Id. at 1225.