Author: Keenan Powell

The three top reasons insurance companies controvert claims are:

1.  Your doctor recommended surgery.  Insurance companies hate to pay for surgery.

2.  Your doctor determined you a chronic pain patient, that you will need pain medication to treat your symptoms.  Insurance companies want to close out claims.

3.  Your employer sabotaged your case. I’ve seen employers deny the accident happened, even if a supervisor witnessed it and I’ve seen employers hide evidence. I’ve seen employers refuse to file the required Report of Injury. Why? They don’t want their rates going up.

For every move the insurance company or your employer makes to deny you benefits, there is a counter move. Know your rights!  If you’ve been hurt at work, you need to talk to an attorney.

Keenan Powell has practiced Workers Compensation law in the State of Alaska for over 30 years and has dedicated her practice to Workers Compensation representing injured Alaskans handling hundreds of cases. www.keenanpowell.com. To make an appointment, use the contact form on this website or call:  907 258 7663.

All consultations are free.

 

 

Doctor shopping is when an injured employee goes from doctor to doctor looking for a different opinion.  It is frowned upon in Workers Compensation.  If the Board finds you have been doctor shopping, the penalty is that the new doctor’s medical opinion will not be considered by the Board and, generally, that means he isn’t going to get paid either.  It can ruin your case.

 

An injured employee is entitled to one (1) change of physician as a matter of right but s/he must inform the insurance company of the change within fourteen days of making the change.  Give the notice in writing and keep a copy for yourself.  It is best if you fax the notice to the insurance company so you can have a fax confirmation sheet proving the insurance company received the fax.

 

It is not considered a change of physician if one physician refers you to another.  Make sure they referral is in writing.  You may need to prove later a referral was made. There are many other exceptions:

 

1. If the Employer sent you to the first physician you saw and you subsequently pick a physician, that does not constitute a change.
2. If you are seen at a hospital or emergency care facility, that is not a change.
3. If you see another doctor in the same clinic as your doctor, that is not a change.
4. If you move more than 50 miles away from your doctor, you can pick another one.
5. If your doctor dies or moves away, you can pick another doctor.
6. If your doctor refuses to treat you, you can pick another doctor.

 

Keenan Powell has practiced Workers Compensation law in the State of Alaska for more than 30 years and has dedicated her practice to Workers Compensation representing injured Alaskans for the past 9 years handling hundreds of cases.  A sample of verdicts she has obtained for Employees is found at  http://www.keenanpowell.com/settlements_wc.html.

 

There is absolutely no fee for a consultation, all consultations are free.  If you want to set up a meeting, use the contact form on this website or call:  907 258 7663.

 

 

1.  Employers don’t like to file Reports of Injury.  On the job injuries raises the Employer’s insurance rates and can disqualify them from bidding for federal contracts

2.  Employers must file Reports of Injury.  Whether they like it or not, they must fill out the Workers Compensation Report of Injury form and file it with the Board 10 days after the injury is reported to them by the worker.

3. Employers will owe the Injured Worker a penalty if it fails to report the injury timely.  The amount of the penalty is based upon the benefits paid to the Injured Worker.  It is 20% of the benefits that were unpaid when due.

4.  Insurance companies don’t like Workers Compensation claims. It eats into their profits.

5.  The “Nurse Case Manager” is hired by the insurance company to keep an eye on the Injured Worker and to “coordinate” medical treatment.  That means she tells the doctor what the insurance company will and will not pay for thereby directing treatment.

6.  It’s against the law for the insurance company to direct medical treatment.  The insurance company is not allowed to tell the doctor what he can or cannot do.  Your treatment is a decision between you and your doctor, alone.

7.  It is against the law for the insurance company to deny or refuse to pay for treatment that your doctor ordered unless they can prove they have a “good faith” basis for the refusal.  Some insurance companies drag their feet without formally controverting benefits. Meanwhile the Injured Worker can’t get the treatment he or she needs and can’t get back to work.

8.  A “good faith” basis for the refusal usually means the insurance company’s doctor (so-called “IME”) says the treatment your doctor recommended is not reasonable or necessary or not related to your work injuries.

9. There is no such thing as an “Independent Medical Evaluation”. The insurance companies regularly employ doctors who will say what they want to hear, that is, give them a reason to deny your treatment.

