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Category: Workers Compensation

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Alaska Workers Compensation law is a body of statutes, regulations, and case law which guarantees certain specific benefits to injured workers. In a nutshell, a brief description of these benefits are:

Time Loss Benefits

TTD:   You are entitled to temporary total disability (TTD) for any time period in excess of 3 days during which you are disabled from work because of your work injury. In order to trigger your employer’s duty to pay TTD, you must provide your employer (or adjuster) a copy of a doctor’s work release.

You are entitled to TTD until such time as your medically stable. The legal definition of “medical stability” is

…the date after which further objectively measurable improvement from the effects of the compensable injury is not reasonably expected to result from additional medical care or treatment, notwithstanding the possible need for additional medical care or the possibility of improvement or deterioration resulting from the passage of time; medical stability shall be presumed in the absence of objectively measurable improvement for a period of 45 days; this presumption may be rebutted by clear and convincing evidence.

AS 23.30.095(28).

In layman’s terms, “medically stable” means you have recovered as much as you probably will.

“Medically stable” does not mean you have been returned to your preinjury status. Many workers suffer a permanent disability or will need medical treatment for the rest of their lives, such as pain management.

“Medically stable” is not necessarily permanent. If a doctor decides you need to have a second surgery, although you were medically stable after the first surgery, you are not medically stable anymore. When the second surgery is recommended, you are entitled to claim TTD until you are medically stable again.

Note: The insurer is obliged to send you the first TTD check within 21 days of receiving the work release. The subsequent TTD checks are due every 14 days. If the insurer doesn’t mail them out on time, you may be entitled to a 25% penalty.

TPD: You may be entitled to compensation, temporary partial disability (TPD) if you can only work part-time because of your work injury. Again, you must provide your employer (or adjuster) a copy of the doctor’s work release.

PTD: You may be entitled to Permanent Total Disability (PTD) if because of your injuries you cannot perform services other than those that are so limited in quality, dependability, or quantity that a reasonably stable market for them does not exist. You do not have to be in a state of abject helplessness. JB Warrack v Roan, 418 P 2d 986 (Alaska 1966). PTD is a such a complicated area of law that a blogpost cannot adequately address it.  If you believe you are PTD, you should contact an attorney.

You can estimate how much you would receive in TTD benefits by using the Alaska Worker Compensation Board’s Benefit Calculator: https://labor.alaska.gov/wc/benefitcalculator.htm

If the insurer is paying you an amount that is too low, you may ask for a compensation rate adjustment. The insurer is supposed to base your rate on the best of the two years of income prior to your injury, taking into consideration all jobs you worked. However, that amount is sometimes unfair such as when a worker’s income dramatically increased in the year s/he was injured due to a new job or a change in career. If the insurer’s calculation is wrong or unfair, you can file a claim with the Board seeking an increase in your compensation rate.

Medical Benefits

You are entitled to medical benefits, including payment of your doctors, physical therapists, prescriptions, diagnostics (X-rays, MRIs, etc), assistive devices (braces, scooters, or modified vehicles) and any other treatment your doctor prescribes for your work injuries, regardless of how long ago you were injured.

There is no limit to how long you are entitled to medical benefits. Every time you visit a doctor for treatment of your work injury, the statute of limitations starts again.

However, there is a time limit for asking for reimbursement for treatment. If you wait for more than two years, after having paid for your own work-related medical treatment, you may have waived your right to recover reimbursements.

Many injured workers receive pain management for the rest of their lives.

Travel Benefits

You are entitled to mileage for traveling round trip from your home for medical treatment. The mileage rate varies by year. You will find the correct mileage rate on the Alaska Workers Compensation Board’s Bulletins: https://labor.alaska.gov/wc/bulletins.htm.

For instance, Bulletin No. 25-01 sets in state mileage at .70 per mile for the calendar year of 2025.

In order to trigger your employer’s insurance company’s duty to pay mileage, you must provide to your employer (or adjuster) a mileage log. Here’s a template of the mileage log that I use for my clients: Travel Log

I also attach to the mileage log google maps showing the trip from home to the provider’s address to verify that I am requesting the correct amount.

Permanent Partial Impairments

When you have become medically stable, you may be entitled to a permanent partial impairment (PPI) rating for any permanent disability you may have sustained. Your treating physician can refer you to someone in your locality who performs PPI ratings. Often the insurance company will ask their doctor to perform the PPI rating from one of their hired guns in a so-called “independent medical evaluation.” Chances are, the rating you would receive from your doctor would be more favorable than the one that the insurance company bought.

