Category: Workers Compensation

 

Some insurance companies provide an "prescription card" to the injured worker to facilitate the filling of prescriptions.  The injured worker is then required to go to one of the pharmacies which accept the card, present it and, in theory, the prescription would be filled immediately.

It doesn't always work.   Frequently the pharmacist will tell the injured worker that the prescription must be "pre-approved" by the insurance company and that it called for authorization. This means waiting 3 days or more to get the prescription filled.

Then the injured worker calls the insurance company to complain and is told that the insurance company does not have a duty to pre-approve prescriptions and if the injured worker is having difficulty with the card, he can pay for the medications himself and submit a request for  reimbursement and wait 30 days for the reimbursement.

Two obvious problems with the insurance companies' instructions: first, the injured worker probably can't afford the prescriptions. Second, and most importantly, that is not the law.

Recently I won a case before the Board, King v UTI, in which the Board said that the prescription must be filled "promptly" and "promptly" means when the prescription is presented to the pharmacy.

The Alaska Supreme Court agreed last week in the decision of Harris v M-K Rivers. In that case, a man who was rendered paraplegic needed a special kind of bed for his bedsores.  The insurance company refused to pre-authorize it so he didn't get it.  The Supreme Court held that because the insurance company did not have a good faith basis to controvert the bed, and failing to pre-authorize the bed essentially prevented him from getting it and because of that penalties should be assessed against the insurance company.

If you're having problems with your prescriptions or any other questions or concerns regarding your workers compensation claim, call me, Keenan Powell.   I have more than 30 years experience fighting for the rights of injured Alaskans. Consultations are FREE.  Call 258-7663.

 

After you’re injured at work, you can expect to receive a letter from the insurance company with several releases.   Do you have to sign them?

Maybe. It depends on what they are asking for.

Medical Release:  The insurance company is entitled to all of the medical records relating to treatment of you work injury.  Also, as a general rule, the insurance company is entitled to all of your medical records relating to the body part that was injured from two years prior to the date of injury.  There is a form on the Alaska Workers Compensation Board’s website which has been drafted by the Board.  Release of Medical Information

If the insurance company’s form looks like the Board’s form and is limited to the body part injured at work and from two years prior to your date of injury, it’s appropriate.  Additionally, certain providers (like Alaska Regional and Providence) insist on their own forms.  As long as these forms are limited to the body part injured at work and from two years prior to your date of injury, they are appropriate.

Employment Records Release: The insurance company is entitled to a list of your employers during the preceding ten years and an employment records release allowing them to speak with your prior employers IF you are applying for reemployment benefits.  As a general rule, they are not entitled to this information unless you are applying for reemployment benefits.

If you have questions about your workers compensation claim, call my office.  I have more than 30 years experience fighting for the rights of injured Alaskans. Consultations are FREE.  Call 258-7663.

There’s been a recommendation for surgery.  The surgeon’s office calls the insurance company requesting it to pre-authorize the surgery so the surgeon knows he’s going to get paid.  Then the insurance company either flatly refuses to pre-authorize the surgery or doesn’t return the surgeon’s call.

So the employee can’t get the surgery and can’t go back to work because the doctor won’t release him to full duty.  Meanwhile, his employer has replaced him.

If the employee can get an adjuster on the phone, the adjuster tells him that the insurance company does not have a duty to pre-authorize medical treatment.  The adjuster suggests that the surgeon go ahead and perform the surgery and the insurance company might pay the bill afterwards knowing, of course, the surgeon won’t do that.  Or, the adjuster will suggest, the employee can pay for the surgery himself and ask for reimbursement.  Like, who has the money for that?

This situation is so common that over twenty years ago, the Supreme Court for the State of Alaska ruled an injured worker who has been receiving medical treatment should have the right to prospective determination of compensability.  Summers v Korobkin Construction, 814 P 2d 1369 (Alaska, 1991).

That means filing a claim.

It also means you can get an attorney.  The second thing the insurance company is trying to do, other than denying medical benefits, is preventing the injured employee from finding a lawyer to represent him.  When you call for an attorney, most lawyers will ask “Have you been controverted?”  That means have you received a formal Notice of Controversion (a document) from the insurance company.  If the answer is no, many attorneys aren’t interested in the case because, as a rule, the attorney cannot bet paid if the claim hasn’t been controverted.

