December 11, 2020
So, you are hurt on-the-job, cannot work, and need medical treatment. You have heard this entitles you to workers’ compensation benefits. What does that mean? You are likely wondering what kind of benefits am I entitled to receive? How long am I entitled to receive those benefits, whatever they are? Who decides when the benefits end? These are just a few of the questions you likely will have if you have suffered a serious injury requiring a long recuperation and extensive medical treatment. I will try to answer some of your questions and provide a general overview regarding benefits typically available under the Alaska Workers’ Compensation system.
What are the benefits under the Alaska Workers’ Compensation system which may be available to seriously injured worker?
The benefits you are or may be entitled to include medical benefits, time loss benefits, permanent partial impairment benefits, reemployment benefits, permanent total disability benefits, and, if appropriate, attorney fees and litigation costs. The facts of your case determine which of these benefits you may be entitled to receive.
The underlying principle behind Workers’ Compensation law is that if you are injured on-the-job you are entitled to benefits so you can heal up and return to the work force. That is what happens in most, but not all, job injury circumstances. I will provide an overview of the various benefits you may be entitled to receive depending on the circumstances of your particular case.
Medical benefits
For workers hurt on-the-job having medical treatment paid for so they can recover is a huge benefit since medical treatment is horrendously expensive. Full recovery without medical treatment frequently does not occur.
An injured worker is entitled to choose the healthcare provider of their choice to help navigate through the treatment and recovery process. The healthcare provider works for the injured employee, not the employer or its insurance company. The injured employee is supposed to designate a healthcare provider as his “attending” physician to help manage the medical care. The attending physician does not have to be the primary treating healthcare provider, though most do provide treatment. Instead, the attending physician usually manages the care by making referrals to specialists who may perform surgery, provide testing, prescribe rehabilitation treatment, perform physical therapy, conduct a permanent partial impairment rating, provide second opinions and any number of other useful contributions to the recovery process. Having a trusted attending physician to manage the care and communicate with the injured worker is invaluable to the workers understanding and the medical outcome of his case.
There are limitations on the amount and kind of medical benefits. The medical treatment must be reasonable and necessary for treatment of the work injury. The injured worker cannot change doctors more than once without permission of the employer’s insurance company unless he has moved more than 50 miles from the attending physician. If there is a good reason for changing physicians more than once, the insurance company may agree. Otherwise, it will resist the change and may not pay for the treatment. Another example of limitations is the limited number of chiropractic treatments provided for under the law. If the insurance company agrees to pay for more than the statutory limited number of treatments, no problem exists. But, if the provider exceeds the limited number of treatments without approval, the insurer will refuse to pay.
Medical treatment typically lasts until the injured worker reaches medical stability. Medical stability is that point in the recovery process when the worker ceases to show objective evidence of improvement for forty-five (45) days and there is no medical basis to believe more or different treatment is going to cause additional improvement. Medical treatment can be terminated even when the worker has not returned to his preinjury state. In short, if the worker does not continue to improve for forty-five (45) days and there is no reason to believe that further treatment will result in medical improvement, you have reached medical stability.
Palliative care is sometimes allowed if the attending physician is willing to make a strong argument that it is necessary for treatment of serious chronic pain conditions and or to allow the injured worker to participate in a reemployment plan or return to work. Palliative care generally is not allowed but under the right circumstances, it will occur.
Time loss benefits.
When an injury prevents the employee from working and earning the wages he was earning at the time of injury, he is considered to be “disabled” and therefore qualifies for time loss benefits. Time loss benefits can be temporary total disability (TTD) or temporary partial disability (TPD). Time loss benefits are usually based on the highest annual earnings of a worker from the two years immediately preceding the year of injury. The rate of reimbursement is based on past earnings, less taxes, and withholdings. There is a specific formula set forth in the Workers’ Compensation Board rules for calculating the rate of time loss compensation.
Usually injured workers can “get by” on TTD they are paid, but it is not uncommon for the time loss benefit to be grossly inadequate. Under those circumstances, it is up to the worker to figure out how he is going to “get by” until he can return to the workforce. However, he may be entitled to a “rate adjustment” depending on the facts of his case.
Time loss benefits typically last until the worker returns to work or until he reaches medical stability. If his doctor opines, he will have a permanent impairment greater than zero, then once he reaches medical stability, he will be referred for a permanent partial impairment rating. Frequently time loss benefits end at the same time a permanent partial impairment rating is issued.
Permanent Partial Impairment (PPI).