The doctor who is making the rating will examine you and your medical records. S/he will then perform calculations pursuant to the American Medical Association Guides to Permanent Impairments. The ultimate percentage s/he assigns will be multiplied against a “whole person” factor established by the Alaska legislature.

If you were injured after January 1, 2023, the “whole person” is $273,000. So, if the rater finds that you are 10% whole person disabled, you are entitled to receive $27,300.

Prior to January 1, 2023, the “whole person” was $177,000.

Reemployment Benefits

If you have missed more than 25 days of work because of your injury, your employer is legally required to notify the Reemployment Benefits Administrator (RBA). At that time, the RBA will initiate the process for determining whether you are entitled to retraining benefits. If you haven’t received notification after being off work for 90 days, you can contact the RBA directly and ask for an eligibility evaluation. The RBA’s contact information is: https://labor.alaska.gov/wc/reemploy-benefits.htm

If you were previously denied retraining benefits because your doctors predicted that you could return to work, and their predictions were proven wrong, you may be entitled to a new investigation.

For more information, check out the Alaska Workers Compensation Board’s website: https://labor.alaska.gov/wc/wc-and-you.htm

There are many caveats and exceptions to the information supplied above. If you have questions about your workers compensation benefits, you should contact a lawyer.

Keenan Powell has practiced Workers Compensation law in the State of Alaska for over 40 years and has dedicated her practice to Workers Compensation representing injured Alaskans handling hundreds of cases. www.keenanpowell.com.

All consultations are free.  To make an appointment, call  907 258 7663 or email keenan@keenanpowell.com.

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Workers Compensation Injured Worker Victory
Happy Lawyer

The Alaska Workers Compensation Board issued a decision in the case of Walker v State, Dec. No 24-0048 (8/22/2024).

The employee worked a physically demanding job for the Department of Transportation as a groundskeeper at the airport. As a result of which, he was injured several times prior to 2023. But he always recovered sufficiently to go back to work – until March 20, 2023.

On March 20, 2023, he was loading ice melt into a pickup truck when his hip and low back popped, causing him pain. He reported the injury. He was diagnosed with lumbar radiculopathy, several central stenosis at L3-4, diffuse bulging on both L5 nerves, and facet degenerative changes causing mass effect on both foraminal L4 nerves. He was placed on work restrictions.

The State sent him to Dr. David Bauer, who diagnosed a lower back strain. Dr. Bauer attributed most of the symptoms to age-related degeneration.

Relying upon Dr. Bauer’s report, the State controverted benefits on July 14, 2023.

A claim was filed on behalf of the Employee on October 10, 2023.

On November 1, 2023, just twenty-two days after the claim was filed, the State agreed it was responsible for the recurrent disc herniation and began paying medical benefits. However, it continued to dispute the hip injury, relying on Dr. Bauer’s report.

TTD payments were consistently late.

On February 26, 2024, the employee was seen by Dr. Jain, a SIME (Second Independent Medical Evaluator). For more information on SIME, see: https://www.keenanpowell.com/blog/2017/08/28/negotiating-the-maze-iii-second-independent-medical-evaluations-sime/

Dr. Jain found that both hips were injured in the course of the employment, and both would need hip replacements.

At the Board hearing on July 9, 2024, the State conceded it was responsible for the bilateral hip and low back injuries and stipulated that it had failed to pay for five days of TTD, and agreed that it owed penalties and interest on the unpaid TTD.

The Board ordered:

  1. The bilateral hip and low back injuries are compensable,
  2. The employer shall pay past and future TTD benefits and PPI when the employee is medically stable following bilateral hip replacement surgeries and surgery on his low back. It will also pay transportation costs.
  3. The state owed the employee interest on late-paid TTD,
  4. The state owed the employee 25 percent penalty for late-paid TTD,
  5. The state owed interest on past due TTD,
  6. The state owed 25 percent penalty on past due TTD,
  7. The state owed attorneys fees,
  8. The decision would be sent to the Commissioner as the controversion had been unfair and frivolous.

The Employee won!

Keenan Powell has practiced Workers Compensation law in the State of Alaska for over 40 years and has dedicated her practice to Workers Compensation representing injured Alaskans handling hundreds of cases. www.keenanpowell.com.

All consultations are free.  To make an appointment, call  907 258 7663 or email keenan@keenanpowell.com.

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independent medical examination
Actor dressed up like a doctor

Dr. Jared Kirkham works both sides of the workers compensation street.

