Category: Workers Compensation

Mediation – Sometimes, the insurance company will suggest that a case should be mediated. There are a few reasons why the insurance company might do this, and these reasons are always to benefit the insurance company, not the injured worker. The insurance company may think you have a really good case and they want to get out of it as soon as possible with the least amount spent. The insurance company may think you have a horrible case and they want to get out of it as soon as possible with the least amount spent.

The insurance company might think you are being unreasonable they want to get out of it as soon as possible with the least amount spent. The insurance company’s attorney might think his adjuster is being unreasonable and he wants to get out of it gracefully.  Sometimes, the insurance company is afraid that Board will find out how badly it treated you and it wants to sweep the whole thing under the rug because the Alaska Workers Compensation Board can send a referral to the Division of Insurance and the insurance company can be investigated for violating insurance laws.

The point is: the insurance company wants to get out of the case.

You don’t have to go to mediation if you don’t want to. If you go to mediation and you don’t like the settlement offer, you don’t have to take it. Settlement negotiations are per se inadmissible in a hearing on the merits so if you refused a settlement offer should not have an adverse impact upon your case.

If you do go to mediation, a mediator will be selected from the Board’s hearing officers unless the insurance company offers to pay for private mediation, which is increasingly rare.

If you do agree to mediation, the mediator will send you a letter setting out what s/he needs before the date of the mediation, including the mediation brief and exhibits.

You do not send a copy of your mediation brief to the insurance company’s attorney. Your brief is filed only with the Board. The insurance company will not send you a copy of their brief.

At the mediation, the mediator will tell you how good s/he thinks your case is and how good s/he thinks the insurance company’s case is.

You don’t have to settle.

You can settle some benefits and leave other benefits open. It is common to settle the indemnity benefits and leave medical benefits open.

If you do go to mediation, plan to spend the day. Bring your cell phone charger. Bring something to read, a deck of cars, a crossword puzzle, or your knitting. Bring plenty of food and water and coffee. The more comfortable and entertained you are, the longer you can hang in there and get a better deal.

The insurance company won’t make a serious offer until after lunch time. Why is that? Why don’t they just tell you up front what they are willing to pay? One reason, I think, is that it’s become part of the culture; it’s been done that way for years. Another reason is that they’re afraid if they offer you everything they have up front, you’ll reject it and the case won’t settle. I tend to think it’s because of the heavy influence of masculine competition that dominated the practice of law for so many years. They need to feel like there was a big fight and that they won something, so you end up playing a tug-of-war like you do with your puppy.

Settlements – If you come to a settlement agreement, with or without mediation, the agreement will be reduced to writing. The insurance company attorney should send you the agreement before you sign it. ALWAYS read the settlement agreement carefully before you sign it. DO NOT go into the insurance company’s law office to sign it unless you have already read and fully understand it. A few things to remember:

DON’T waive your reemployment benefits unless you are actually getting money for them. There is currently a dispute about whether waiving reemployment benefits will forever foreclose an injured worker from seeking reemployment benefits in the future even if it’s for a different injury. For instance, if you injured your knee in one case and waived reemployment benefits because you could go back to work and didn’t need retraining, someday if you injure your back and can’t go back to work, you would not be eligible for reemployment benefits because you waived your benefits in the knee case. Because insurance companies generally insist on a waiver of reemployment benefits, you might be better off years down the line if you went to hearing instead and had the Board order you were not eligible. That way, you would not have waived your benefits and may be eligible some day in the future.

Waiving medical benefits is usually a bad idea, especially in back cases and some knee and shoulder cases which can become a lifetime problems. Think hard about whether the money they are offering you is worth the risk of you not being able to get medical treatment some day in the future for that injury. Talk to your doctor and ask him or her whether you may need treatment in the future.

Closing indemnity benefits means you are going to give up all your future claims to temporary total disability, temporary partial disability, permanent partial impairment rating and permanent total disability. That means if you are ever off work again because of this injury, you will not get any more money. There are many reasons why you could be off work in the distant future because of your current injury. You may need more surgeries or your injury may deteriorate to the point where you just can’t work anymore.

Don’t forget penalties and interest. If the insurance company failed to pay any of your past benefits on time without a legally-recognized excuse, you are entitled to 25% penalties.

Don’t forget your transportation benefits. For the past several years, you have been entitled to more than 50 cents per mile for round-trip travel to your treatment, including physical therapy appointments. That can add up fast.

