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Author: Keenan Powell

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Preauthorization usually becomes an issue when you need surgery because a doctor will not perform surgery if someone doesn’t promise to pay the bill. And if you can’t get the insurance company to preauthorize the surgery, you’re stuck. You can’t work without the surgery and you can’t get the surgery.

Insurance companies will sometimes say that they are under no duty to preauthorize medical treatment. That’s not true. In Alaska workers compensation cases, the insurance company has a duty pay all reasonable and necessary medical treatment which is caused by the work-related injury. If they don’t want to pay the bill, the insurance company must justify its refusal.

The right way for the insurance company to do that is to controvert the recommended surgery based upon an EIME report. Sometimes the insurance company will stall preauthorization while it sends the injured employee to an EIME (Employer “Independent” Medical Evaluation) to see if the doctor of their choosing agrees that you need surgery and the recommended surgery was caused by the work injury.  When the insurance company controverts, it should send you a Controversion Notice.

But sometimes the insurance company will just blow you off. That is called “controversion-in-fact.”

In each of these cases, there is something you can do. You can file a claim for medical benefits including obtaining a Board order authorizing the surgery. The claim must be filed with the Workers Compensation Division. http://labor.state.ak.us/wc/home.htm.

If the insurance company is refusing to preauthorize your surgery, you need to find out whether you are being treated fairly. Call an experienced Workers Compensation 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.

 

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The Alaska Workers Compensation Act provides that a disabled injured worker is entitled to TTD (Temporary Total Disability) or TPD (Temporary Partial Disability) for the period of time during which he or she cannot work.

TTD is paid when the injured worker cannot work at all.  TPD is paid when the injured worker is working part-time.

These payments begin when the employer, or his insurance adjuster, receives written notice that the injured worker is disabled. This is where a lot of injured workers make their first mistake. They trust the doctor to send the note to the right people. Or they trust a nurse case manager who the insurance company sent to get the note to the right people.

Don’t trust anyone to do your work for you. Doctor’s offices do not routinely send out work releases. They might. But they don’t always do it, nor do they think to do it. The folks at the doctor’s office front counter who process your bill don’t need to see the work release so they probably won’t look for it.

The nurse case manager is an insurance company spy. Her job is not to make sure you get the most you can out of your case. Her job is to make sure the insurance company pays as little as possible. So she has no incentive to ask for the work release and deliver it to the right people.

You need to get a copy of the written work release during your doctor visit. Do not leave the office without the work release. Ask for three copies: one for you, one for your employer and one for the insurance adjuster. Then, drive straight to your employer’s office and deliver a copy of the work release to them. Make a note on your copy of the work release of the date and time when you delivered it and the person you handed it to.

Then drive to the adjuster’s office and do the same thing. Make a note of the date and time you delivered it and who you gave it to. If the adjuster doesn’t have an Alaska office, go to Mail Boxes Etc or the UPS store or the Fed Ex store and fax it to the adjuster with your claim number, if you have it. If you don’t have the claim number, fax it anyway with the name of your employer and your date of injury. Keep a copy of the fax confirmation sheet for your records.

Get a new doctor’s work release every time you go see the doctor. Every time you get the work release, give a copy to your employer and a copy to the adjuster documenting again when it was delivered, as before.

Your first TTD or TPD check is due on the 14th day after the employer received the work release. AS 23.30.155(b). Subsequent payments should be made every 14 days after that. The payments will continue until you go back to work or are deemed medically stable or you are controverted.

If the payments are more than seven days late, you are entitled to a 25% penalty. AS 23.30.155(e). Some insurance companies will voluntarily pay the penalty but the recent trend is that you have to fight for it.  To do that, you must file a claim with the Workers Compensation Division. http://labor.state.ak.us/wc/home.htm.

If your payments are not paid, or paid late or if you are controverted, you need to find out whether you are being treated fairly. Call an experienced Workers Compensation 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.

 

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The 2015 Annual Report from the State of Alaska Division or Workers Compensation shows what a big business workers compensation claims are and insurance companies’ trends to improve their profits. The full report is accessible on the Division’s website at: http://labor.state.ak.us/wc/forms/2015AR.pdf

In 2015, Reports of Injury increased 6.5% from to 19,909 reported injuries. Insurance companies controverted 3,682 claims and after cases were filed with the Board, the insurance companies controverted 2,645 claims.

And the insurance companies are often wrong. 1,200 claims were filed in the Division (cases filed after the insurance companies controverted the claim). 614 cases settled after the insurance company controveted benefits and the Employee filed a claim. That’s more than one-half.  Another 164 cases went to hearing.

