Performance Details

Department of Labor and Workforce Development - Workers' Compensation

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Mission

The mission of Workers' Compensation is to ensure the efficient, fair and predictable delivery of indemnity, medical and vocational rehabilitation benefits intended to enable workers to return to work at a reasonable cost to employers.

Core Services

• Ensure compliance with the Workers' Compensation Act.
• Conduct timely Workers' Compensation hearings.
• Operate a timely and efficient appeals program.
• Process Fishermen's Fund claims timely.
• Administer a vocational rehabilitation benefits and training program for injured workers.

Mission Results	Core Services
A: All employers comply with AS 23.30, the Alaska Workers' Compensation Act.  Details > TARGET #1: Zero alleged uninsured employers. TARGET #2: Zero uninsured employee injuries. TARGET #3: 100 percent of uninsured employers take responsibility for uninsured injuries.	A1: Ensure compliance with the Workers' Compensation Act.  Details > TARGET #1: Investigate 100 percent of alleged uninsured employers. TARGET #2: Investigate 100 percent of alleged Workers' Compensation Act fraud. TARGET #3: 85 percent of investigations are completed within six months. TARGET #4: Educate 600 employers per year about the Workers' Compensation Act requirements.
Mission Results	Core Services
B: Improved delivery of efficient, low cost and legal informal and formal dispute resolution.  Details > TARGET #1: Resolve at least 90 percent of disputed issues without a formal hearing. TARGET #2: Process open cases at the Appeals Commission within 360 days.	B1: Conduct timely Workers' Compensation hearings.  Details > TARGET #1: 100 percent of all written decisions will be issued within 30 days of record closure. TARGET #2: Hearings will be scheduled within an average of 90 days from receipt of readiness for hearings. B2: Operate a timely and efficient appeals program.  Details > TARGET #1: Issue final Workers' Compensation Appeals Commission decisions within an average of 90 days of record closure.
Mission Results	Core Services
C: More Alaskans available for jobs.  Details > TARGET #1: Requests for reimbursement from the Fishermen's Fund will be paid within 30 days of receipt. TARGET #2: 20 percent of injured workers eligible for reemployment benefits complete a viable retraining plan.	C1: Process Fishermen's Fund claims timely.  Details > TARGET #1: Keep the number of days it takes to get the Fishermen's Fund Advisory & Appeals Council's approval to within 90 days. C2: Administer a vocational rehabilitation benefits and training program for injured workers.  Details > TARGET #1: Reduce the percentage of retraining plans that are returned to the rehabilitation specialists by 20 percent per year until no plans need to be returned. TARGET #2: Review of all pending retraining plans will be performed quarterly.

Performance Detail

Target #1: Zero alleged uninsured employers. Methodology: Number of alleged uninsured employers is based on information received from the workers’ compensation fraud hotline, workers’ compensation fraud email, injured workers, the general public, other agency referrals, onsite inspections, expired/canceled policies data, and self-directed investigations. Compliance checks are conducted, and cases referred to investigators when employers are confirmed noncompliant. Number of Alleged Uninsured Employers (did not achieve the target of zero in FY2018) Fiscal Year # FY 2018 534 +21.09% FY 2017 441 -41.59% FY 2016 755 +27.32% FY 2015 593 +238.86% FY 2014 175 -42.43% FY 2013 304 +153.33% FY 2012 120 +106.9% FY 2011 58 +26.09% FY 2010 46 -49.45% FY 2009 91 -46.15% Analysis of results and challenges: The Special Investigations Unit (SIU) conducted 379 compliance checks and found 150 of those alleged uninsured employers in compliance. The remaining 129 alleged uninsured employers were referred for further investigation. SIU began FY2018 with 57 pending failure to insure investigations, and opened or reopened another 284 cases for a total of 341 investigations worked during FY2018. Out of 341 investigations, 197 were resolved as investigations only (meaning that either (1) proof of coverage (POC) was found, (2) proof of coverage was no longer necessary due to business closure/no longer operating with employees, or (3) the employer’s coverage reinstatement resulted in a small enough lapse that pursuing a penalty would not be cost effective). Out of 151 remaining investigations, 72 cases resulted in penalties assessed to employers via stipulated settlement (64) or formal decision and order issued by the Alaska Workers’ Compensation Board (8). A total of 79 employers were petitioned for failure to insure in FY2018. Three petitions were withdrawn due to either POC found or business closure. There were 69 remaining investigations actively pending at the close of FY2018. In FY2018, this measure was changed from "uninsured employers" to "alleged uninsured employers", as the original target was very difficult to quantify. Values were retroactively updated for FY2017, FY2016, and FY2015.

Target #2: Zero uninsured employee injuries. Methodology: Number of injuries is based on claims made to the Workers Compensation Board. Workforce is the "Labor Force" determined by the Division of Research & Analysis. Number of Uninsured Employee Injuries (did not achieve the target of zero in FY2018) Fiscal Year Injuries Workforce % of Workforce FY 2018 27 360,804 .007% FY 2017 24 363,612 .007% FY 2016 29 339,092 .008% FY 2015 16 366,569 .004% FY 2014 14 367,166 .005% FY 2013 20 365,537 .006% FY 2012 36 365,681 .010% FY 2011 9 358,000 .003% FY 2010 17 344,100 .005% FY 2009 77 335,000 .023% Analysis of results and challenges: During FY2018, Special Investigations Unit (SIU) received notification of 27 allegations of uninsured injury and fully investigated each one. Out of the 27 alleged uninsured injuries allegations, all were confirmed to have occurred. SIU opened failure to insure investigations for all 27 employers with uninsured injuries. Out of the 27 confirmed uninsured injuries, SIU petitioned 22 uninsured employers. Five employers either ceased business operations, or had minimal lapses not cost effective for SIU to petition. One employer was a federally recognized tribe. Out of the 27 confirmed uninsured injuries, it appears 11 uninsured workers filed workers’ compensation claims against the Benefits Guaranty Fund.