Keenan Powell has practiced law in 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.

 

On 9/17/15, the Employee won his case. Williams v Arctic Terra/Umiliak Insurance Co., AWCB Decision No 15-0116 after a year of litigation during which time he was required to attend another “independent” medical evaluation plus testify at his deposition plus fly to San Diego for the Board-ordered second independent medical evaluation and a full day of trial. The Board ordered Umialik Insurance Company to pay his temporary total disability (TTD) back to January 24, 2014, to pay his past and future medical costs for his work injury and to pay his fees and costs.  Umialik was also ordered to pay penalties because it had obtained an “independent” medical evaluation from Dr. Yodlowski in which she rated the Employee with a PPI rating but Umialik never paid it.

Because of the decision, he was able to get the surgery he needed. However Umiliak was consistently late with his checks, which were supposed to be issued every 14 days. A new claim was filed against Umialik for penalties. The case went to hearing on 9/28/16 and the Umialik adjuster, Robbie Sullivan, testified. Williams v Arctic Terra/Umiliak Insurance Co., AWCB Decision No 16-0095 (10/26/16).

She testified that she had timely mailed a 5/16/16 TTD check to the Employee. By 5/19/16, his attorney had contacted her attorney who told her the check had not been received. She stopped payment on it on 5/27/16 and mailed the first replacement check on 6/1/16, a period of 13 days.

On 6/8/16, she was informed by her attorney that neither the 5/19/16 check nor the first replacement check had been received. On 6/27/16, she mailed an unrelated, routine TTD check but still had not made good on the missing 5/19/16 check. By 7/15/16, she has learned that neither the 5/19/16 check nor the first replacement check had been received. On 8/12/16, she stopped payment on the 6/1/16 first replacement check and mailed a second replacement check. She had no explanation for why she waited from 6/8/16 to 8/12/16, a period of two months and 6 days to issue the second replacement check.

The second replacement check was received by the employee on 8/13/16, the day after she mailed it.

Umialik said it mailed the 5/16/16 check on time, however it claimed that it did not owe penalties because the check had been lost in the mail. However it was the Employee’s position that once Umialik learned the check had been lost, it needed to issue a new check and the 14-day payment period began to run with that notice. The Board agreed, holding the event which trigged the 14-day payment period is when the Employer learns that the check had not been received, cashed or returned.

Although Robbie Sullivan testified she followed the statute in issuing TTD checks and replacement checks, the Board found she had not. Once she learned a check was missing, she had 14 days to investigate and issue a replacement check. “The adjuster inexplicably waited until August 12, 2016, to stop payment and to issue the second replacement check…well beyond the 14 day period and the seven day grace period following notice on June 8, 2016 and July 15, 2016 (that the first replacement check had not been received.)

“Furthermore, Employer had an obligation to either pay or controvert the penalty and interest claims….It did neither.” Because of Umialik and Robbie Sullivan’s failure to issue the second replacement check on time and failure to pay penalties and interest, it was ordered by the Board to pay penalties and costs and fees associated with bringing the claim.

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.

 

 

 

When you travel for treatment as the result of your work-related injury, you are entitled to the same mileage a state worker receives.  In order to obtain these benefits, you need to send a travel log to the insurance adjuster documenting: the date of travel, from (address), to (address) and the round trip mileage. I always attach a google map showing the directions between the two destinations to document the distance.  This is a sample of what a travel log would look like if I received benefits for mileage from my office to the Alaska Workers Compensation Board: Travel Log sample

Here is the google map showing the distance: 750 W 2nd Ave, Anchorage, AK 99501 to 3301 Eagle St, Anchorage, AK 99503 - Google Maps

The amount of the travel benefits depends on what year the travel was made. Link to Bulletin 17-01 from the Alaska Workers Compensation Board to find that information, http://labor.state.ak.us/wc/bulletins/17-01.pdf.

As always, when you turn in documentation that you are entitled to benefits, the insurance company has a duty to pay it or controvert it within a specific time period. That time period commences when you turn in the documentation. So you need to save proof of the date that you turned it in. If you faxed it, save the fax confirmation page. If you emailed it, save the email. If you went in person and handed it to someone, make a second copy of the log for yourself (which you should have anyway) and ask the receptionist to date-stamp your copy. That will prove when you were in there. If you mail it, mail it certified. If the benefits are not timely paid, you will be entitled to a 25% penalty plus interest.