He treats injured workers at Anchorage Fracture and Orthopedic.

And in the past few years, he has become one of the insurance companies’ favorite go-to guns for hire. The insurance companies call these reports "independent" but there's nothing independent about them - they're bought and paid for.

The remarkable thing about Dr. Kirkham’s EME (Employer Medical Evaluation) opinions is that he consistently opines that the injured worker’s ongoing pain and need for treatment is caused by “age, genetics, degenerative changes, deconditioning, and psychosocial factors.”  Sometimes, he also say the workers are obese.

His opinion is remarkable because he has the same opinion regardless of the injury the employee suffered or how he or she was injured. Whether it’s a low back strain, disc protrusion, post-concussion syndrome, epicondylitis, or COVID, Dr. Kirkham always blames the same non-work-related causes: age, genetics, obesity, lifestyle factors, and psychosocial factors.

It doesn’t matter if the injury was sustained when rearended by a car, repetitive strain, exposure to COVID, lifting, hit in the head with frozen fish, or getting crushed.

Take a look at a few decisions below in which his reports have been cited.

(Note: you can find all these cases on the Alaska Workers Compensation Board’s legal research engine, https://labor.alaska.gov/wc/legaldir.htm)

Gaona v SEARHC/Alaska National Insurance Co., Dec. No-25-0010 (2/14/25)

Injury: L4-5 disc protrusion resulting in surgery.

Mechanism of injury: Squeezing between two parked cars.

Dr. Kirkham’s EME: Shimmying between two vehicles cannot cause a disc protrusion and the injury was more likely related to age and genetics, obesity, poor physical fitness, and psychosocial factors.

Toennis v Crowley Holdings/Old Republic Insurance Co., Dec. No 25-0002 (1/16/25)

Injury: Post-concussion syndrome, cervical and lumbar whiplash, ankle sprain.

Mechanism of injury: Rearended by car doing 50 mph.

Dr. Kirkham’s EME: No clear etiology for widespread, diffused pain and that the cause of the pain was history of chronic pain, age, genetics, personality factors, obesity, deconditioning, and psychosocial factors.

Johnston v ASD, Dec. No. 24-0065 (12/3/24)

Injury: Bilateral epicondylitis.

Mechanism of injury: Repetitive strain as a foodservice worker.

Dr. Kirkham’s EME: No objective evidence of an injury from the work-related activities. He stated that her pain and functional impairment were out of proportion to what would be expected. Just as in the Gaona case and the Toennis case, he opined that the causes for her current pain was “age, genetics, obesity, deconditioning” and “psychosocial factors.”

In this case, Dr. Kirkham’s opinion was given less weight by the Board because it found that he had not actually reviewed all the medical records he claimed he had – instead he was reviewing the adjuster’s notes.

Zanosko v Southcentral Foundation/Alaska National Insurance Co., Dec. 23-0037 (6/30/2023)

Injury: Long COVID

Mechanism of injury: Exposure to COVID.

Dr. Kirkham’s EME: Symptoms attributed to age, genetics, obesity, lifestyle factors, psychosocial factors, amongst other non work related psychological problems.

Wolfe v Advance Powder Coating/Alaska National Insurance Co., Dec. 23-0055 (10/5/23)

Injury: low back injury.

Mechanism of injury: Lifting.

Dr. Kirkham’s EME: Chronic low back pain was caused by “age, genetics, degenerative changes, deconditioning, and psychosocial factors.”

Rivas v Pacific Stevedoring/Seabright Insurance Co, Dec. 22-0028 (4/26/22)

Injury: Neck injury with chronic pain and right arm radiculopathy.

Mechanism of injury: Struck in the head with a box of frozen fish.

Dr. Kirkham’s EME: Any future medical care was caused by age, genetics, diabetes, deconditioning, and psychosocial factors.

Bennett v Ketchikan Pulp Co/National Union Fire Ins, Dec. 21-0043 (5/21/21)

Injury: Chronic low back pain.

Mechanism of Injury: Lifting

Dr. Kirkham’s EME: The substantial factors for ongoing pain and disability were “age, genetics, obesity, smoking, general poor health, deconditioning and psychosocial factors.”

Again, the Board gave Dr. Kirkham’s opinion less weight because he attached low significance to the employee’s pain symptoms even though his pain complaints were consistent and worsened due to the work injury and he cited studies that did  not support his conclusions.

The Bottom Line!

If the insurance company arranged for you to see Dr. Jared Kirkham, they are setting you up for a controversion. Prepare yourself for a fight!

