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Published on Leave a comment on Three Signs You Need a Lawyer In Your Workers Compensation Case
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Do you know the signs of when the insurance company is going to cut you off?

Be prepared!

If you see one or more of these signs, you will need to fight for your benefits.

1.         The Nurse Case Manager. If the insurance company sends a nurse to sit on your doctor’s visits, it’s not to support you. She’s there to protect the insurance company.  She’ll do this in a variety of ways:

  • Instruct the physician as to what the insurance company will or will not pay for.
  • Guide the physician into giving a causation opinion that excludes the workers compensation injury.
  • Guide the physician into issuing a work release that exceeds the injured worker’s abilities.

But most importantly, she is a spy. Her job is to report back to the adjuster immediately as to what the doctor said so the adjuster can start the process of denying benefits.

For more information about nurse case managers, see:

Nurse Case Managers - Insurance Spies - Keenan Powell, Attorney at Law

2.         The “Independent” Medical Evaluation. Adjusters will hire a doctor of their choice to examine an injured worker. The purpose of these questions is to give the adjuster reasons to terminate disability and/or medical benefits.

            Some of the insurance company’s favorites are:

            Dr. David Bauer, an orthopedic surgeon based in Texas. For more information about Dr. Bauer, see: Dr. David Bauer’s Opinion is "Inconclusive and Doubtful" - Keenan Powell, Attorney at Law

            Dr. Scot Youngblood, an orthopedic surgeon based in San Diego. For more information about Dr. Youngblood, see: Dr. Youngblood Opinion is "Questionable" - Keenan Powell, Attorney at Law

            Dr. Jared Kirkham, a physical medicine physician based in Anchorage, Alaska. For more information about Dr. Kirkham, see: Dr. Jared Kirkham - The New Kid in Town - Keenan Powell, Attorney at Law

            Dr. Dennis Chong a physical medicine physician based in Seattle. For more information, see: Dr. Dennis Chong, Insurance Expert - Keenan Powell, Attorney at Law

            Dr. Lynne Bell, a neurologist based in Portland, Oregon. For more information, see: Gang of Seven: Lynne Bell MD - Keenan Powell, Attorney at Law

3.         Overbroad Medical Releases. The insurance company is entitled to a medical release that goes back two years prior to your first known treatment on the injured body part. So, if your current injury is to your right knee and it occurred on 1/1/25, but you had surgery on that knee on 6/15/05, then the release can go back to 6/15/03. But they don’t get your left knee records. Insurance companies sometimes send out releases that cover all medical conditions. This is a violation of your right to privacy.

            If the insurance company sends you an overbroad release, its because its hunting around for some excuse to deny your claim.

WHAT CAN YOU DO?

Call an experienced workers compensation attorney for advice!

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 claims
Workers Compensation Claims

Insurance companies routinely set the compensation rate (the amount you are paid) for an injured worker by relying upon the workers’ income records from two years prior to the injury. It’s legal, but is it fair?

The answer is: it may not be fair to you. And you may be entitled to seek an increase in your benefits.

But Is It Fair?

When is it not fair to look at past income? When the injured worker’s current income or future income is greater.

That’s because the purpose of disability benefits is to compensate the injured worker for the wages he is losing while he is disabled, which can be more than he was making in the past two years.

A Recent Case: Injured Worker Received an Increase in Compensation Rate

Recently, the Alaska Workers Compensation Board issued a decision in the case of Geerhart v Yukon Kuskokwim Health Corp, Dec. 23-0020 (April 4, 2023). The employee was a nurse who was injured while lifting a patient. She had just completed nursing training the year before. While she was in school, she didn’t work one year, and worked as a flagger one summer, earning significantly less than she earned as a nurse.

Alaska National Insurance Company used her flagging income to calculate her disability benefits. As a result, it paid her $308 per week, far less than she lost when she was off work recovering from her injuries.

After a claim was filed, the insurance company, represented by Jeffrey Holloway, voluntarily raised the compensation rate to $1,1125.25 per week, which still did not reflect her loss of income.

The Board ruled that both the $308 rate and $1,1125.25 rate were irrational. It increased the compensation rate to the legal maximum, $1298 per week.

The Board ruled:

There is no better evidence of what Employee lost than actual wages she was making when she became disabled and continues to make, as she still works for the Employer.

Here’s a link to the case on the Board’s website:

Click to access D&O%2023-0020.pdf

Are Your Disability Benefits Underpaid?

Find out!

Keenan Powell has practiced Workers Compensation law in the State of Alaska for 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.

