Category: Workers Compensation

"An employee may not be required to pay a fee or charge for medical treatment or services provided under this chapter."  AS 23.30.097(f).

An employee never has to pay for his medical treatment for a Workers Compensation Claim.  AS 23.30.097(f).  If you were made to pay for any of your treatment then you need to submit the proof of the charge and payment to the insurance company for reimbursement.  Be sure that you keep a copy for your own files of the proof of payment and the date upon which you sent it to the insurance company for reimbursement.  There are two ways to prove that you submitted the payment:

1. You can hand carry the payment to the insurance company and ask the receptionist to sign and date your copy of the document, or

2. You can mail it priority mail.  You will be given a tracking number by USPS.  After the mail is delivered, go to the USPS website and print off the proof of delivery.

The reason that is important to keep proof of your submission is that you are entitled to a 25% penalty if the insurance company is late reimbursing you.  For more information: http://keenanpowell.com/faq-wc.html.

If the insurance company controverts you and refuses to pay the medical bills, you are not required to pay the bills.  AS 23.30.097(f).  However the doctors are not required to treat you if they are not paid under most circumstances, so you probably won’t receive treatment.

If you have health insurance or are eligible for Medicaid or Medicare, the providers can bill those entities while you are sorting out the Workers Compensation case.

If you do not want to file a claim for payment of medical benefits, then the providers are entitled to file a claim directly.

Call:  Keenan Powell 258-7663.  E-mail:  keenan@keenanpowell.com.

Workers Compensation is a whole new world and if you’ve never dealt with it before, you might feel like you just fell into the Land of Oz.

Many Employees that I meet think that they have been dealing with the Workers Compensation Board when actually they have been talking to an adjuster for an insurance company. So when the adjuster tells them something like"Workers Compensation will not pay for that surgery", the Employee believes that it’s the law that is preventing them from getting the surgery whereas the truth is that it’s an insurance company trying to increase it’s profits by denying the Employee’s benefits.

So who is "Workers Compensation"?  The Division of Workers Compensation is a part of the State of Alaska’s Department of Labor.  http://labor.state.ak.us/wc/home.htm.   It has a director in Juneau and offices in Anchorage, Fairbanks and Juneau.   In each of the offices, there hearing officers who manage the files.  In the Anchorage office, there are legal technicians who are available to talk to injured Employees.  If a case goes to a hearing, it will be decided by Board members of which there are three: a hearing officer who is an employee of the Division, and two members of the public appointed by the governor.  One of the members is from labor and one is from management.   These are the people who decide what an Employee’s rights are.

There is usually an insurance company involved in your case because all employers in the State of Alaska are required to carry workers compensation insurance unless they are approved as self-insured employers.  If they are self-insured, they will hire an adjusting firm to handle the files.  The adjuster does not work for the State.  The five largest insurers in Alaska are: Alaska National, State of Alaska, Liberty Northwest, Commerce & Industry, and Liberty Insurance.  http://labor.state.ak.us/wc/forms/2011AR.pdf.

It is important to remember that when you are talking to someone from the insurance company, they do not speak for the Board.  They represent the insurance company who pays their salary and their job is to save the insurance company money.   The adjusters have orders from the supervisors on how to handle claims, they have very little discretion.  So there is no point in arguing with them.

If you have any questions regarding your case, you can go to the Workers Compensation office and talk to a legal technician and you can consult with an attorney.   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.

mailto:keenan@keenanpowell.com.

When the employer is determined to be "medically stable", then he or she is entitled to a Permanent Partial Impairment (PPI) rating.

"Medically stable" means that there is no objective measurable improvement.  Medical stability is presumed in the absence of objectively measurable improvement for a period of 45 days however that presumption can be rebutted.

The PPI rating is determined by a physician who is specifically trained to conduct PPI ratings.  He examines the Employee and reviews medical records and then makes his determination based upon the American Medical Association Guidelines to the Evaluation of Permanent Impairment.

When the physician assesses a certain PPI rating, he will state that the Employee has a per centage of whole body disability.  The whole body figure used in Alaska in $177,000.  Thus if the physician says that the Employee has a 10% PPI rating, then the Employee should be paid 10% of $177,000 or $17,700.

There is a lot of room for disagreement in this process.   Frequently the insurance company will hire an doctor to perform an Employer Medical Evaluation (EME) and that doctor concludes that the Employee is medically stable but the treating physician say that he isn’t, that he needs more treatment to improve.