Keenan Powell has practiced Workers Compensation law in the State of Alaska for over 40 years and has dedicated her practice to Workers Compensation representing injured Alaskans handling hundreds of cases. www.keenanpowell.com.

All consultations are free.  To make an appointment, call: 907 258 7663 or email keenan@keenanpowell.com.

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The Alaska Supreme Court recently issued a seminal decision in the case of Amos v Tidwell and State of Alaska, Workers’ Compensation Benefits Guaranty Fund, Op No. 7709 (7/26/24).

In 2019, David Tidwell, an unlicensed and uninsured contractor, was hired to construct a shed for a homeowner. In turn, he hired Samuel Amos and others to provide labor. He promised to pay Mr. Amos from the proceeds.

A few days into the project, Mr. Amos fell from the roof and was injured so severely that Mr. Tidwell called an ambulance to have him transported to the hospital. A claim was filed on his behalf against Mr. Tidwell. Because Mr. Tidwell did not have workers compensation insurance, a claim was filed against the Guaranty Fund, which is set up to reimburse injured workers when their Employers were not insured.

At the hearing, Mr. Tidwell claimed that he did not “hire” Mr. Amos as an Employee, that instead he hired him because they were buddies. He claimed he did not promise to pay Mr. Amos for his labor. Instead, he claimed that Mr. Amos agreed to “help” him with the construction in exchange for which Mr. Tidwell would “help” Mr. Amos with money.

The Alaska Workers Compensation Board adopted Mr. Tidwell’s reasoning, holding that there was a “buddy” exception to an Employer-Employee relationship so that when one hired a friend, the Employer is not required to provide insurance coverage.

The Board’s decision was appealed to the Alaska Workers Compensation Appeals Commission which likened Mr. Amos to a farm laborer and, as such, ruled that he was not eligible for workers’ compensation benefits.

The Alaska Supreme Court reversed both the Commission and the Board. In a lengthy opinion, it held, amongst other things, the following:

            1.         There is no such thing as a “buddy” exception to the requirement of an Employer to provide an Employee with workers compensation coverage.

            2.         An Employer must carry workers compensation insurance. It does not matter if:

            a.         The Employer is only making little income,

            b.         The Employer is unlicensed,

            c.         The Employer has another full-time job,

            d.         The Employer pays wages in cash.

The Employee won!

Keenan Powell has practiced Workers Compensation law in the State of Alaska for over 40 years and has dedicated her practice to Workers Compensation representing injured Alaskans handling hundreds of cases. www.keenanpowell.com.

All consultations are free.  To make an appointment, use the contact form on this website or call:  907 258 7663.

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independent medical examination
Insurance Doctor

Dr. Dennis Chong is a Physical Medicine & Rehabilitation Specialist is a favorite insurance company expert, hired to deny Employee claims. The following cases can be found on the Alaska Workers Compensation Board’s website legal research engine: Home Page (alaska.gov)

These cases are remarkable in the wide range of injuries the Employees suffered, and the various diagnoses their doctors made, but Dr. Chong diagnosed that the Employee was not injured or, if he was, it was mild injury and he should have recovered, could go back to work, and didn’t need further medical treatment.

Unsel v Liberty Northwest Insurance Company, AWCB Dec. No 24-0007 (2/14/24)

On 9/6/12, the Employee was involved in a work-related motor vehicle accident which caused back pain so severe he was treated with pain medication and treated with epidurals and nerve root blocks. The MRI showed that he had neural foraminal narrowing.  The insurance company sent him to Dr. Michael Fraser and Dr. Dennis Chong who diagnosed a lumbar sprain/strain that had resolved. He later had two surgeries and was diagnosed with “failed back syndrome.” The Board ordered that a spinal cord stimulator treatment was reasonable.

Thomas v Republic Indemnity of America, AWCB Dec. No 23-0078 (12/18/23)

On behalf of the insurance company, Dr. Dennis Chong diagnosed the Employee with a work-related cranial contusion and opined that the disability would have ended within one week, that the Employee was medically stable, did not require further medical treatment, and did not have a permanent partial impairment rating. Based on his report, the Employer controverted reemployment benefits. The Board restored the benefits.

Nartey v State of Alaska, AWCB Dec. No. 23-0053 (9/5/23)

The Employee, a nursing assistant at API, was attacked by a patient. She reported head and neck injuries and a concussion. Dr. Dennis Chong and Dr. Richard Rivera performed “independent medical evaluation” and opined that she had reached medical stability one month after conservative treatment to her neck, had no work restrictions, and no further need for treatment. The case is ongoing.

