Category: Workers Compensation

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.

How much a doctor is paid for providing services to an injured worker in Alaska is regulated by Alaska law. Most Alaska doctors get that.  The problem comes up when an injured worker moves out of state.  It used to be the out of state doctors were paid under the Alaska fee schedule but a new bill, HB 141, which became effective a few months ago provides that out of state doctors are entitled to be paid fees pursuant to the rates set for workers compensation in their state.  HB 141.

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.  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.

 

 

It is the position of most insurance companies that they do not have a duty to pay medical benefits, that the only duty they have is to reimburse the Employee for medical expenses 30 days after the Insurer received notice of the Employee’s expenditures, and that, just to be nice, the Insurer’s arrange to pay some of the medical benefits directly to the providers.

 That’s not what the law says.  The law says the insurance companies have a duty to pay medical benefits immediately on demand.  In other words, “now” means “now”. The case which said interpreted the law to hold that the benefits are due immediately is Harris v. M-K Rivers, 325 P.3d 510 ( Alaska, 2014)  decided in March of 2014 by the Alaska Supreme Court. “To determine when an employer's payments for medical care are due under the Workers' Compensation Act, for purposes of determining whether the employer is subject to a penalty for failing to timely pay amount due, payments due are more appropriately characterized as payable immediately or on claimant's demand, rather than owed as a debt.”  Id, 519. Harris v MK

So if the insurance company is dragging its feet in pre-authorizing surgery, some other medical benefit, it will owe penalties and interests and is flirting with the possibility of being referred to the Division of Insurance for an investigation.

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.  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.

 

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

The answer is: sometimes.

The Alaska Workers Compensation Act is meant providers benefits to workers injured in the course and scope of their employment.  If an assault or sexual assault is reasonably foreseeable and incidental to the employment, then the employee is entitled to workers compensation benefits.  Obvious examples of an occupation where an assault is reasonably foreseeable and incidental to the employment include jail employees, hospital employees, police, security employees.

If the employment provided a unique opportunity which led to the assault, then workers compensation should apply.  In Temple v Denali Lodge, 21 P 3^rd 813 (Alaska, 2001), the Supreme Court cited a North Carolina case where a cocktail waitress stopped to help a stranded motorist who she recognized as a customer.  He kidnapped and sexually assaulted her and she sustained serious injuries escaping.

If the employment creates a special risk, then subsequent injuries should be covered by workers compensation.  The Supreme Court also cited a California case of a woman whose job required her to do home visits.  Her husband posed as a customer under an assumed name and shot and killed her when she came to his apartment.

It is unlikely however that an employer would be responsible merely for failing to protect his employees from assault.

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.

 

 

 

 

Workers Compensation insurance companies can, and do, spend a lot of money on private investigators following injured employees around and videotaping them.

 

Then, the private investigator will provide the insurance company with confidential reports which are not automatically produced to the injured employee (nor are the videotapes) because the insurance company wants to blind side the injured employee with the report and videotapes at a hearing and use the report and videotapes to influence its doctors.  If the injured employee doesn’t know about the surveillance, reports and videotapes, there is nothing s/he can do.

 

In a recent case before the Juneau board, Cornielson v Rappe Excavating, the insurance company’s attorney introduced the report and edited video.  The Board demanded to see the entire video, unedited, and when it saw the entire video, unedited, the Board came down hard on the insurance company.

 

In the first place, the private investigator’s report didn’t match the unedited videotape and in the second place, the video was edited to cut out all of the scenes showing the injured worker was in real pain, not knowing that he was being videotaped.

 

Word to the wise: if you’re in a Workers Compensation case and you think you’re being followed, you are.  Even if you don’t think you’re being followed, you may be.  You need to demand all surveillance videos and reports.

 

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

 

 

A Second Independent Medical Evaluation (SIME) is ordered by the Alaska Workers Compensation Board. It can be ordered for three different reasons.  First, SIMEs are most commonly ordered when there is a dispute between the injured Employee's treating physician and the the Employer's expert doctor.

A SIME can also be ordered if, second, there is a gap in evidence or, third,  if the Board wants an evaluation for the purpose of developing the evidence before a hearing.  A gap in the evidence occurs when there is not a clear cut dispute between the treating physician and Employer's physician but there is some evidence of a dispute.

When the Board orders a SIME, it sends the injured Employee to a physician on its list. See: SIME list Bulletin 13-06. The physicians on this list were approved by a committee but it does not mean that the physicians on the list are neutral. If you are facing a SIME, it is important to review cases in which that physician has been involved to determine whether s/he is fair.  All decisions issued by the Board are available to the public and can be accessed on the Board's website: http://labor.state.ak.us/wc/legaldir.htm.  

There are two ways to obtain a Board order for a SIME: the first is to obtain the agreement of the Employer's attorney.  The second way is to file a Petition for SIME and go to hearing on the Petition.  The forms for requesting a SIME are on the Board's site as well.  You will need a Petition, form 07-6111, and a SIME form, form 07-6147.

