Keenan Powell, Attorney at Law

What do you do if the health care provider’s office doesn’t or won’t bill the Workers Compensation insurance claim, or does and the insurance company doesn’t pay the bill and the provider’s office is billing you, calling you, for the money?

 

It’s illegal for a health care provider to charge an injured worker.  AS 23.30.097(f) states unequivocally:  “An employee may not be required to pay a fee or charge for medical treatment or service provided under this chapter.”

 

So what? What happens to a health care provider who continues to charge an employee for treatment as the result of a workers compensation injury? So you report the provider to the State of Alaska Consumer Protection Unit, http://www.law.state.ak.us/consumer/.At its website, the State of Alaska provides a complaint form for you to fill out and mail or fax to the Attorney General’s Office.  http://www.law.state.ak.us/department/civil/consumer/cp_complaint.html. There are instructions on how to do fill out the form and where to send it.

 

What will the Attorney General’s Office do?  They’ll send a copy to the offending provider and ask for a response.  At that point, the provider may realize what he is doing is illegal and will agree to stop hounding you for the bill.  If not, the Attorney General may proceed with a prosecution against him which means he will incur not only legal fees but may be fined.

 

The problem isn’t the doctor, it’s the biller. Any more, most doctors hire outside billing agencies who don’t understand and don’t want to learn Alaska law. In the event you hire an attorney to pursue a Workers Compensation Claim on your behalf, your attorney should deal with these issues for you.

 

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.

 

 

 

Frequently, an employer thinks he can avoid a Workers Compensation claim by refusing to provide the injured employee with the name of his insurance company and the appropriate forms to fill out.  But that won't work.

All employers are required to carry workers compensation insurance.  And if they fail to do so, a fund has been established by the State of Alaska to pay benefits to injured workers.

If you want to know if your employer carries workers compensation insurance, you can check that out on the Alaska Workers Compensation Board's website:  http://labor.state.ak.us/wc/home.htm.  

On the right of the home page is a menu. Click the link that states "Online Employer Coverage Verification Service" and follow the prompts.  You will be provided with the name of the insurer responsible on your date of injury and contact information for that company.

If your employer has failed, or refused, to provide you with a Report of Injury form, you may obtain that on the same website.  On the home page, click on the "Forms" link and pull up the Employee Report of Injury to Employer, Form 7-6100.  Or you can print use the attached form, EE ROI Form 6100.

You need to fill the form out, give a copy to your employer, a copy to the insurance company and you should file a copy with the Alaska Workers Compensation Board, 3301 Eagle St Ste 304, Anchorage, Alaska.  If you live near Fairbanks or Juneau instead, the local AWCB office addresses are posted on its website.

As always, you should keep a copy of the Report of Injury for your files.  You should keep a copy of everything that has anything to do with your injury in your files: any and all correspondence from the insurance company and the Workers Compensation Board, and all bills from your treating health care providers.

Sometimes the insurance company will deny a claim on the grounds that the injured employee did not timely report the injury to his employer.  Failing to report the injury does not mean its barred.  It means the insurance company doesn't want to pay your benefits and you will have to file a Claim with the Alaska Workers Compensation Board to obtain your benefits.

The Board will order the insurance company to pay benefits even if the injury is not reported within 30 days in a number of circumstances.  One reason, discussed earlier in this blog, is if the Board finds that the insurance company and employer were not prejudiced by the late notice.

Another reason the Board will excuse late notice is called the "discovery rule". Sometimes a worker can be seriously injured, especially common in back injuries, and not feel anything painful at the time of the injury.  As his back starts to hurt, he hopes that its just a strain and it'll go away by itself.  But ,the nature of serious back injuries is that they tend to get worse over time so after weeks have passed, he realizes that there is something very wrong and he goes to the doctor.  And the doctor tells him he has a slipped disc or a herniated disc or an annular tear.  He reports it to his employer, who reports it to the insurance company, who denies the claim because it was not timely filed.

This fact pattern comes up regularly in workers compensation.  And regularly the Board sides with the injured worker.

If this has happened to you, you need to hire an experienced Workers Compensation attorney.

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.

 

Alaska law requires an injured employee to report his injury to his employer within 30 days.  AS 23.30.100.  If the employee fails to report his injury timely, his failure to do so can bar his claim.  That means that he won't get any benefits.  That is the general rule.

There are exceptions.  The first exception is when the Alaska Workers Compensation Board determines that the employer was not prejudiced by a delay in reporting the injury. AS 23.30.100 (d)(1).  This means you have to go to a hearing and get a ruling.

When is the employer prejudiced by late notice?  If he is unable to investigate the circumstances of the injury because of the delay, if he is unable to investigate prior medical conditions of the employee because of the delay, if evidence is lost or witnesses disappear.

If the insurance company refuses to pay your claim because it says that you failed to give notice, that isn't the end of your claim.  It's the beginning of your fight.  Meet with an attorney and explain the reasons why you gave late notice.   "Lack of prejudice" is just one of a number of reasons for which the Board will excuse failure to give timely notice.

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

Keenan Powell has more than 30 years experience representing injured Alaskans.  For a free consultation, call the Law Office of Keenan Powell: 907 258 7663.

 

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.