But there are formal and informal controversions.  If the insurance company has resisted paying benefits, then its action constitutes a “controversion in fact” and justifies an award of fees.

If you hit a wall when you tell the person answering the attorney’s phone that the claim has not been controverted, call another attorney. Keenan Powell has more than 30 years experience fighting for the rights of injured Alaskans.

At the Law Office of Keenan Powell, you can get a free consultation by call 258-7663.

Joseph Heller's quote is as true in workers compensation as it is in real life.  There are individuals, and companies, who make a living following around injured employees to "detect" the injured employee acting "not injured".  In fact, the 2013 ACS yellow pages lists at least 19 such companies which is about twice as many orthopedic physicians listed.

Not surprising then that the insurance companies spend a lot of money on defense, and that amount is increasing, as the amount paid to injured workers is decreasing.

So if you were injured at work and you think someone is following you around, you probably right.  Things you should look for: a man or woman walking towards you wearing baseball caps (cameras can be hidden inside), or walking around you carrying briefcases (camera inside) or a newspaper folded under his arm (camera hidden in the newspaper).

You should also be aware of people  in cars.  In the last case where I obtained video surveillance of my client, the "investigators" followed him from his house to his house, video'd him walking into the doctor's office, and out of the doctor's office, smoking a cigarette outside a building, and driving home again. The investigator's report claimed my client did not look injured but when I watched the video, it was obvious that he was.  The Workers Compensation Board agreed with me.

I've also seen videos of my clients pumping gas and carrying milk out of the grocery store.

Try to be aware of nondescript cars or trucks that seem to be everywhere.  Try to be aware of someone sitting in a car outside your home.  Go out, talk to him, get his name, ask him if he's lost or looking for someone, take his photo with your phone, get his license plate number. It's a lousy private investigator who gets caught.

And look for a lawyer because the insurance company is building a case to terminate your benefits.

If you have any questions regarding your case, the Law Office of Keenan Powell provides free consultations regardless of whether or not you have been controverted. To contact Keenan Powell, use the contact form on this page or call 258-7663.

For more information about Workers Compensation, see: http://www.keenanpowell.com/faq-wc.html.

 

 

When you’re off work as result of a work-related injury, you receive Temporary Total Disability (TTD) which is about 80% of what your net. The exact figure, known as your “compensation rate”, is determined by looking at the two years before you were injured, picking the best of those two years and then applying a formula that was developed by the Workers Compensation Board.

Most workers feel that the amount they receive is unfair because it is not as much as they were bringing home and most people need every dime they earn to pay the bills. The Board’s justification for the ruling is that it is equally unfair to everyone and no one should be singled out for particularly unfair treatment.

You can seek to have your TTD increased if the amount is incorrect or if when it was calculated it failed to take into consideration a second income or benefits. As a rule, most people’s income will be determined by their net wages earned in the two years before the injury.

The formula is adjusted every year so every year there is a new bulletin published setting out the compensation rates. To access the bulletins, visit the Workers Compensation Board’s website: http://labor.state.ak.us/wc/bulletins.htm.

If you have any questions regarding your case, the Law Office of Keenan Powell provides free consultations regardless of whether or not you have been controverted. To contact Keenan Powell, use the contact form on this page or call 258-7663.

For more information about Workers Compensation, see: http://www.keenanpowell.com/faq-wc.html.

The State of Alaska Division of Workers Compensation released 2012 Annual Report: http://labor.alaska.gov/wc/forms/2012AR.pdf.

It shows that the insurance companies are paying their attorneys more than they were paid in 2011.  The insurance defense attorneys received 10.3 million dollars in 2012.  Doctors were paid more too: 176 million dollars in 2012.  But employee's disability benefits (temporary total disability, temporary partial disability, permanent partial impairment, permanent total disability), that amount went down 2.5% despite the fact that compensation rates were raised (See Bulletins 10-04 and 11-06 at the Board's website).

That means fewer employees are getting less money while defense attorneys and doctors are getting paid more.  In the words of Father Guido Sarducci, "Coincidenza?"

 

 

When things go the way they are supposed to: you report your injury to your Employer.  Your Employer reports the injury to his insurance company and the Alaska Workers Compensation Board. The insurance company adjuster contacts you with a claim number to give to your medical providers.  You send your doctor’s work releases to the insurance company and the insurance company sends you temporary total disability as long as you are off work.  You get the medical treatment you need and go back to work.