Hermans v State of Alaska, AWCB Dec. No. 21-0085 (9/15/21)

In 2019, the Employee reported low back pain after moving heavy objects at work. The State sent him to Dr. Dennis Chong, who diagnosed (1) chronic morbid obesity, (2) preexisting chronic mechanical back pain, (3) preexisting lumbar spine multilevel degenerative disc disease and spondylosis, and (4) work-related lumbar sprain/strain. Dr. Chong further opined that no further medical treatment was necessary, that the Employee had reached medical stability and did not have a PPI rating.  The Alaska Workers Compensation Board ordered a SIME (Second Independent Medical Evaluation). For more information about SIME: Negotiating the Maze III: Second Independent Medical Evaluations (SIME) - Keenan Powell, Attorney at Law

Cartwright v Mat-Su Borough School District, AWCB Dec. No 21-0059 (7/15/21)

The Employee, a special education teacher, was attacked by a student. She was initially diagnosed with a closed head injury and concussion. When her symptoms persisted and worsened, she was diagnosed with a traumatic brain injury. The Employer hired Dr. Chong who opined that her closed head injury was work-related but that it had resolved, and she could go back to work. The Alaska Workers Compensation Board ordered a SIME (Second Independent Medical Evaluation).

Brink v State of Alaska AWCB Dec. No. 21-0011 (2/16/21)

The Employee was a nurse at API. She was attacked by a patient. She suffered cognitive symptoms, nausea, photophobia, dizziness, head pain, and fatigue and was treated by a neurologist. Her Employer sent her to Dr. Chong who opined that there was no evidence that she had a concussion or brain injury, and if she had one, it would have resolved within three months. 

Womack v American Zurich Insurance Company, AWCB Dec. No. 20-0086

An Employee slipped and fell at work, hitting his eye and losing consciousness. He was diagnosed with a closed head injury. He developed regular headaches that worsened when he strained his eyes and other symptoms. He was eventually diagnosed with post-concussive syndrome and restricted from work. The Employer’s expert, Dr. Chong, opined that he had a “possible” mild traumatic brain injury that should have resolved in one to two months, and that his need for treatment was related to his anger, catastrophizing, and magnified sense of injustice. He also opined the Employee did not need further treatment.

Harrison v Liberty Northwest Insurance Corp, AWCB Dec. No. 20-0008 (2/26/20)

The Employee broke his foot at work when he was chased by a grizzly bear. He was diagnosed with complex regional pain syndrome (CRPS). Dr. Chong diagnosed a broken foot bone, anxiety and a learned disability from being told he had CRPS, but that there was no CRPS. He specifically stated that his 8/23/18 examination showed none of the symptoms for CRPS (the Budapest Criteria). He further opined that no further medical treatment was necessary and there was no PPI rating. Three weeks after the “IME”, the Employee was seen by his own physician who documented four Budapest Criteria.  The Alaska Workers Compensation Board sent the Employee to a SIME (Second Independent Medical Evaluation) in which the Board’s doctor also documented several Budapest Criteria and agreed with the treating physician that the Employee had CRPS. The Alaska Workers Compensation Board awarded medical benefits, transportation benefits, temporary total disability (TTD), and a permanent impartial rating (PPI).

Rogers v Marke Insurance Company, AWCB Dec. no 19-0098 (9/30/19)

The Employee, a mechanic, was swinging a large hammer when the hammer head came off the handle, striking him on the left hand and thumb and smashing his hand. He was initially diagnosed with a contusion. Later, when his hand continued to hurt, he was diagnosed with a non-displaced fracture. When the pain continued, he was diagnosed with complex regional pain syndrome (CRPS). The Employer sent him to Dr. Chong, who diagnosed a hairline fracture and opined there was no CRPS because the Employee did not meet the Budapest criteria. The Alaska Workers Compensation Board awarded medical benefits, transportation benefits, and temporary total disability (TTD).

Elardo v Walmart, AWCB Dec. No 19-0057 (5/8/19)

Employee injured his back at work. He was diagnosed with an annular tear and disc herniation. He was treated with epidural injection and physical therapy. Dr. Chong diagnosed a lumbar strain/strain opined that his low back pain was not work-related. The SIME doctor disagreed. After a hearing, the Employee won benefits.