Injured worker won his workers compensation case after his employer cut off his benefits, based upon a so-called "independent" medical evaluation.
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Happy Workers Compensation Lawyer

The Workers Compensation Case, Guerrissi v State Dec. No 22-0020

On February 13, 2019, the Employee injured his neck and left shoulder at work. He say his physician the next day because of his neck pain and numbness in his shoulder radiating into his hand. After evaluations by a number of doctors, he had neck surgery, a discectomy and fusion, for a herniated disc. He then had surgery on his shoulder.

Enter The Hitman: Dr. David Glassman

On September 7, 2019, the Employer sent him to Dr. David Glassman, an orthopedic surgeon for an employer’s medical evaluation (EME). (Employers wrongly refer to these as “independent” medical evaluations.) Dr. Glassman works at the Navy hospital along side a long-time insurance defense expert, Dr. Scot Youngblood. For more on Dr. Youngblood, see: "Independent" Evaluations: Scot Youngblood, MD - Keenan Powell, Attorney at Law.

Not surprisingly, Dr. Glassman issued a report that stated all of the Employee’s problems were pre-existing, that he had a temporary aggravation of neck pain because of the work injury which had resolved, and that neither surgery was the result of the neck injury. As a result of the report, the Employer controverted all benefits including medical.

The Case

The Employee hired Keenan Powell. A claim was filed together with a petition for second independent medical evaluation (SIME). A SIME is an evaluation by an expert selected by the Alaska Workers Compensation. Board. For more about SIMEs, see: Negotiating the Maze III: Second Independent Medical Evaluations (SIME) - Keenan Powell, Attorney at Law

The Employer opposed a SIME evaluation. So the case went to hearing the first time. The Alaska Workers Compensation Board ordered a SIME over the Employer’s objection. Guerissi v State, Dec. No 20-0013 (3/16/20): D&O 20-0013.pdf (alaska.gov)

The Employee was seen by Dr. Bruce McCormack for his neck issues and Dr. John Lane for his shoulder issues. Both doctors agreed this his injuries were work-related and his surgeries were reasonable and necessary.

The Board's Decision: Employee Wins!

The case went to hearing on November 4, 2021. The Board ruled in favor of the Employee, specifically finding:

1.         The February 13, 2019, work injury is the substantial cause of the Employee’s need for medical treatment for his cervical spine and left shoulder,

2.         The Employee is entitled to medical and transportation benefits including all his out-of-pocket expenses, plus interest,

3.         The Employee is entitled to PPI benefits,

4.         The Employee is entitled to interest and penalty,

5.         The Employee is entitled to fees and costs.

To read the full decision, see: D&O 22-0020 .pdf (alaska.gov)

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, email: keenan@keenanpowell.com or call:  907 258 7663.

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Espionage in Workers Compensation

Don't you just love a good spy movie? James Bond maybe? Maxwell Smart? I like Tinker, Tailor, Soldier, Spy. Tales of loyalty, betrayal, truth, and lies are all great fun - when it isn't your life.

Who Can You Trust?

There are two types of spies in Workers Compensation cases. The first is the Mata Hari. She pretends to be your friend. She makes life easier for you. But all the while, she's telling your deepest secrets to those who wish you harm, the insurance company. She is the nurse case manager, that nice person the insurance company sent to sit with you at your doctor visits and help move things along. Only she isn't moving things along for you. She's moving things allow for her boss, the insurance company. And that insurance company has only one goal: closing out your file. So beware of the Mata Hari!

By the way, you don't have to allow Mata Hari into your visits. You can just say no and there is nothing the insurance company can do to retaliate.

To learn more about nurse case managers, check out my post here: https://www.keenanpowell.com/blog/2018/10/18/nurse-case-managers-insurance-spies-2/

The Double Agent

There's a new spy in town: the double agent. He's the guy who is loyal to no one. He's acts like he's going to fix your problems. But he's on both sides. While he's treating your injuries, he takes money from insurance companies by performing "independent" medical evaluations, trashing the claims of other injured workers. When it comes time that the insurance company wants to close out your file, he's their go-to guy. The horrible thing is that they've trained him to say the magic words that will kill your claim. Want to learn more about double agents practicing medicine in Alaska?

Stay tuned.

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, email keenan@keenanpowell.com or call  907 258 7663.

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Workers Compensation claims

Do not assume that you have blown the statute of limitations in your workers compensation case! The statute is complicated. So, before you give up, talk to an experienced workers compensation attorney and find out what can be done.

