Category: Workers Compensation

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.

In Workers Compensation cases, an injured worker is free to leave Alaska while he is drawing benefits.  However his compensation rate (how much he is paid for temporary total disability) will be adjusted for cost of living.   To check the exact adjustment, go to the Workers Compensation Board's website, http://labor.state.ak.us/wc/home.htm.  In the right hand side there is a menu.  Go to "Bulletins".  In the Bulletins section, look for the most recent bulletin regarding "Cost of Living Adjustment for Recipients Residing Outside of the State of Alaska".  Currently that is Bulletin No 11-02.  Your rate will be determined by the city which you live in or to which you are closest.

Effective January 1, 2013, the rate for reimbursement for workers compensation travel to medical appointments has been increased to 0.565 per mile.  When you request reimbursement for travel from the insurance company, you need to accumulate $100 worth of reimbursements and you need to prepare a log showing the date of travel, the places traveled from and and to and the distance.

If you were injured at work, and you think someone is following you around, you're not paranoid. Insurance companies routinely hire private investigators to follow injured workers around, videotape and photographing them. In the cases I've handled, I've discovered photos and video of my clients going to doctors visits, going to the grocery store, pumping gas, hardly suspicious activity. So talk to your friends and neighbors and if you see someone sitting in a car in your neighborhood, go up to them, introduce yourself, ask their names and call a lawyer. The insurance company is preparing to controvert your claim.