Nielsen v Teamsters, AWCB Dec. No. 19-0019 (2/15/19)

The Employee rammed his head onto a truck differential housing while working as a mechanic causing neck pain. He had disc replacement surgery on his C6-7. He continued to have neck pain and headaches and was diagnosed with chronic pain. Dr. Chong opined that his problems were not work related. After a hearing, the Board awarded continued palliative medical care (pain management).

Umiker v Seabright Insurance Co, AWCB Dec. No 15-0006 (1/21/15)

The Employee was a registered nurse.  She slipped and fell at work and began seeing a chiropractor for her neck and back pain. She was later diagnosed with severe degenerative disc disease L5-S1 and grade 2 spondylolisthesis of L5 on S1. Surgery was recommended. Dr. Chong opined that she had merely suffered a neck and back strain, as medically stable and did not require further treatment. The Board awarded her benefits including temporary total disability, a PPI rating, and a reemployment benefits determination, finding that the work injury was the cause of her disability and need for medical treatment.

All Consultations are Free. 

To make an appointment, email keenan@keenanpowell.com or call 907 258 7663.

Keenan Powell has practiced Workers Compensation law in the State of Alaska for over 40 years and has dedicated her practice to Workers Compensation representing injured Alaskans. www.keenanpowell.com.

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I am honored to represent injured workers.

In 2022, we were again victorious!

Workers Compensation Injured Worker Victory

Kvernik v The Ohio Casualty Insurance Co. AWCB Dec. No 22-0001 (January 3, 2022)

The Employee injured his calf muscle and Achilles’ tendon while pushing a heavy pallet up a ramp at work. He had surgery to repair the tendon.

The insurance company underpaid temporary total disability (TTD) when it did pay, paid some TTD late, and failed to pay TTD for 12 weeks. It also failed to reimburse for travel expenses incurred to visit his doctor and medical costs the employee was required to pay out-of-pocket.

A claim was filed for an increased compensation rate, payment of unpaid TTD, payment of medical and transportation costs, interest, penalties, and unfair/frivolous controversion.

The Board held that the insurance company’s failure to pay TTD, failure to reimburse for medical and transporation costs, and failure to pay penalties and interest when it late-paid certain benefits was an unfair or frivolous controversion. It ordered that a referral would be made to the Division of Insurance for investigation. Additionally, the Employee won all the benefits he sought.

Employee won!

 

Guerrissi v State of Alaska AWCB Dec. No 22-0020 (March 23, 2022)

The Employee injured his neck and left shoulder while standing on a ladder, working with his arms overhead, when he turned his head. The doctors diagnosed a rotator cuff tear, SLAP tear, and a cervical disc herniation.

He had neck surgery to repair the herniation. He then had another surgery to repair the shoulder injuries.

After his surgeries, the State sent him to Dr. David Glassman for a “independent” medical evaluation. Dr. Glassman’s opinion was that neck was not injured at work and the shoulder injury was due to degenerative changes.

The State controverted all benefits, relying on Dr. Glassman’s report. The Employee filed a claim.

After two SIME (second independent medical evaluations) – one with a neck specialist and one with a shoulder specialist, the case went to hearing.

The Board ruled:

1.     The need for medical treatment for the cervical spine was work-related.

2.     The need for medical treatment for the shoulder was work-related.

3.     The State was required to reimburse him for medical treatment and transportation costs.

4.     The State was required to pay the Employee PPI ratings.

5.     The Employee was entitled to penalties and interest for unpaid benefits.

Employee won!

Torres v Zurich American Insurance Co. AWCB Dec. No 22-0021 (March 24, 2022)

The Employee, a roofer,  injured both shoulder when he was tearing off a roof. He experienced pain and weakness in both shoulders immediately. He tried physical therapy and when that didn’t improve his condition, he decided to go forward with recommended surgeries. He has not been able to work since the injuries.

The insurance company sent him to Dr. Scot Youngblood for an “independent” medical evaluation. As Dr. Youngblood so often opines, he stated that the Employee’s shoulder injuries were degenerative.

The insurance company controverted benefits, cutting of his medical and disability benefits.

The Employee filed a claim. After a SIME(second independent medical evaluation), the case went to hearing.

The Board ruled:

1.     The need for shoulder surgeries was work-related and it ordered the insurance company to pay for both of them,

2.     The Employee’s disability was work-related. The Board ordered the insurance company to pay for TTD benefits from the time it was cut off until he recovered from his surgeries.

3.     The Employee was entitled to transportation costs for visiting his providers,

Employee won!