 But beware! If you are not vigilant in pursuing your rights under the Alaska Workers Compensation Act, your case – no matter how valid it is – can be dismissed. Here are two recent examples:

Vanderpool v State of Alaska, AWCB Dec. No. 21-0123 (12/28/21)

The Employee’s claim was dismissed because his attorney failed to ask for a hearing before the deadline.

On January 1, 2017, the Employee reported a traumatic injury to multiple parts caused by ice or snow. Two years and one month later, on January 31, 2019, an attorney entered file a claim on his behalf for temporary total disability (TTD), permanent partial impairment (PPI), unfair/frivolous controversion, penalty for late paid benefits, and interest.

On February 28, 2019, the State’s attorney filed a controversion notice denying all benefits. It relied on its “independent” medical evaluation report which stated that he was medically stable and did not sustain a permanent injury.

On October 23, 2019, the Employee’s attorney brought up the topic of a SIME (Second Independent Medical Evaluation) at a prehearing. (For more information about SIMEs, see: Negotiating the Maze III: Second Independent Medical Evaluations (SIME) - Keenan Powell, Attorney at Law. The Employee’s attorney did not file a petition for SIME.

On June 11, 2021, over two years after the Employee’s attorney filed the claim, he sent a letter to the State’s attorney asking the State to agree to a SIME. Note: you don’t need the Employer’s agreement to go forward on a SIME.

On June 16, 20201, the Employer filed a petition to dismiss the Employee’s claim because had failed to request a hearing within two years of the February 28, 2019, post-claim controversion.

On August 17, 2021, the Employee’s attorney filed an ARH (Affidavit of Readiness for Hearing), the document that must be filed no later than two years following the post-claim controversion. It was due on March 3, 2021, so it was five months and 26 days late.

The Board dismissed the Employee’s case, finding:

1.            The Employee’s attorney could have filed an ARH on time or a request for additional time to prepare for one – on time. He did not.

2.            A SIME is one reason to excuse filing an ARH within two years, but the Employee’s attorney never filed a petition seeking a SIME.

3.            The Employee’s attorney’s neglect in failing to file the ARH on time was not excusable.

4.            The Employee’s attorney’s claim that he was confused about the deadlines was not reasonable when he had been served with a notice about the deadlines twice.

5.            The Employee’s attorney’s failure to calendar his deadlines was not good cause to excuse his failure to request a hearing.

6.            The COVID epidemic was not an excuse for meeting the deadline.

You can read the opinion for yourself here: D&O 21-0124 not 21-0123 .pdf (alaska.gov)

Moral of the story: An attorney who isn’t familiar with workers compensation law or procedure, or who isn’t vigilant in pursuing your rights, can destroy your case.

Ducasse v Making Employment Connections, AWCB Dec. No 22-0002 (1/5/2022)

The Employee’s claim was dismissed because her claim was filed late.

On December 19, 2017, the Employee injured her back when wheeling a Hoyer lift with a patient in it around a door. The Employer accepted the work injury and began paying TTD and medical costs.

On December 11, 2018, the Employee received her final TTD payment. On February 14, 2019, the Employee received her final PPI payment. Also on February 14, 2019, the Employer controverted all benefits based on an “independent” medical evaluation.

On August 10, 2021, the Employee’s attorney filed a new claim for TTD, PPI, medical and transportation benefits, fees, costs, and reemployment benefits.

On August 30, 2021, the Employer filed a petition to dismiss the Employee’s TTD claim as it was time-barred, i.e. the statute of limitations had run.

In dismissing the Employee’s case, the Board held:

1.            The statute of limitations applies to PPI as well as TTD claims. The Employee could file a claim for additional TTD or PPI no later than two years after the last payment of either benefit.

2.            The August 10, 2021, claim had missed both deadlines.

You can read the opinion for yourself here: D&O 22-0002.pdf (alaska.gov)

Moral of the story: You need to be vigilant in pursuing your workers compensation rights.

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, email keenan@keenanpowell.com or call  907 258 7663.

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At the Law Office of Keenan Powell, we received a number of favorable decisions from the Alaska Workers Compensation Board in 2021. Below are two significant wins:

Brown v Titan Medical Holdings AWCB Dec. No. 21-0081 (9/8/21)

The Employee fell on icy stairs at her employer-provided housing while she was on her way to work, injuring her back, right hip, right knee, and right shoulder. Most of her injuries resolved within a few months, but surgery on her right shoulder was recommended on October 14, 2020.