When things don’t go right.  The first problem I’ve seen, time and again, is the Employer refuses to report the injury to his insurance company and the Alaska Workers Compensation Board.  If that happens, contact an attorney immediately.  You will need an attorney to obtain the benefits to which you are entitled.

What kind of benefits are you entitled to?  Reasonable and necessary medical treatment for your work-related injury, for as long as you need it.  That could mean the rest of your life.  You are entitled to be compensated for time lost from work, whether you’re off full time or part time.  You are entitled to a PPI rating if you’re injury is permanent.  You may be entitled to retraining.  You are entitled to be compensated for your travel for treatment, even if it is few miles.  Gas is expensive.

For more information, check out FAQ page: http://www.keenanpowell.com/faq-wc.html.  With more than 30 years of experience representing injured Alaskans, Keenan Powell is currently accepting workers compensation cases.For a free consultation, call the Law Office of Keenan Powell: 907 258 7663.

When the Board orders an SIME (Second Independent Medical Evaluation), the Employer is obligated to pay the doctor, provide transportation and pay per diem to the Employee. These arrangements must be made and conveyed to the Employee no later than 10 days before the SIME appointment. 8 AAC 45.090.

The “per diem” is the amount of money to which the Employee is entitled for meals and incidentals. The proper amount depends on how long the Employee is out of state and where the Employee is set. The Alaska Workers Compensation Board had adopted the federal standards for establishing per diem. http://labor.state.ak.us/wc/bulletins/13-01.pdf.

The federal per diem rates are found at the government website: http://www.gsa.gov/portal/content/104877.

For instance, if an Employee was sent to San Francisco for 24 hours for a SIME, the Employer should send the Employee a check for $71 to cover meals and incidentals. http://www.gsa.gov/portal/category/100120.

If the Employer fails to provide timely notice of the travel arrangements, that is 10 days or more in advance, then the Employee is not obligated to attend the SIME. The reason for the 10 days notice is apparent. It allows the Employee time to arrange time of work or babysitting or dogsitting or any other arrangements that need to be made.

If the Employee does not attend the SIME because the Employer did not make travel arrangements timely, the Employer is obligated to pay the doctor’s missed appointment fee. If the appointment is missed, the Employee call the Board and/or request a prehearing to inform the Board designee so that another appointment can be made.

The Law Office of Keenan Powell provides free consultations regardless of whether or not you have been controverted. To contact Keenan Powell, use the contact form on this page or call 258-7663.

For more information about Workers Compensation, see: http://www.keenanpowell.com/faq-wc.html.

When you start looking for an attorney to handle your workers compensation claim, you will quickly find out that attorneys will ask you to pull together a number of records to review. At the very least, he or she will want to see all of your medical records since your date of injury, the report of the insurance doctor (EIME), if one exists, and the controversion notice, if one exists. Depending on the circumstances, the attorney may want to request more documents in order to review your case.

There are two basic reasons why attorneys ask for the file before deciding whether to accept the case: first, in order to evaluate the case properly, and second, it is a test.

It is difficult for an attorney to determine whether he or she can help the claimant without reviewing the file because Workers Compensation law, and the process, is complicated and each case is unique. Many claimants have seen a number of doctors before they call an attorney, so obtaining their medical records can be a complicated and tedious process. Moreover, where many doctors will give their patient a copy of the file for free, they charge attorneys up to $75 or more for the records, even if there is only one visit. It’s easy to see that if attorneys went to the expense and time to collect documents for every person that called, he or she would not have time to devote to pursuing his client’s claims.

The second reason for asking claimants to gather the records is that, it is a test. If a claimant does not have enough motivation to collect the files, then he or she probably doesn’t have enough motivation to see the case through. If he or she cannot or does not follow directions, then he or she will be a difficult client to work with because the claimant must cooperate during the case in order to proceed.

So if you are serious about your workers compensation claim, collect the records which are asked of you. All of them.

The Law Office of Keenan Powell provides free consultations regardless of whether or not you have been controverted. To contact Keenan Powell, use the contact form on this page or call 258-7663.

For more information about Workers Compensation, see: http://www.keenanpowell.com/faq-wc.html.