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.

 

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.
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. Claims eat 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. She is an insurance company spy.
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. The doctor’s opinion must be a “responsible medical opinion”. A “responsible medical opinion” should be based on scientific principles widely accepted in the medical community, review of the employee's medical records, and the specialized knowledge and training of the physician.
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.

 

 

 

You are entitled to a Permanent Partial Impairment (PPI) rating when your injury has become "medically stable". "Medical stability means the date after which further objectively measurable improvement...is not reasonably expected to result from additional medical care..." As 23.30.095(27).

In other words, if your injury isn't expected to improve, then you are medically stable. If you are receiving Temporary Total Disability (TTD), those checks stop when you are medically stable. You are paid PPI and that is the end of the checks you receive unless you are in the reemployment process, or unless something else happens on account of which you cannot work such as you need a second surgery.

Who determines when you are medically stable and what your PPI rating is?

Your doctor may determine that you are medically stable. He may send you to another clinic to perform the PPI rating or if there is someone in his clinic that does them, they will perform the rating there.

Sometimes the insurance company will send you to their doctor (Employer Independent Medical Evaluation) and that doctor will opine whether you are medically stable and what your PPI rating is.

When you are referred for a PPI rating, the doctor will review your medical records, perhaps examine you, perhaps review a Physical Capacity Evaluation, and then refer to the American Medical Association's Guides to the Evaluation of Permanent Impairment (6th edition) which lists nearly every kind of injury that can occur to a person and instructs the doctor how to evaluate the injury.  The Alaska Workers Compensation Board mandates the use of the AMA Guidelines, there is no getting around it.  However the doctor does have some discretion in classifying your injury based upon many factors, one of which is the amount of pain created by the injury.  Therefor it is important for the doctor to have all of your medical records, including your MRIs and x-rays, as well as a full knowledge of how the injury has impacted your life.

If you disagree with the insurance doctor's PPI rating, you can ask your own physician to review it and to refer you to someone who will do a PPI rating on your behalf.

If it has been some time since your injury and you are no longer being treated, or your treatment is only for pain and isn't going to improve your underlying condition, and you haven't been referred for a PPI rating yet, ask your doctor to do so.

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.

www.keenanpowell.com/faq-wc.htl

Sometimes a worker is injured as the result of an event that also gives rise to a personal injury claim. The most common example is a driver of some sort: parts store runner, pizza delivery guy, or taxi driver. If the driver is involved in an accident while he is working, he is entitled to workers compensation benefits. If the accident was caused by the negligence of a third person, he is also entitled to pursue a personal injury claim against the at-fault driver.

Problems can come up when its time to settle his personal injury claim. He must obtain the consent of his employer or the workers compensation insurance company before he accepts the personal injury settlement. If he does not obtain his employer or the workers compensation insurance company’s consent, then he will have lost all of his workers compensation benefits.

This came up in the case of Atkins v Inlet Transportation & Taxi Service, AWCAC Appeal No 14-011 decided September 26, 2016. Tracy Atkins, a taxi driver, was seriously injured in a head on collision in 2009. He filed a claim for workers compensation benefits. At the time of the accident, his employer was not insured so the workers compensation claim was being pursued against the Alaska Workers’ Compensation Benefits Guaranty Fund.

Neither Mr. Atkins nor his attorney knew about the Alaska statute, AS 23.30.015(h) which required him to obtain written consent prior to settling the claim. In 2011, his personal injury attorney settled his personal injury case without the written approval of the employer.

When the Fund found out he had settled his PI case without written consent, it filed a petition to dismiss his workers compensation claim. The Board dismissed the case. He appealed to the Commission. The Commission agreed with the Board even though the Employer had never participated in the Workers Compensation case and had failed to respond to Mr. Atkins’ attorney attempts to contact them about insurance coverage.

Mr. Atkins could have avoided the outcome had he first sought his employer’s permission to settle the case and then when the employer failed to respond, or he refused to do so, he could have filed a petition to the Board asking the Board to approve the settlement.

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.

 

 

 

If you settle your workers compensation case, your agreement will be sent to the Board for approval. Unless you agree that the insurance company will have an extension, it must pay your benefits within 14 days of the approval of the agreement. AS 23.30.155(f). If the payment is not postmarked by the 14^th day after the agreement is approved, the insurance company owes you another 25% on top of what it agreed to pay you. It used to be the insurance company would voluntarily include that payment when the first check is mailed, as it required under the law. But now you must fight for it.