On January 20, 2021, the Employer controverted her benefits relying upon an opinion from Dr. Pino, its “independent” medical evaluator, having failed to read or understand his report. Dr. Pino had performed an evaluation the prior summer and found that the right shoulder condition was caused by the work injury and that recommended treatment was reasonable and necessary. The insurance company failed to attach a copy of Dr. Pino’s report to the controversion.

A claim was filed on her behalf by this office for unfair controversion and for a compensation rate adjustment as the adjuster had purposefully selected a year when the Employee made the least amount of money to calculate her benefits. Dr. Pino’s report was demanded. When it came in, the undersigned emailed opposing counsel, pointing out to him that his expert had agreed with the treating physicians. The insurance company immediately lifted the controversion of right shoulder benefits.

The case went to hearing on July 15, 2021. The Alaska Workers Compensation Board held:

            1.         Work was the substantial cause of the Employee’s disability and need for medical treatment,

            2,         The Employee was entitled to medical benefits and transportation costs,

            3.         The Employee was entitled to a compensation rate adjustment.

            4.         The insurance company had committed unfair or frivolous controversion and was referred to the Division of Insurance.

Nelson v State of Alaska, AWCB Dec. No 21-0092 (9/27/21)

This case has a long and storied past.

The Employee injured his neck at work in 2015. In early 2016, the Employer controverted benefits relying up a report by its “independent” medical evaluator, Dr. Craven. A claim was filed together with a petition for second independent medical evaluation. In late 2016, the Employee was seen by Dr. Scarpino in Hawaii who reported that the neck pain was caused by the work event. After that report, the Employer withdrew its controversion and the Employee had neck surgery.

In 2019, the Employer obtained another “independent” medical evaluator, this one from Dr. David Bauer. Dr. Bauer reported that the ongoing neck pain was not work-related. The Employer did not controvert at the time of the report.

In late 2020, the Employee’s doctor said he needed another neck surgery. The Employer refused to authorize the surgery. In early 2021, the undersigned filed a claim on the Employee’s behalf.

The Employer had a third “independent” medical evaluation, this one by Dr. Bauer, performed in April of 2021. He again stated that the need for treatment was not work-related.

A petition for second independent medical evaluation (SIME) was filed by the undersigned in May of 2021. The Employer objected to a SIME so the petition went to hearing.

The Board granted the Employee’s petition for SIME and ordered that it would be performed by Dr. Scarpino, who had performed the first SIME.

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, email: keenan@keenanpowell.com or call:  907 258 7663.

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Sign No 1: No Communication

The adjuster doesn’t respond to your calls or emails.

Sign No 2: No Reimbursements.

The insurance company didn't reimburse you for travel and out-of-pocket medical expenses.

Sign No 3: The “Independent” Medical Evaluation

The insurance company scheduled an “independent” medical evaluation. Ain’t nothing independent about them. The only one reason the insurance company sends you to its doctor is to cut off your benefits. It wants their hired guy to say you don’t need the treatment your doctor recommended, or you can work. Or both.

For more information on “independent” medical evaluations, click here: Gang of Seven: Insurance "Independent" Experts - Keenan Powell, Attorney at Law

Sign No 4: Medical Treatment Delayed

Your medical treatment is delayed because the insurance company refuses to authorize it. This usually happens when surgery is recommended. The problem is, the longer your surgery is delayed, the longer it is before you can go back to work.

Sign No 5: Disability Payment Late or Never

Your temporary total disability payments are not being paid, paid late, or underpaid. If you want to check to see what your benefits should be, look at this benefit calculator: Workers' Compensation Online Benefits Calculator. (alaska.gov)

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, email: keenan@keenanpowell.com or call:  907 258 7663.

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Prepare!

If you have looked for a workers compensation attorney, you may have called a few offices and learned that the attorneys ask you to collect your medical records. Most attorneys require prospective clients to provide them with a complete set of medical records relating to the injury. Often we will ask for records in the two years prior to the injury as well.

Reasons Why You Need to Collect the Medical Records

1.            The injured worker knows who he or she treated with.

2.            The injured worker is entitled to a copy of his or her medical records.

3.            If attorneys took on the responsibility of collecting medical records, it invokes an ethical responsibility to collect all of them before reviewing the file. If the injured worker didn’t give us all the names of the all the treaters, its impossible. We are set up to fail.

4.            When attorneys request medical records, they are billed by each office. I’ve seen bills ranging from $20.84 to $100. Most injured workers have seen an emergency room doctor, their family physician, one or two specialists, and one or two physical therapists. The costs of collecting these records mounts up.