Once a SIME is ordered, a Board employee will pick the physician(s) unless the injured Worker and Employer have stipulated to a particular physician and will send a letter out to the injured Employee and the Employer informing them of the date and time of the appointment and the name and location of the examination. The Employer is responsible for arranging, and paying for, transportation, hotel and meals for the Employee.

If you have questions about your workers compensation claim, call my office.  I have more than 30 years experience fighting for the rights of injured Alaskans. Consultations are FREE.  Call 258-7663.

 

 

When you are looking for an attorney to help you with your workers compensation case, there are a few things you need to know:

 

First, some attorneys require payment for review of your case.  It is ethical for an attorney to charge up to $300 as an on-time-only charge if the attorney does not enter the case.

 

Second, it is illegal for an attorney to require a retainer (up front money) to secure payment of his fees.  An attorney can, however, ask the client to front costs.  Most attorneys do this on a case-by-case basis.

 

Third, when you are considering attorneys to hire, look at their track record.  Have they been practicing Workers Compensation for a number of years?  Have they always represented Employees or have they been an Employer’s attorney.  If the attorney previously was an Employer’s attorney, you would be right to believe that s/he would have insight into that mind set.  However, you have to ask yourself, why did this person change who s/he is working for?  Was it a cataclysmic change in a belief system?  Or are you in danger of hiring someone with an attitude that most Employees don’t deserve benefits.

 

Fourth, ask whether the attorney has had experience in a case similar to yours.  Is the insurance company is claiming you didn’t notify them of the injury timely or is the insurance company claiming that your injury is not work-related?  Is it a shoulder case, knee case, back or neck case, or hearing loss, carpal tunnel or some other degenerative injury?  Is the attorney comfortable dealing with the issues that may be raised depending on your particular injury?

 

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

What do you do if the health care provider’s office doesn’t or won’t bill the Workers Compensation insurance claim, or does and the insurance company doesn’t pay the bill and the provider’s office is billing you, calling you, for the money?

 

It’s illegal for a health care provider to charge an injured worker.  AS 23.30.097(f) states unequivocally:  “An employee may not be required to pay a fee or charge for medical treatment or service provided under this chapter.”

 

So what? What happens to a health care provider who continues to charge an employee for treatment as the result of a workers compensation injury? So you report the provider to the State of Alaska Consumer Protection Unit, http://www.law.state.ak.us/consumer/.At its website, the State of Alaska provides a complaint form for you to fill out and mail or fax to the Attorney General’s Office.  http://www.law.state.ak.us/department/civil/consumer/cp_complaint.html. There are instructions on how to do fill out the form and where to send it.

 

What will the Attorney General’s Office do?  They’ll send a copy to the offending provider and ask for a response.  At that point, the provider may realize what he is doing is illegal and will agree to stop hounding you for the bill.  If not, the Attorney General may proceed with a prosecution against him which means he will incur not only legal fees but may be fined.

 

The problem isn’t the doctor, it’s the biller. Any more, most doctors hire outside billing agencies who don’t understand and don’t want to learn Alaska law. In the event you hire an attorney to pursue a Workers Compensation Claim on your behalf, your attorney should deal with these issues for you.

 

If you have questions about your workers compensation claim, call my office.  I have more than 30 years experience fighting for the rights of injured Alaskans. Consultations are FREE.  Call 258-7663.

 

 

 

Frequently, an employer thinks he can avoid a Workers Compensation claim by refusing to provide the injured employee with the name of his insurance company and the appropriate forms to fill out.  But that won't work.

All employers are required to carry workers compensation insurance.  And if they fail to do so, a fund has been established by the State of Alaska to pay benefits to injured workers.

If you want to know if your employer carries workers compensation insurance, you can check that out on the Alaska Workers Compensation Board's website:  http://labor.state.ak.us/wc/home.htm.  

On the right of the home page is a menu. Click the link that states "Online Employer Coverage Verification Service" and follow the prompts.  You will be provided with the name of the insurer responsible on your date of injury and contact information for that company.

If your employer has failed, or refused, to provide you with a Report of Injury form, you may obtain that on the same website.  On the home page, click on the "Forms" link and pull up the Employee Report of Injury to Employer, Form 7-6100.  Or you can print use the attached form, EE ROI Form 6100.

You need to fill the form out, give a copy to your employer, a copy to the insurance company and you should file a copy with the Alaska Workers Compensation Board, 3301 Eagle St Ste 304, Anchorage, Alaska.  If you live near Fairbanks or Juneau instead, the local AWCB office addresses are posted on its website.

As always, you should keep a copy of the Report of Injury for your files.  You should keep a copy of everything that has anything to do with your injury in your files: any and all correspondence from the insurance company and the Workers Compensation Board, and all bills from your treating health care providers.