What are the typical types of Workers Comp cases?
There are two typical cases that I see in Workers Compensation: The first is when the Employer refuses to fill out or file a Report of Injury because he wants to avoid increased insurance premiums or an OSHA investigation. The second is when a treating physician recommends surgery and the insurance company doesn't want to pay for it. I have successfully represented Employees in many of both kinds of cases.
What is an Employee's Rights under the Alaska Workers Compensation Law?
An Employee's right under Alaska Workers Compensation law is designed to provide a fast remedy for a person injured on the job. It is not designed to compensate the Employee for all of his damages as the result of being injured. It does not compensate him for his full lost wages. It does not compensate him for pain and suffering.
What are Workers Compensation Benefits?
Workers Compensation benefits include Temporary Total Disability, Temporary Partial Disability, Permanent Partial Impairment, Permanent Total Disability, Medical Benefits, Reemployment Benefits and Travel. In addition, if the insurance company does not treat an Employee fairly, it may be required to pay interest, penalties, and attorneys fees.
What are Disability Benefits?
When an Employee cannot work at all because of his injury, he or she is entitled to Temporary Total Disability (in most cases) from the date of his injury until he or she is "medically stable". The Employee is "medically stable" when he or she is no longer improving. At that point, the Employee is entitled to have a rating for Permanent Partial Impairment (PPI).
What is the differences Temporary Total Disability, Temporary Partial Disability, & Permanent Total Disability?
Temporary Total Disability is approximately 80% of the net wages of the Employee. A Permanent Partial Impairment rating is multiplied against a "whole body" of $177,000. So if the worker receives a rating of 10%, he or she is entitled to a payment of $17,700. That payment will be made in a lump sum unless the Employee is participating in a reemployment training program.
Temporary Partial Disability may be paid when an Employee can work part-time until he or she is medically stable. If the Employee cannot return to work at all after becoming medically stable, he or she may be entitled to Permanent Total Disability which is a benefit that will be paid to the Employee for life. Offsets will be calculated when the Employee receives Social Security Disability.
What are the terms of Medical Benefits?
Medical benefits will be paid for the reasonable and necessary treatment of the work-related injury. This treatment includes treatment that is "curative" (treatment intended to cure the injury) and which is "palliative" (treatment to abate chronic debilitating pain).
What are Travel Benefits?
The Employee is entitled to travel benefits for going to and from medical treatments.
What are Reemployment Benefits?
Training for reemployment may be available if the Employee cannot go back to the job that he or she was doing at the time of the injury. There are many exceptions. When a treating physician determines that the Employee will receive a Permanent Partial Impairment rating and cannot do the job he or she was doing when injured, the Employee should request Reemployment Benefits.
Reemployment Benefits include the cost of the evaluation, plus tuition, books, and other things necessary for the retraining (such as a computer) as well as a "41k" benefits. The Employee may elect to waive Reemployment Benefits and accept a Job Dislocation Benefit instead, the amount of which is determined by the Permanent Partial Impairment (PPI) rating. "41k" benefits replace Temporary Total Disability and are paid after the PPI payment is exhausted. They are paid for the duration of the training. The rate of "41k" benefits is approximately 70% of the Employee's net wages.
What are & who pays Penalties, Interest, Attorney's Fees?
The Employee is entitled to a 25% penalty for any payments which are paid late. The insurance company may also be assessed penalties by the Workers Compensation Board if the Board determines that any controversions were frivolous or unfair.
Interest will be awarded as well for late payments made to the Employee or treating physicians.
The insurance company will be required to pay for the Employee's attorneys fees if the attorney was successful in prosecuting the claim on the behalf of the Employee or if the attorney was helpful in obtaining benefits for the Employee.
What are the Workers Compensation Procedures?
Procedures are as follows: A Report of Injury is filed. An Employer Independent Medical Evaluation is performed. A Controversion Notice may be issued. The Claim may be filed after the controversion notice is filed. A Second Independent Medical Evaluation (SIME),Prehearings, Hearings, and Appeal may follow.