5.            I take about ten per cent of the prospective clients who call me. If I took on the responsibility of collecting records for all of them, and paying for the records, then I wouldn’t have time to devote to my current clients.

6.            It’s a test. A good client will pull together their entire file and provide it. One thing I think about when taking the case is how cooperative my client is going to be.

If the Doctor Refuses to Release Your Records

If the doctor’s office says they will only release the records to your attorney, they are breaking the law. Alaska Statute 18.23.005 states:

Notwithstanding the provisions of AS 18.23.005-18.23.070 or any other law, a patient is entitled to inspect and copy any records developed or maintained by a health care provider or other person pertaining to the health care rendered to the patient.

So if you hear that from your doctor’s office, tell them about the law. If they still refuse, file a complaint with the Medical Board and with Consumer Protection.

For More Information

For more information on medical records, check out these blogposts:

Do Not Write On Your Medical Records - Keenan Powell, Attorney at Law

Why Do You Have to Get Your Medical Records? - Keenan Powell, Attorney at Law

Negotiating the Maze II: Medical Records - Keenan Powell, Attorney at Law

Call an Experienced Attorney

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, email: keenan@keenanpowell.com or call:  907 258 7663.

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Doctors Cannot Make Injured Workers Pay The Bill

Sometimes a medical care provider will demand an injured worker to pay his or her own medical bills. This is illegal. And it happens all the time.

Alaska Statute 23.30.097(f) bars collection of fees or charges for medical treatment or services provided under the Alaska Workers Compensation Act from the Employee.  Efforts to collect such a fee from an employee may also constitute unlawful trade practice under AS 45.50.471(a) and AS 45.50.471(b)(14) by the person referring the alleged debt to a collection service and the collection service attempting collection of the debt.

When The Doctor Can't Get Paid

There are a couple of reasons why a doctor’s office might bill an injured worker:

  1. The billing clerk doesn’t know the law, or
  2. The insurance company didn’t pay the bill.

The doctor’s office can file its own claim before the Alaska Workers Compensation Board to recover unpaid bills. They have filed and they have won.

Provider Filed Claim and Won

In the April 16, 2021, decision in Alaska State Commission for Human Rights vs United PT, the State of Alaska had filed a retroactive controversion of medical benefits – after the treatment had been rendered. United PT filed a claim before the Board. The Board ordered the State of Alaska to pay United PT $510.

The State of Alaska appealed to the Alaska Workers Compensation Appeals Commission. It lost its appeal.

The State of Alaska appealed to the Alaska Supreme Court. It lost again.

The short story is the State of Alaska paid its attorney and ended up having to pay United PT’s attorneys thousands of dollars just so it could avoid a $510 bill.

To read the full opinion, go to the Alaska Court System slip opinion page, scroll down to the date and click on the page icon. The pdf will download https://appellate-records.courts.alaska.gov/CMSPublic/Home/Opinions?isCOA=False

Employee's Rights

If the provider demands the injured worker to pay its bill, the recourse is to file a complaint with Consumer Protection. For more information, check out my blogpost: https://www.keenanpowell.com/blog/2014/05/23/can-doctors-bill-you-for-a-workers-compensation-injury/

Call a Lawyer

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, email: keenan@keenanpowell.com or call:  907 258 7663.

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Workers Compensation claims
Workers Compensation Claims

You got hurt at work. You need medical treatment. Maybe you can’t go back to your job. When do you need a lawyer?

Danger Sign No 1: The “Independent” Medical Evaluation

The insurance company schedules an “independent” medical evaluation. Ain’t nothing independent about them. There is only one reason the insurance company sends you to its doctor. It wants to cut off your benefits. It wants their hired guy to say you don’t need the treatment your doctor is recommending. Or they want the hired gun to say you can work. Or both.

For more information on “independent” medical evaluations, click here: Gang of Seven: Insurance "Independent" Experts - Keenan Powell, Attorney at Law

Danger Sign No 2: Medical Treatment Delayed

Your medical treatment is being delayed because the insurance company refuses to authorize it. This usually happens when surgery is recommended. The problem is, the longer your surgery is delayed, the longer it is before you can go back to work.

Danger Sign No 3: Disability Payment Problems

Your temporary total disability payments are not being paid, paid late, or underpaid. If you want to check to see what your benefits should be, look at this benefit calculator: Workers' Compensation Online Benefits Calculator. (alaska.gov)

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, email: keenan@keenanpowell.com or call:  907 258 7663.