10. You can fight the insurance company.  You can file a Claim with the Alaska Workers Compensation Board.  You can hire an attorney.

Keenan Powell has practiced Workers Compensation law in the State of Alaska for over 30 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.

 

 

 

 

Under Alaska Workers Compensation law, an injured employee is entitled to mileage reimbursement for traveling to doctors, physical therapists etc for treatment.  This year's rate of reimbursement is $.56 per mile.  That means that if you drive 5 miles one way to the physical therapist (10 mile round trip) for only 13 visits, the insurance company owes you $72.80.  Did anyone tell you that? POV_Rate_Table.

Probably not.  The way you get the reimbursement is to demand it.  You need to provide the date of the visit, where you started from, where you went and the round trip mileage.  The insurance company needs to pay you or controvert you benefit within 30 days otherwise it owes you another 25%.  Attached is a form I developed that I use in my cases to demand travel benefits.  Travel log.  Feel free to use it.

Keenan Powell has practiced  law in the State of Alaska for more than 30 years and has dedicated her practice to Workers Compensation representing injured Alaskans.

All consultations are free.  If you want to set up a meeting, use the contact form on www.keenanpowell.com or call:  907 258 7663.

 

Beware.  Be very aware if the insurance company is calling you in to talk about a settlement.  Remember firstly, the insurance company is about making profits.  It isn't interested in helping you.  And the adjuster just wants the file off his or her desk.  He or she doesn't care about what your needs are.

Secondly, you should be particularly worried if the insurance company controverted you and then wants to settle the claim. They're trying to get you into the office before you have time to talk to an attorney.

Thirdly, Workers Compensation settlements are practically impossible to undo.  You will have to live with the results for the rest of your life.

So before you sign a settlement, talk to a Workers Compensation attorney.

Keenan Powell has practiced Workers Compensation law in the State of Alaska for more than 30 years and has dedicated her practice to Workers Compensation representing injured Alaskans.

All consultations are free.  If you want to set up a meeting, use the contact form on www.keenanpowell.com or call:  907 258 7663.

In a series of stunning decisions from the Alaska Supreme Court and the Alaska Workers Compensation Board, it was ruled that when an insurance company stalls authorization of an injured worker's surgery, the insurance company has violated the law.

These are the dirty tricks that the insurance companies will use to stall an injured worker's needed surgery:

1.  They will claim they have no duty to preauthorize surgery.  Not true.  There is a duty to provide prompt medical treatment and to preauthorize needed surgery.  In Bockus v First Student/ Sedwick CMS AWCB Decision No 14-00400 (3/24/14), the Board ruled that when the adjuster told the doctor that the account was "open and billable" but refused to specifically authorize the surgery, it was illegal.

2.  They will claim they need an Employers Medical Evaluation (or "Independent Medical Evaluation") before they can authorize.  Again, untrue.  Although the insurance company has the right to demand an EME, it is not bound to do so.  Bockus.

3.  They will claim they need to send a letter to the doctor for clarification and cannot authorize the surgery until the doctor responds.  Again, not true.  In Kamitchis v Swan Employer/Liberty Mutual, AWCB Decision No 14-0039 (3/24/14), the Alaska Workers Compensation Board ruled that when Liberty Mutual adjuster Sam Moore failed to promptly authorize surgery, his actions were illegal.  In that case, Liberty Mutual said would not specifically authorize the surgery until the doctor responded to a letter Mr. Moore had sent him.

Under these cases, it is clear that the insurance company must tell the doctor that they will pay for the recommended surgery (preauthorize) and if they don't, they must have a legally recognizable reason and they must controvert within 30 days of the surgical recommendation.

So what do you do if the insurance company is stalling your surgery? You call an attorney and get a claim filed. The Board can order the insurance company to pay for the surgery, award you money penalties against the insurance  and order the insurance company to pay your attorneys fees.

Keenan Powell has practiced Workers Compensation law in the State of Alaska for more than 30 years and has dedicated her practice to Workers Compensation representing injured Alaskans.

All consultations are free.  If you want to set up a meeting, use the contact form on www.keenanpowell.com or call:  907 258 7663.