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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.

 

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 14^th 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.

 

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.

 

 

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.

 

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.

 

When someone calls me for a consultation, I request they bring at the minimum the following documentation to the appointment:

1. Controversion Notice(s), if any,
2. All of the medical records relating to the injury,
3. Any and all insurance doctors reports.

I may also request:

1. All medical records from two years prior to the date of injury, if the insurance company is claiming there is a pre-existing injury,
2. Tax records for the two years prior to the date of injury if there is an issue regarding the compensation rate.

Tip #1:  Getting the Board’s file:  You can obtain a complete copy of your Alaska Workers Compensation Board file which would include your Report of Injury, Controversion Notices, Claims, Answers, Prehearing Conference Summaries and some medical records directly from the Alaska Workers Compensation Board.  In Anchorage the address is 3301 Eagle St Ste 304. The telephone number is 269-4980. However, that file will not have your complete medical records so you still need to get them from the providers.

Tip #2:  Getting your medical records:  You should obtain complete medical records from each provider you have seen.  The papers the doctors hand to you when you leave the appointment is not the complete file so you need to request the records from every provider. That includes hospital emergency rooms, urgent care clinics, family practitioners, chiropractors, orthopedic surgeons, pain doctors and physical therapists. To obtain the records, you can call the provider’s general information number and ask for the records department. Under Alaska law, you are entitled to a copy of your file. Most providers will give you one copy free of charge.

Tip #3:  Getting your tax records. You can obtain a copy of your tax records directly from the IRS.

Tip #4:   Be prepared for the appointment. If you don’t have the complete file prior to the appointment, call to reschedule.  The reason for your appointment is for you to obtain the most informed evaluation of your case which means that you need all of the documentation which was requested.

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.

All consultations are free.  To make an appointment, use the contact form on this website or call:  907 258 7663.

 

 

 

 

An injured worker is entitled to one change of physician in the Alaska Workers Compensation Act.  AS 23.30.095(a). The policy behind allowing only one change of physician is to prevent "doctor shopping."  However, the following changes are not considered changes in physician:

1.  Referral by one doctor to another doctor,
2. Written consent by the insurance company to a change in physician,
3. All the doctors in the same clinic,
4. Hospital treatment or emergency care facility treatment,
5. Physicians selected by the employer, or insurer,
6. When the employee moves more than 50 miles from his/her doctor,
7. When the attending physician dies or moves more than 50 miles away,
8. If the attending physician refuses to treat the injured worker,
9. If the injured worker requests the employer or insurer in writing to consent to change of physician and the employer or insurer do not respond in writing within 14 days of the request.

AS 23.30.095(a), 8 AAC 45.082(b),(c).

Of course, an injured worker can obtain treatment anywhere and from anyone he or she chooses however if s/he makes an excessive change of physician under the Alaska Workers Compensation Act, then under the current regulations, the reports of the subsequent physicians will not be admissible in a hearing and the insurer will not be ordered to pay the subsequent physicians even if the employee wins. 8 AAC 45.082(c). Whether this regulation is constitutional has not been litigated.

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. www.keenanpowell.com.

All consultations are free.  To make an appointment, use the contact form on this website or call:  (907) 258-7663.

 

 

When you are injured at work, your employer's insurance company is required to pay 100% of your medical benefits. All you need to do is tell the doctor's office the name of the insurance company. The doctor's office will know who to contact to get paid.

If you have paid any expenses out of pocket, including prescriptions, for your treatment, you are entitled to be reimbursed by the insurance company. To obtain the reimbursement, you need to send copies of the receipts to the adjuster. Sending it certified mail is best so you can prove what date you sent them. If the reimbursements are late, you are entitled to a penalty.

You are entitled to treatment for your work-related injury as long as is necessary to cure, or improve, your condition. You may also be entitled to "palliative care" after your condition has reached maximum improvement. "Palliative care" is care which alleviates pain.

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.

Free consultations.

If your TTD check is late, you are entitled to 25% penalty. The first payment from the insurance company is due 14 days of it learning that you are disabled. That means that it needs to have a note from the doctor in its file. The payment is late if it is mailed 7 days after it became due.

After the first payment is due, if your disability continues, then the subsequent payments are due every 14 days.

It sounds straightforward but it isn't. First, the insurance company needs the doctor's note in its file before it must pay you TTD. The doctor does not send the note to the insurance company. That is the injured worker's job. If you don't know who the insurance company is, deliver it to your employer.

The next issue is proving you gave it to your insurance company or your employer. The best proof is a receipt signed and dated by whomever you gave the note to.

The next problem is that these doctor's notes often expire. If the doctor wrote you off work until the next follow up visit, it's your job to get another work release from him at that follow up visit and deliver it to the insurance company or your employer. And keep the proof of that.

The next problem is proving the  payment was late. Keep the envelope the check came in. Make a xerox of the check. The check should be dated. The envelope should have a post-mark.

So in sum these are the things you need to prove that the TTD check was late and that you are entitled to penalties:

1.  A doctor's note saying you cannot work,
2. Proof that you delivered the doctor's note to the insurance company or your employer,
3. Copy of the late check,
4. The envelope the late check arrived in.

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. www.keenanpowell.com.

All consultations are free. To make an appointment, use the contact form on this website or call: (907) 258-7663.

 

Someone asked me today why I give free consultations.

I do that because injured workers are usually broke. It's bad enough they can't afford to support themselves or pay for medical treatment, they shouldn't have to pay for legal advise.

And if they don't have free access to information, they won't have a chance to fight their case.  And that's what the insurance companies want. They want to starve out injured workers to make them go away.

So I'm happy to review cases for free whether or not the injured worker has been controverted yet.  Sometimes a little advise before a problem arises will help the injured worker to avoid some of the pitfalls.

If I take the case, it's on a contingency fee basis which means I'm only paid by the insurance company at the end of the case if we are successful.  The injured worker is never responsible for paying my fees.

For a free consultation, call Keenan Powell at 258-7663.