PPI benefits are in addition to medical benefits and time loss benefits. A PPI rating is only provided if the injured worker has been determined to suffer a permanent impairment greater than zero as determined by a trained physician following the American Medical Association Guides to the Evaluation of Permanent Impairments, 6th Edition.
For each percentage of impairment as determined by the PPI physician, the injured worker is entitled to $1,770. So, for example if the PPI rating is 10% of the whole body, the payment would be $17,700.
PPI payments are typically made in a “lump sum”, but if the worker has been qualified for reemployment benefits, the PPI money may be paid out over time and during the retraining process.
Reemployment Benefits.
An injured worker who is not able to return to the job of injury or is not able to be employed in the same or a similar occupation with similar earnings for ninety (90) days may be entitled to a reemployment evaluation. The law requires the employer to notify the state Reemployment Benefits Administrator (RBA) when an injured worker has been out for ninety (90) days, so an evaluation can be scheduled. This is the first step of the reemployment process.
If, after going through the reemployment evaluation, it is determined by the RBA that the worker is eligible for reemployment benefits, he will be given two options. The injured worker can choose a lump sum “dislocation” benefit, frequently only $5,000, or chose to go through a “reemployment plan” with the help of a reemployment specialist. The purpose of the reemployment plan is to help the worker get training which takes into consideration his work injury limitations and his existing transferable skill. The goal is for the worker to be trained so he can reenter the workforce. There are substantial limitations on what constitutes retraining benefits.
Permanent Total Disability Benefits (PTD).
If the on-the-job injury renders the worker unable to return to work, he has a right to seek permanent total disability benefits. These benefits are based on the concept that the worker is permanently and totally disabled. PTD benefits will be paid for the injured workers’ lifetime. It is difficult to qualify for PTD benefits because most injured workers can perform some work in the job force.
A worker who suffers an injury resulting in his inability to continue working in the normal line of work may be entitled to PTD, even though he might be able to perform “odd lot” work. An “odd lot” job is work which is not regularly available in the job market. Such work may have a limited number of hours per day or week. The facts related to the work, establish whether it is an “odd lot” job.
An injury which in and of itself is not totally disabling may be combined with pre-existing medical conditions suffered by the worker to qualify him as PTD. It is the combined effect of the work injury and the pre-existing conditions which render the injured worker PTD.
Because PTD benefits are to be paid for the life of the worker, not just the projected retirement date, insurers and employers fight these cases with vigor. These cases, more than any other workers’ compensation cases in my opinion, require the assistance of an experienced workers’ compensation attorney knowledgeable about the law of permanent total disability benefits.
Attorney Fees.
Attorney fees are a “benefit” to the worker under the Workers’ Compensation Act. Attorney fees are only awarded if the injured worker employs an attorney whose work results in the injured worker receiving benefits he would not have received without the lawyer’s assistance. Attorney fees must be reasonable under the facts of the case. The fees must be approved by the Alaska Workers’ Compensation Board, before the insurance company will pay those fees.
If the insurance company does not resist a workers’ compensation claim for benefits, but instead pays all benefits the injured worker is entitled to under the law, then an attorney is not likely to take the case because he will not be paid for his time spent. The system is set up to encourage resolution of disputes between insurance company and the unrepresented injured worker, without involvement of a lawyer. Clearly, this places the injured worker at a disadvantage. But, if the insurance company properly adjusts the claim and treats the injured worker in accordance with Workers’ Compensation law, the attorney will not be able to provide benefit to the injured worker. Under those circumstances, if the attorney were to involve himself on behalf of the injured worker but his efforts provided no benefit, the attorney would receive no pay.
Summary
Understanding what benefits are available for an injured worker to tap into is important. Though insurance adjusters are supposed to notify the worker what benefits they are entitled to under the facts of the case, it is not uncommon to learn certain benefits have not been given to the worker. If the adjuster does not pay benefits to the worker which they are entitled to receive, that is when an experienced Alaska Workers’ Compensation attorney should be contacted.
If you have suffered a serious injury at work and believe one or more of the benefits discussed above have not been made available to you, please contact the Law Offices of Elliott T. Dennis. We may be able to get benefits for you which you did not know of or which have been denied through omission or denial by the insurance company. The benefits for you to focus on in your review of your case are temporary total disability benefits beginning three days after being taken off work for the injury, reasonable and necessary medical treatment, a permanent partial impairment rating, reemployment benefits, or permanent total disability benefits. Remember, permanent total disability benefits can result from the work injury combining with pre-existing conditions so that the injured worker is not able to perform a job which is regularly available in the job market.