Another area of disagreement is when the Employee became medically table.  Sometimes the EME will conclude that the Employee was medically stable months before the evaluation but the treating physician assesses a different date.  The reason that is a problem is that if the Employee was drawing Temporary Total Disability during the period time after which the EME said that he is medically stable, the insurance company is going to want that money back.

The obvious area of disagreement is the PPI rating itself.  The EME will often conclude that the rating is very low, claiming that there is pre-existing degenerative changes and/or that the Employee was malingaring (faking) the extent of his disability.

When these disagreements come up, the Employee is entitled to a Second Independent Medical Evaluation (SIME).  A SIME is an evaluation by physician chosen by the Board.  The insurance company pays for the SIME and if the Employee needs to travel to the doctor, the insurance company is required to pay for the travel as well as time missed from work.

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

Contact Keenan Powell through the contact form or call: 258-7663.  Toll free: 888-368-5678.

In Workers Compensation cases, the first question most attorneys ask when a prospective client calls is: "Have you been controverted?"

A controversion can be formal or informal.  If the insurance company is obeying the law, it will send you a Controversion Notice explaining why it is no longer paying your benefits.  The back side of the form sets out what your rights and obligations are if you wish to pursue a Claim before the Board.  That information is very important, so read it.  If you don’t understand it, you can go to the Board’s office and ask to speak to a legal tech.  Or you can call an attorney.

 Controversion Notice

An informal controversion is when the insurance company resists payment of benefits.  For instance, the insurance company may refuse to preauthorize your surgery.  Because it refuses to preauthorize your surgery, the doctor won’t perform the operation.  Suddenly you’re stuck not being able to get the surgery that you need and you can’t go back to work because your injury isn’t fixed.  Even if the insurance company is paying you temporary total disability or temporary partial disability, it’s not enough to live on.  And you fall farther and farther behind.

 Even if the insurance company has not formally controverted you, you are still entitled to file a Claim to recover your benefits and you can still find an attorney to help you, because once the insurance company has controverted you, or resisted payment of your benefits, and you are successful in obtaining benefits through the services of your attorney, the insurance company will have to pay your attorneys fees.

 See http://www.keenanpowell.com/faq-wc.html for more information.

The insurance companies pay their own attorneys and doctors substantially more than they are required to pay employees attorneys.  In 2011, they spent a total of $11 million ($9.4 million and another $1.6 in litigation costs) to defeat employee’s claims.  But they only paid employee attorneys a total of $4.4 million, less than half of what the spent on their own doctors and lawyers.    Source: Alaska Workers Compensation Board Annual Report, 2011:  http://labor.state.ak.us/wc/forms/2011AR.pdf.

Workers Compensation in Alaska is a multi-million dollar business.  A total of $260.7 million was paid in benefits in 2011 including $160.4 million on medical benefits and $55.1 million in indemnity (TTD, TPD, PPI and PTD) benefits.  These benefits include those paid to workers injured in prior years as well as 2011.

In 2011, over 21,000 workers were injured.  Most of these injuries were to fingers and backs.

Employers filed 4,655 controversions in 3,550 cases in 2011, an increase of 18.1%.  But only 1,224 claims were filed which means that there are well over 2,000 workers in 2011 alone who are not pursuing their rights under the Workers Compensation Act.

The Employers do not always file controversions which would alert the Employee to his rights when they treat Employees unfairly.  The Employers will not tell you if you have the right to challenge the compensation rate which they have calculated or that you are entitled to travel benefits for every trip to a doctor or therapist.  The Employers will not tell you that you have the right ask the Board to order the insurance company to pay for your surgery.  The Employers will not tell you when you have the right to seek a Second Independent Medical Evaluation from the Board when the insurance doctor disagrees with you treating physician.

Bottom Line:  There are many injured workers who are being controverted or treated unfairly that do not seek legal representation and the insurance companies spend are willing to pay hefty sums to keep from paying Employees.  For more information regarding Workers Compensation benefits, visit: http://www.keenanpowell.com/faq-wc.html. 

In Workers Compensation cases, the amount of money which the Employee receives while off work (Temporary Total Disability, Temporary Partial Disability) is usually determined by looking at earnings during the previous two years, which is often unfair if the Employee had a much lower income in that time period.  In those cases, the Employee can file a Claim with the Board asking for an adjustment of the compensation rate.