Keenan Powell has practiced Workers Compensation law in the State of Alaska for over 35 years and has dedicated her practice to Workers Compensation representing injured Alaskans handling hundreds of cases. www.keenanpowell.com

All consultations are free.  To make an appointment (in person, telephonic, or zoom), email: keenan@keenanpowell.com or call:  907 258 7663.

 

 

Employees have no duty to cooperate with a nurse case manager sent by the insurance company.  
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Employees have no duty to cooperate with a nurse case manager sent by the insurance company.  

Think of the nurse case manager as an insurance adjuster with a nursing degree because that is what she is. Her job is to minimize the medical benefits paid for an injured worker. She looks for evidence that the injury may not be work-related in an effort to defeat medical benefits.

Cozy Nurse-Doctor Relationship

In Freeman v ASRC, AWCB Decision No 15-0073 (6/26/15). the nurse case manager directed the injured worker from one physician to another with whom she had an established professional relationship - a relationship so cozy that the doctor signed letters that had been written by the nurse as if he had written them himself. The real reason the nurse sent the employee to that doctor was not because she was trying to secure good medical treatment from him but because she was hoping her favorite doctor would say the surgery wasn't needed or that it wasn't work related.

Under the Freeman case, the nurse case manager has a legal duty to inform the injured worker :

  • of her role, of the adversarial nature of workers compensation (i.e. she is working against him),
  • his right to decline her assistance
  • and the possibility and likelihood that the insurance company's and the worker's interest may someday diverge.

If the nurse case manager you're working with hasn't disclosed all this to you got to wonder what's going on.

Keenan Powell has practiced Workers Compensation law in the State of Alaska for over 30 years and has dedicated her practice to Workers Compensation representing injured Alaskans handling hundreds of cases.  A sample of verdicts she has obtained for Employees is found at  http://www.keenanpowell.com/past-verdicts-settlements.

All consultations are free.  To set up an appointment, use the contact form on this website or call:  907 258 7663.

The Alaska Workers Compensation Divisions’ 2021 Annual Report (released on October 24, 2022, but not yet posted online) shows alarming trends for injured workers.
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The Alaska Workers Compensation Divisions’ 2021 Annual Report (released on October 24, 2022, but not yet posted online) shows alarming trends for injured workers.

More Controversions

There were 3,605 total controversions filed in 2021, a 24.9% increase from 2020. Contoversions is the formal process by which insurance companies deny benefits to injured workers. This number does not include all the cases in which the insurance companies fail to report the benefits that were denied or withheld.

More Aggressive Legal Tactics

While insurance companies paid employee attorneys less in 2020, they paid their own attorneys more – another factor that would explain increased profits. Employers paid employees attorneys 4.3 million, a 30.8% decrease from 2020. Employers paid their own attorneys 7.2 million, a 11.86% increase from 2020.

Employees Fighting Back Less

The statistics suggest that employees are fighting back less than in previous years. There were 678 claims for benefits filed in 2201, a 6.7% decrease from 2020.

There were 161 hearings in 2021, decreased from 188 hearing in 2020 and 225 hearing in 2019. That’s a 28% decrease in hearings over those two years. The decrease in payment of employee attorney fees supports this conclusion.

Less Benefits = More Insurance Profits

Not surprisingly with the increase in controversions, insurers saved more in profits. Total benefits paid in 2021 were 188.2 million, a decrease of 8.28% from 2020.

Follow the Money

The reason insurance companies deny injured workers benefits is to improve their profits. The aggressive use of insurance attorneys coupled with increased controversions have led to increased profits.

What Are Your Rights? Find Out Now

You don’t need to wait until your claim is controverted to speak with an attorney. Find out your rights are and what you should be looking out for.

Keenan Powell has practiced Workers Compensation law in the State of Alaska for over 35 years and has dedicated her practice to Workers Compensation representing injured Alaskans handling hundreds of cases. www.keenanpowell.com

All consultations are free. 

To make an appointment (in person, telephonic, or zoom), email: keenan@keenanpowell.com or call:  907 258 7663.

Should you be worried? You should.
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The Workers Compensation Insurance Company Has the Right to Request an IME.

The law is clear. The insurance company is entitled to schedule IMEs (so-called “independent medical evaluation”). But the IME must be done at a reasonable time. If you’re out of state or cannot attend the scheduled IME for some other reason, contact the insurance company immediately in writing and ask them to reschedule the exam.

Do You Need to Collect Medical Records for the IME Doctor?

