Category: Workers Compensation

Sometimes the insurance company will deny a claim on the grounds that the injured employee did not timely report the injury to his employer.  Failing to report the injury does not mean its barred.  It means the insurance company doesn't want to pay your benefits and you will have to file a Claim with the Alaska Workers Compensation Board to obtain your benefits.

The Board will order the insurance company to pay benefits even if the injury is not reported within 30 days in a number of circumstances.  One reason, discussed earlier in this blog, is if the Board finds that the insurance company and employer were not prejudiced by the late notice.

Another reason the Board will excuse late notice is called the "discovery rule". Sometimes a worker can be seriously injured, especially common in back injuries, and not feel anything painful at the time of the injury.  As his back starts to hurt, he hopes that its just a strain and it'll go away by itself.  But ,the nature of serious back injuries is that they tend to get worse over time so after weeks have passed, he realizes that there is something very wrong and he goes to the doctor.  And the doctor tells him he has a slipped disc or a herniated disc or an annular tear.  He reports it to his employer, who reports it to the insurance company, who denies the claim because it was not timely filed.

This fact pattern comes up regularly in workers compensation.  And regularly the Board sides with the injured worker.

If this has happened to you, you need to hire an experienced Workers Compensation attorney.

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.

 

Alaska law requires an injured employee to report his injury to his employer within 30 days.  AS 23.30.100.  If the employee fails to report his injury timely, his failure to do so can bar his claim.  That means that he won't get any benefits.  That is the general rule.

There are exceptions.  The first exception is when the Alaska Workers Compensation Board determines that the employer was not prejudiced by a delay in reporting the injury. AS 23.30.100 (d)(1).  This means you have to go to a hearing and get a ruling.

When is the employer prejudiced by late notice?  If he is unable to investigate the circumstances of the injury because of the delay, if he is unable to investigate prior medical conditions of the employee because of the delay, if evidence is lost or witnesses disappear.

If the insurance company refuses to pay your claim because it says that you failed to give notice, that isn't the end of your claim.  It's the beginning of your fight.  Meet with an attorney and explain the reasons why you gave late notice.   "Lack of prejudice" is just one of a number of reasons for which the Board will excuse failure to give timely notice.

For more information, see http://keenanpowell.com/faq-wc.html.

Keenan Powell has more than 30 years experience representing injured Alaskans.  For a free consultation, call the Law Office of Keenan Powell: 907 258 7663.

 

Some insurance companies provide an "prescription card" to the injured worker to facilitate the filling of prescriptions.  The injured worker is then required to go to one of the pharmacies which accept the card, present it and, in theory, the prescription would be filled immediately.

It doesn't always work.   Frequently the pharmacist will tell the injured worker that the prescription must be "pre-approved" by the insurance company and that it called for authorization. This means waiting 3 days or more to get the prescription filled.

Then the injured worker calls the insurance company to complain and is told that the insurance company does not have a duty to pre-approve prescriptions and if the injured worker is having difficulty with the card, he can pay for the medications himself and submit a request for  reimbursement and wait 30 days for the reimbursement.

Two obvious problems with the insurance companies' instructions: first, the injured worker probably can't afford the prescriptions. Second, and most importantly, that is not the law.

Recently I won a case before the Board, King v UTI, in which the Board said that the prescription must be filled "promptly" and "promptly" means when the prescription is presented to the pharmacy.

The Alaska Supreme Court agreed last week in the decision of Harris v M-K Rivers. In that case, a man who was rendered paraplegic needed a special kind of bed for his bedsores.  The insurance company refused to pre-authorize it so he didn't get it.  The Supreme Court held that because the insurance company did not have a good faith basis to controvert the bed, and failing to pre-authorize the bed essentially prevented him from getting it and because of that penalties should be assessed against the insurance company.

If you're having problems with your prescriptions or any other questions or concerns regarding your workers compensation claim, call me, Keenan Powell.   I have more than 30 years experience fighting for the rights of injured Alaskans. Consultations are FREE.  Call 258-7663.

 

After you’re injured at work, you can expect to receive a letter from the insurance company with several releases.   Do you have to sign them?

Maybe. It depends on what they are asking for.

Medical Release:  The insurance company is entitled to all of the medical records relating to treatment of you work injury.  Also, as a general rule, the insurance company is entitled to all of your medical records relating to the body part that was injured from two years prior to the date of injury.  There is a form on the Alaska Workers Compensation Board’s website which has been drafted by the Board.  Release of Medical Information

If the insurance company’s form looks like the Board’s form and is limited to the body part injured at work and from two years prior to your date of injury, it’s appropriate.  Additionally, certain providers (like Alaska Regional and Providence) insist on their own forms.  As long as these forms are limited to the body part injured at work and from two years prior to your date of injury, they are appropriate.

Employment Records Release: The insurance company is entitled to a list of your employers during the preceding ten years and an employment records release allowing them to speak with your prior employers IF you are applying for reemployment benefits.  As a general rule, they are not entitled to this information unless you are applying for reemployment benefits.

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.

There’s been a recommendation for surgery.  The surgeon’s office calls the insurance company requesting it to pre-authorize the surgery so the surgeon knows he’s going to get paid.  Then the insurance company either flatly refuses to pre-authorize the surgery or doesn’t return the surgeon’s call.

So the employee can’t get the surgery and can’t go back to work because the doctor won’t release him to full duty.  Meanwhile, his employer has replaced him.

If the employee can get an adjuster on the phone, the adjuster tells him that the insurance company does not have a duty to pre-authorize medical treatment.  The adjuster suggests that the surgeon go ahead and perform the surgery and the insurance company might pay the bill afterwards knowing, of course, the surgeon won’t do that.  Or, the adjuster will suggest, the employee can pay for the surgery himself and ask for reimbursement.  Like, who has the money for that?