The point is: when insurance companies controvert benefits, the controversion is not always fair. According to these numbers, in more than half of the cases the insurance companies initially controverted, they later paid out settlements. They would not have done so if they thought they could win the case.

If you have been controverted, you need to find out whether you are being treated fairly. Call an experienced Workers Compensation 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.

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The 2015 Annual Report from the State of Alaska Division or Workers Compensation shows what a big business workers compensation claims are and insurance companies’ trends to improve their profits. The full report is accessible on the Division’s website at: http://labor.state.ak.us/wc/forms/2015AR.pdf

In 2015, payments made to injured workers during the reemployment process (“41k”) were down .4 million dollars. Employee evaluations were down .9 million. Plan developments were down .03 million. And job dislocation benefits were up 1.7 million.

Why the push for job dislocation benefits when at first look it seems the insurance companies are spending more money on those benefits than they would have had they retrained the Employee?  The insurance companies are playing the long game in reemployment for two reasons:

First, reemployment can last for up to two years. Spending a little extra in the first year on job dislocation benefits will result in a savings the following year in retraining costs that weren’t paid.

Second, Employees only get reemployment or job dislocation benefits once in their life. By offering a few thousand to an Employee instead of retraining, when he is broke and needs it most, the insurance companies have insured that Employee will never be able to ask for reemployment benefits again. Ultimately, years down the line the savings will be huge.

There has been at least one recent important development in the law of reemployment: the job description which is used when evaluating an Employee’s ability to return to work in the job he was performing when injured. It used to be the Reemployment Benefits Administrator would pick one job description even if that description did not encompass all of the Employee’s duties. That is now against the law, they must consider more than one job description if that better fits the job that the Employee was doing. This difference can be crucial in whether or not an Employee received retraining or job dislocation benefits.

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.

 

 

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Events in Anchorage this weekend include: the immortal ballet, The Nutcracker Suite, at the PAC, the immortal warriors, Alaska Aces, playing at the Sullivan Arena and the immortal theater experience, Christmas in Spenard, at Hard Rock Cafe.

If you don't want to spend money, there's sledding at Kincaid Park and the various hills around town. The lakes are still a little thin, use caution if you're skating. The cross-country trails haven't been groomed yet so you can still walk your dogs. IceTrailsStatus.

Temperatures are predicts to drop to single digits over the weekend.

Only twelve days to Solstice and counting.

 

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The 2015 Annual Report from the State of Alaska Division or Workers Compensation shows what a big business workers compensation claims are and insurance companies’ trends to improve their profits. The full report is accessible on the Division’s website at: http://labor.state.ak.us/wc/forms/2015AR.pdf

In 2015, a total of 301.7 million dollars of benefits was paid, an increase of 2% over 2014. Medical benefits of $162.5 million and indemnity (temporary total disability, temporary partial disability, permanent partial impairment and permanent total disability) in the amount of $73 million were paid.

There were some interesting changes in the amount of indemnity benefits paid in 2015. TTD (temporary total disability) was down by 4.8 million. TPD (temporary partial disability) was down by .1 million while PPI (permanent partial impairment ratings) were up 2.4 million.

One could infer from these numbers that insurance companies are forcing PPI ratings earlier which in turn terminates the Employee’s TTD or TPD benefits sooner at a huge savings to the insurance companies.  In 2015, the savings to the insurance companies for rushing the PPI rating according to these numbers is 2.5 million dollars!

These numbers are consistent with what I have been seeing . More and more Employees are sent to an “independent” medical evaluation (arranged by an insurance company) where that doctor states that they are medically stable, able to go back to work and have a small, if any, PPI rating – even while the Employee is still in pain and still seeing his doctor for treatment, even while the treating doctors are contemplating surgery or a second surgery.

Although it looks legal enough on paper, so much so that a trusting Employee would not contest the insurance doctors’ statements, the Employee still has rights. He always has the right to fight unfair treatment by the insurance company. Being rushed to a PPI rating is one such example of unfair treatment.

If an Employee is disabled from work and requires medical treatment, he is entitled to TTD or TPD and medical benefits regardless of what the insurance doctor says. The Employee has the right to file a Claim to pursue his rights and to hire an attorney to assist him.

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.

 

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Insurance companies don't like to pay for “palliative care”.

“Palliative care” is defined as “medical care or treatment rendered to reduce or moderate temporarily the intensity of pain caused by an otherwise stable medical condition, but does not include those medical services rendered to diagnose, heal, or permanently alleviate or eliminate a medical condition. AS 23.30.395(29).