What is a Report of Injury?
A form called "Report of Injury" is filled out by the Employee and the Employer when the Employee is injured. The Employer is responsible for filing the form with the Alaska Workers Compensation Board and with contacting the insurance company.
What is an Employer Independent Medical Evaluation?
Many times, the insurance company will arrange for a medical evaluation by a doctor of its choice. The Employee must cooperate and submit to the examination or file a Petition for Protective Order with the Workers Compensation Board stating reasons why the Employee believes he or she should not have to submit to the examination.
What is a Controversion Notice?
Under the law, the insurance company should mail a Controversion Notice to the Employee if it refuses to pay any benefits stating the reason for the refusal.
What is a Claim?
Most claims are filed by the Employee if the insurance company fails to pay benefits, delays benefits or controverts benefits. Claims or Petitions can be filed for any number of other reasons if the Employee, or Employer or treating physician, wants to litigate an issue before the Workers Compensation Board. A Claim must be filed within two years of the Controversion Notice. There are exceptions to this rule but the best practice is to file the Claim within the two year period.
What is a Second Independent Medical Evaluation (SIME)?
If there is a dispute between the treating physician and the Employer's Independent Medical Evaluator, the Workers Compensation Board will require a SIME. A SIME is an examination and report by one or more doctors selected by the Board. The insurance company is responsible for paying the SIME doctor's fee as well as travel and per diem for the Employee to attend the evaluation.
What are Prehearings for?
Prehearings are scheduled in order to bring everyone into one room to make sure that all parties are clear about what the disputes are and the case is progressing.
What are Hearings?
The hearing is a trial. Evidence is submitted. Testimony is taken under oath. The parties submit hearing briefs, witness lists and exhibits in a manner prescribed by regulations. The parties have the opportunity to make an opening statement and closing arguments. The Board will make a written Decision and Order after the hearing which is mailed to the parties and posted on the Board's website.
What is the purpose of an Appeal?
If either party disagrees with the Board's decision, he or she can file an appeal with the Appeals Commission within the time limit established in the Decision and Order. If either party disagrees with the decision of the Appeal Commission, he or she can file an appeal with Alaska Supreme Court.
What is the "Coming and Going" Rule?
The "coming and going" rule is that an injured employee is not entitled to Workers Compensation benefits if he is coming or going home when he was injured. The exception is if he was injured on the employer's premises, such as slipping and falling on the employer's sidewalk.
What is the "Remote Site Doctrine"?
The "remote site doctrine" says that everything that happens to an employee is a Workers Compensation injury if he is working at a remote site.
What if you are assaulted at work?
Intentional torts are not compensated under the Workers Compensation Act. The only remedy is to the person who committed the assault and possibly that person's employer.
What if you were injured at work while intoxicated?
Injuries which were sustained with the substantial cause of the injury was the employee's intoxication are not covered by Workers Compensation.
What if the insurance company is claiming a "Pre-existing injury"?
"Pre-existing injury" is an issue raised by the insurance company when it doesn't want to pay benefits. It will claim that the symptoms are related to degenerative changes or a prior injury. When a work-related injury combines with, aggravates or accelerates a pre-existing injury, the employee is still entitled to benefits.
Can the insurance company hire surveillance?
The insurance companies can and do hire private investigators to follow injured employees around and to video tape the injured employee hoping to catch evidence that the employee is not injured.
What are other resources for Workers Compensation?
The Anchorage Workers Compensation Board's website is an excellent resource for Employees. On the website is a brochure that can be printed, "Workers Compensation and You". The Board's forms also can be downloaded using Adobe Acrobat or printed. Bulletins which are issued by the Division are posted on the website. The Rate Tables for Temporary Total Disability can be accessed on the site as well as instruction for computing the rate.
The Board's website is: http://labor.state.ak.us/wc/home.htm