This situation is so common that over twenty years ago, the Supreme Court for the State of Alaska ruled an injured worker who has been receiving medical treatment should have the right to prospective determination of compensability.  Summers v Korobkin Construction, 814 P 2d 1369 (Alaska, 1991).

That means filing a claim.

It also means you can get an attorney.  The second thing the insurance company is trying to do, other than denying medical benefits, is preventing the injured employee from finding a lawyer to represent him.  When you call for an attorney, most lawyers will ask “Have you been controverted?”  That means have you received a formal Notice of Controversion (a document) from the insurance company.  If the answer is no, many attorneys aren’t interested in the case because, as a rule, the attorney cannot bet paid if the claim hasn’t been controverted.

But there are formal and informal controversions.  If the insurance company has resisted paying benefits, then its action constitutes a “controversion in fact” and justifies an award of fees.

If you hit a wall when you tell the person answering the attorney’s phone that the claim has not been controverted, call another attorney. Keenan Powell has more than 30 years experience fighting for the rights of injured Alaskans.

At the Law Office of Keenan Powell, you can get a free consultation by call 258-7663.

Joseph Heller's quote is as true in workers compensation as it is in real life.  There are individuals, and companies, who make a living following around injured employees to "detect" the injured employee acting "not injured".  In fact, the 2013 ACS yellow pages lists at least 19 such companies which is about twice as many orthopedic physicians listed.

Not surprising then that the insurance companies spend a lot of money on defense, and that amount is increasing, as the amount paid to injured workers is decreasing.

So if you were injured at work and you think someone is following you around, you probably right.  Things you should look for: a man or woman walking towards you wearing baseball caps (cameras can be hidden inside), or walking around you carrying briefcases (camera inside) or a newspaper folded under his arm (camera hidden in the newspaper).

You should also be aware of people  in cars.  In the last case where I obtained video surveillance of my client, the "investigators" followed him from his house to his house, video'd him walking into the doctor's office, and out of the doctor's office, smoking a cigarette outside a building, and driving home again. The investigator's report claimed my client did not look injured but when I watched the video, it was obvious that he was.  The Workers Compensation Board agreed with me.

I've also seen videos of my clients pumping gas and carrying milk out of the grocery store.

Try to be aware of nondescript cars or trucks that seem to be everywhere.  Try to be aware of someone sitting in a car outside your home.  Go out, talk to him, get his name, ask him if he's lost or looking for someone, take his photo with your phone, get his license plate number. It's a lousy private investigator who gets caught.

And look for a lawyer because the insurance company is building a case to terminate your benefits.

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.

 

 

When you’re off work as result of a work-related injury, you receive Temporary Total Disability (TTD) which is about 80% of what your net. The exact figure, known as your “compensation rate”, is determined by looking at the two years before you were injured, picking the best of those two years and then applying a formula that was developed by the Workers Compensation Board.

Most workers feel that the amount they receive is unfair because it is not as much as they were bringing home and most people need every dime they earn to pay the bills. The Board’s justification for the ruling is that it is equally unfair to everyone and no one should be singled out for particularly unfair treatment.

You can seek to have your TTD increased if the amount is incorrect or if when it was calculated it failed to take into consideration a second income or benefits. As a rule, most people’s income will be determined by their net wages earned in the two years before the injury.

The formula is adjusted every year so every year there is a new bulletin published setting out the compensation rates. To access the bulletins, visit the Workers Compensation Board’s website: http://labor.state.ak.us/wc/bulletins.htm.

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.

The State of Alaska Division of Workers Compensation released 2012 Annual Report: http://labor.alaska.gov/wc/forms/2012AR.pdf.

It shows that the insurance companies are paying their attorneys more than they were paid in 2011.  The insurance defense attorneys received 10.3 million dollars in 2012.  Doctors were paid more too: 176 million dollars in 2012.  But employee's disability benefits (temporary total disability, temporary partial disability, permanent partial impairment, permanent total disability), that amount went down 2.5% despite the fact that compensation rates were raised (See Bulletins 10-04 and 11-06 at the Board's website).

That means fewer employees are getting less money while defense attorneys and doctors are getting paid more.  In the words of Father Guido Sarducci, "Coincidenza?"

 

 

When things go the way they are supposed to: you report your injury to your Employer.  Your Employer reports the injury to his insurance company and the Alaska Workers Compensation Board. The insurance company adjuster contacts you with a claim number to give to your medical providers.  You send your doctor’s work releases to the insurance company and the insurance company sends you temporary total disability as long as you are off work.  You get the medical treatment you need and go back to work.

When things don’t go right.  The first problem I’ve seen, time and again, is the Employer refuses to report the injury to his insurance company and the Alaska Workers Compensation Board.  If that happens, contact an attorney immediately.  You will need an attorney to obtain the benefits to which you are entitled.

What kind of benefits are you entitled to?  Reasonable and necessary medical treatment for your work-related injury, for as long as you need it.  That could mean the rest of your life.  You are entitled to be compensated for time lost from work, whether you’re off full time or part time.  You are entitled to a PPI rating if you’re injury is permanent.  You may be entitled to retraining.  You are entitled to be compensated for your travel for treatment, even if it is few miles.  Gas is expensive.

For more information, check out FAQ page: http://www.keenanpowell.com/faq-wc.html.  With more than 30 years of experience representing injured Alaskans, Keenan Powell is currently accepting workers compensation cases.For a free consultation, call the Law Office of Keenan Powell: 907 258 7663.