Also if you win an award from the Board after a hearing, it’s the same thing. The insurance company must mail the payment by day 14. If it doesn’t, then it owes you another 25%.

There are no excuses. Either the insurance company mailed the payment on time or it did not.

To get the additional 25%, you will need to file a Claim with the Board. An attorney would be happy to help you.

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.

When the insurance company owes you money arising from a Workers Compensation case, the checks have to be mailed on time or it owes you a 25% penalty.

The first installment of temporary total disability is due 14 days after the employer has knowledge of the injury or death. The subsequent installments are due every 14 days. AS 23.30.155(c).

If compensation without an award is not paid with 7 days it became due, then there is a 25% penalty.

If compensation with an award is not paid within 14 days of it becoming due, then there is a 25% penalty.

Sometimes, the insurance company will cut a check and the check will show the date it is cut, but they don't mail it until a day or several days later. They "pay" when they mail the check, not when they cut the check.

So it's critical that you save the envelope to see what date the check was mailed. It could be worth a lot of money to you.

Keenan Powell has practiced law in 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 injured workers call me and ask me why the insurance company did something, I tell them I can’t explain it logically. That’s the short answer.

I’ve never worked inside an insurance company and I don’t know how they organize their tasks (if they do), but having observed their behavior for 35 years, I have drawn some conclusions.

Greed makes the greedy paranoid and then they behave insanely. When you’re broke, you think having money would make you feel secure. It doesn’t make you feel secure; it makes you afraid of running out of money. So you need more. The more you get, the more you need.

Insurance companies are a profit industry. The workers compensation insurance carriers who operate in Alaska make between 45 and 100 million dollars per year profit.

Insurance companies are a profit industry. The workers compensation insurance carriers who operate in Alaska make between 45 and 100 million dollars per year profit.

• In 2013, 192.4 million in benefits were paid. Premiums were 298.9. Profit: 100 million. Source: http://labor.state.ak.us/wc/forms/2013AR.pdf

• In 2012, 189.7 million in benefits were paid. Premiums were 234.5. Profit: 45 million. Source: http://labor.state.ak.us/wc/forms/2012AR.pdf

• In 2011, 169.3 million in benefits were paid. Premiums were 255.6. Profit: 85 million. Source: http://labor.state.ak.us/wc/forms/2011AR.pdf

One way for insurance companies, or any greedy employer, can improve their profits is by hiring less people to do more work. Then they give them the minimal amount of training to do the work. Then very little supervision and guidance. And they pay the adjusters poorly so the adjusters quickly develop the opinion that the injured worker, who may be receiving more money on workers compensation than the adjuster makes, is bilking the system.

Add to that a corporate philosophy that the injured workers are trying to “get away with something”, and you have an adjuster who doesn’t really care if the injured worker gets his comp check on time or if his surgery is preauthorized. You are just another file to them.

So don’t waste your time trying to rationalize their behavior. It’s impossible. Instead, talk to an experienced attorney who will tell you what your rights are and how to enforce them.

Keenan Powell has practiced law in 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.

 

 

 

 

Collect all the medical records from every provider that has seen you since the date of injury. Also collect all the correspondence from the insurance company and its attorney, all claims, answers, petitions, and prehearing conference summaries and notices that were filed with or by the Alaska Workers Compensation Board.

When you start looking for an attorney to handle your workers compensation claim, you will quickly find out that attorneys will ask you to pull together a number of records to review. At the very least, he or she will want to see all of your medical records since your date of injury, the report of the insurance doctor (EIME), if one exists, and the controversion notice, if one exists. Depending on the circumstances, the attorney may want to request more documents in order to review your case.

There are two basic reasons why attorneys ask for the file before deciding whether to accept the case: first, in order to evaluate the case properly, and second, it is a test.

Ab attorney cannot determine whether he or she can help the claimant without reviewing the entire file. Workers Compensation law is complicated and each case is unique.

The second reason for asking claimants to gather the records: it is a test. If a claimant does not have enough motivation to collect the files, then he or she probably doesn’t have enough motivation to see the case through. If he or she cannot or does not follow directions, then he or she will be a difficult client to work with.

So if you are serious about your workers compensation claim, collect the records which are asked of you. All of them.

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.