In other words, palliative care isn’t going to fix you but it will help you deal with your pain. The most common types of palliative care are chiropractic treatment and chronic pain medication.

The Employer is obligated to pay for palliative care even after medically stability (not going to get better) under the following conditions:

  1. To enable the employee to continue in the employee’s employment at the time of treatment,
  2. to enable the employee to continue to participate in an approved reemployment plan, or
  3. to relieve chronic debilitating pain.

AS 23.30.095(o).

In order to receive palliative care, you doctor must certify that the care meets on of those three requirements.

If your benefits have been controverted, you need to speak with 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.

medical-stuff

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gavel-booksThe question is:  Do an injured employee get workers compensation benefits when he or she is assaulted in the workplace?

The answer is: Maybe.

As a general rule, workplace assault is not covered by workers compensation. However in a recent case, Devine v Great Divide Ins. Co., the Alaska Supreme Court held that because the employer engendered, exacerbated or facilitated a workers’ assault, the then injuries arose out of an in the course of employment.

The facts of the case are: Thomas Sindorf was helping out Paul Chatari in his concrete business on July 7, 2009. Chatari had an employee, Christopher Todd Allen, who hated Sindorf. Allen told Chatari that he could not work in Sindorf’s presence. In order to calm him down, Chatari gave Allen two Valium.

Chatari knew Allen well enough to know that he was a violent person. Allen left the job side and then returned. Chatari did nothing to warn Sindorf or to warn the other employees about Allen. Chartari did nothing to stop Allen from attacking Sindorf.

When Allen returned to the jobsite, Allen attacked Chartari twice causing him significant injuries to his teeth, hip, shoulders and head. Allen was charged and convicted of assault.

If you were assaulted in the workplace, your entitlement to benefits will depend on the evidence. Did the business owner or your supervisor know that the person who assaulted you was violent? Did the business owner or your supervisor know that the person would single you out? Did the business owner or your supervisor warn you or take any steps to protect you?

If you were assaulted in the workplace and required medical attention or were disabled, you should speak with 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.  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.

 

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medical-stuffThis time of year, I get a lot of calls from workers who have been unfairly denied Workers Compensation benefits. Some of the illegal excuses that the employers or the insurers use are:

  1.  The injury was not reported on time. FALSE. You are required to report your injury when you have lost time from work or sought medical treatment AND you know that your injury is work-related. Most workers try to shake off their work injuries and don't want to complain about every little scratch and strain. So its reasonable that they would wait until the injury does not resolve to go see the doctor. If you report the injury after you saw the doctor, then you reported it timely. And if your boss or supervisor was aware you were hurt, then you reported it timely.
  2. You didn't fill out a report of injury. FALSE. It's the employer's responsibility to fill out the report of injury and to file it with the board.
  3. Your work injury is an aggravation of a preexisting condition (which never bothered you before). FALSE. When a work injury accelerates, aggravates or combines with a preexisting injury to cause a disability or need for medical treatment, it is still a workers compensation injury.

Workers Compensation law is complicated. If you have been denied benefits, for whatever reason, you need to speak to 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 found on the website, www.keenanpowell.com or call 258-7663.

For more information about Workers Compensation, see:  http://www.keenanpowell.com/faq‑wc.html.

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The general rule is that Temporary Total Disability (TTD) is computed based upon the best of the employee’s prior two years of earnings. Say the employee was injured in 2016 and he would have made $30,000 but in 2015 he made $15,000 and in 2014, he made $4,000. His TTD would be computed based on the $15,000 he earned in 2015.

There are exceptions to this rule.  In order to determine whether an exception applies to your case, you will need to speak with an attorney.

To find out how much money you would be entitled to, you divide the gross earnings of that best year (in our case $15,000) by 50 to yield a Gross Weekly Wage.  If the gross earning were $15,000, that divided by 50 equals $300 Gross Weekly Wages.

Then you go to the Alaska Workers Compensation Board website’s Benefit Calculator Page: http://labor.state.ak.us/wc/benefitcalculator.htm.

In box marked "type of benefit", you would select Temporary Total Disability, then type in your date of injury and your Gross Weekly Wage and the website will compute how much you are entitled to. In our case, if the Employee was injured on 2/1/2016 and had a Gross Weekly Wage of $300, and he filed his taxes as single with one exemption, then he would be entitled to $259.14 per week. The checks come every two weeks so he would receive $518.28 for every two-week period that he was totally disabled from work.

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.