There is nothing in the law that says you do. The IME is the insurance company’s expert and it is their responsibility to provide him with all the records he needs. The insurance company should have been collecting your records since shortly after you were injured.

Why Does the Insurance Company Want an IME?

There are several reasons the insurance company might want an IME and they all boil down to: the insurance company is looking for excuse not to pay your benefits. Some of the typical questions they will ask their “independent” doctor are:

  1. Are you really injured?
  2. Is the work  injury the cause of medical treatment?
  3. Is the work injury the cause of disability?
  4. Can the injured worker go back to work?
  5. Does the injured worker need future medical treatment?
  6. Does the injured worker have a permanent impairment?

Where Do Insurance Companies Find IME Doctors?

They have two sources. If the IME doctor is practicing in Alaska, be aware. He’s working both sides of the street: giving insurance companies the opinions they want (and getting paid) and treating injured workers (and getting paid). The common denominator here is the doctor is getting paid by the insurance companies and that is where his loyalty lies.

Otherwise, there are staffing agencies that provide doctors for “IME” evaluations. Here are some of those companies in Alaska cases:

Examworks: ExamWorks|Independent Medical Examinations, Peer Reviews, Bill Reviews

Objective Medical Assessments Inc (OMAC): OMAC | Genex (genexservices.com)

First Medical Advisory Group: About (firstmagime.com)

Oregon Medical Evaluations: Oregon Medical Evaluations, Inc. – a resource for effective claims management (ormedeval.com)

Should You Be Worried?

You should. If the insurance company wanted to continue paying your benefits, it wouldn’t have scheduled an “IME.” There is nothing “independent” about these evaluations. The insurance companies have established relationships with the evaluators. They pay these doctors, many of whom are retired, lots of money. And the insurance companies are shopping for a particular opinion, one that is favorable to them and unfavorable to the injured worker.

What Should You Do?

You need to go to the appointment.

If they get the opinion they want, they will immediately cut off your medical benefits, your disability benefits, or both. And then you'll be scrambling to collect your records. Don't wait.

Meanwhile you should be collecting a complete set of your medical records. You will need them to fight for your rights if the insurance company controverts your case. That means contacting every provider that saw and asking their records department for all you records. You are legally entitled to these records.

Why Bother Fighting?

Because the insurance companies lose these cases all of the time. Most often, they lose because the Alaska Workers Compensation Board decides the so-called “IME” doctor was wrong. For a list of cases employees won, check out:

Never give up! Never surrender! 2021 in Review - Keenan Powell, Attorney at Law

Never Give Up, Never Surrender 2020! - Keenan Powell, Attorney at Law

Never Give Up, Never Surrender - 2019 Victories - Keenan Powell, Attorney at Law

Never Give Up. Never Surrender. - Keenan Powell, Attorney at Law

What Are Your Rights? Find Out Now

You don’t need to wait until your claim is controverted to speak with an attorney. Find out your rights are and what you should be looking out for.

Keenan Powell has practiced Workers Compensation law in the State of Alaska for over 35 years and has dedicated her practice to Workers Compensation representing injured Alaskans handling hundreds of cases. www.keenanpowell.com

All consultations are free!

To make an appointment (in person, telephonic, or zoom), email: keenan@keenanpowell.com or call:  907 258 7663.

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When You Need to Call a Workers Compensation Lawyer

Don't wait to call a Workers Compensation Lawyer! You need to know your rights before you are controverted. It is important to be prepared as early as possible in case you need to fight for your rights.

When to Call a Workers Compensation Lawyer

  1. If the insurance company is not paying you a fair temporary total disability rate,
  2. If the insurance company scheduled an examination with their doctor, the so-called "independent medical evaluation,"
  3. If you need to reschedule the insurance examination because you can't attend it,
  4. If the insurance company sends you a Controversion Notice (see below),
  5. If the insurance company refuses to pay your medical benefits,
  6. If the insurance company is late paying your disability benefits,
  7. If you are being evaluated for reemployment benefits (retraining),
  8. If the insurance company claims your case is closed,
  9. If the insurance company makes an offer to settle your case,
  10. If you have any questions.

What Are Your Rights? Find Out Now

Call now! (907) 258-7663

You don’t need to wait until your claim is controverted to speak with an attorney. Find out your rights are and what you should be looking out for.

Keenan Powell has practiced Workers Compensation law in the State of Alaska for over 35 years and has dedicated her practice to Workers Compensation representing injured Alaskans handling hundreds of cases. www.keenanpowell.com

keenan@keenanpowell.com

Controversion Notice