Target #3: 100 percent of uninsured employers take responsibility for uninsured injuries. Methodology: Percentage of uninsured employers that are participating in board proceedings in the uninsured injury case, paying the compensable claim costs direct or by reimbursement to the Benefits Guaranty Fund. Also includes uninsured employers that are not doing either only because the uninsured injured worker did not file or pursue a workers’ compensation claim. Percentage of Uninsured Employers who Took Responsibility for Uninsured Injuries (achieved the target of 100 percent in FY2018) Fiscal Year Total % FY 2018 27 100% FY 2017 22 100% FY 2016 24 96% FY 2015 15 93.8% Analysis of results and challenges: During FY2018, out of the total 27 confirmed uninsured injuries, a total of 11 uninsured injured workers filed workers’ compensation claims against their uninsured employers and the Benefits Guaranty Fund and their employers are actively participating in the uninsured injury case. Of the remaining 16 alleged uninsured injuries, all 16 of the alleged uninsured injured workers failed to pursue compensation for their injuries before the Alaska Workers’ Compensation Board, and therefore these employers have not been ordered to pay compensation and need not participate in the matter until the injured workers pursue their claims.

Target #1: Investigate 100 percent of alleged uninsured employers. Methodology: The number of alleged uninsured employers investigated is the same number as total alleged uninsured employers. These investigations range from conducting simple compliance checks that do not result in opening a formal failure to insure investigation to completing the more complex investigations that result in issuance of warning letters, penalties agreed upon via the settlement process, and formal hearings. Percentage of Alleged Uninsured Employers Investigated (achieved the target of 100 percent in FY2018) Fiscal Year Total % FY 2018 534 100% FY 2017 441 100% FY 2016 755 100% FY 2015 593 100% Analysis of results and challenges: The Special Investigations Unit conducted 150 less complex investigations that did not result in opening a formal failure to insure investigation, and opened 284 formal investigations during FY2018.

Target #2: Investigate 100 percent of alleged Workers' Compensation Act fraud. Methodology: The number of Workers’ Compensation Act fraud allegations is calculated by adding the total number of calls received from the public alleging criminal fraud perpetrated by a claimant, employer, care provider, insurer/claims administrator, or attorney to the total number of requests for assistance received from other law enforcement agencies. Percentage of Alleged Workers' Compensation Act Fraud Investigated (achieved the target of 100 percent in FY2018) Fiscal Year Total Reported Total Investigated % FY 2018 216 216 100% FY 2017 178 178 100% FY 2016 170 170 100% FY 2015 155 155 100% Analysis of results and challenges: The Special Investigations Unit received 216 fraud allegations in FY2018. Of the 216 fraud allegations, 19 were alleged claimant fraud, 77 were alleged employer fraud, one was alleged care provider fraud, one was alleged attorney/non-attorney rep fraud, one was alleged insurance company/agent fraud, and 117 were other agency assist requests.

Target #3: 85 percent of investigations are completed within six months. Methodology: The percentage of investigations completed within six months is generated by comparing the total number of cases investigated within the fiscal year against the total number of cases investigated within the fiscal year that are closed for any reason within 180 days. Percentage of Investigations Completed in Six Months (did not achieve the target of 85 percent in FY2018 Fiscal Year Total Investigations Total closed in six mo. % FY 2018 341 234 68.6% FY 2017 348 214 61.5% FY 2016 340 162 47.6% FY 2015 444 222 50% Analysis of results and challenges: The Special Investigations Unit (SIU) investigated a total of 341 formal matters, including those carried over from FY2017 and new matters opened in FY2018. Of the 341 formal investigations, SIU closed 234 within 180 days from the actual date opened to the actual date closed.

Target #4: Educate 600 employers per year about the Workers' Compensation Act requirements. Methodology: The number of employers educated is generated by adding the total number of attendees at formal employer education presentations, to the total number of documented public inquiries received, to the total number of onsite visits conducted. Number of Employers Educated about the Workers' Compensation Act (did not achieve the target of 600 employers in FY2018) Fiscal Year Total FY 2018 583 FY 2017 607 FY 2016 634 Analysis of results and challenges: During FY2018, the Special Investigations Unit conducted seven formal education presentations with a total of 181 attendees, responded to 339 documented public inquiries, and conducted a total of 63 onsite visits.

Target #1: Resolve at least 90 percent of disputed issues without a formal hearing. Methodology: Total number of claims and petitions filed, compared to the number of decisions and orders issued. Percentage of Disputed Issues Resolved without a Formal Hearing (achieved target of 90 percent in FY2018) Fiscal Year Total Disputed Issues Total D&Os Issued % FY 2018 2,022 160 92% FY 2017 2,479 143 94% FY 2016 2,350 159 93% FY 2015 2,242 137 94% Analysis of results and challenges: The Division of Workers’ Compensation is exceeding the goal to resolve at least 90 percent of all claims and petitions without a formal hearing. Many less complex issues are resolved at prehearing conferences by Workers’ Compensation Officers and Hearing Officers. Many of the more contentious cases with difficult parties are resolved through mediation, which saves the parties and the division hours of hearings and weeks of work for a Hearing Officer and board panel. For example, in the most recent fiscal year, the division’s mediation program mediated 114 cases, which is almost as many as were decided by formal hearings and written decisions (137). A challenge continues to be self-represented injured workers who cannot find an attorney willing to represent them before the board. The claimant’s bar is aging and few younger lawyers are entering this field. Associated with this problem are some non-attorney representatives who attempt to assist injured workers and often provide incorrect advice, miss deadlines or complicate simple cases.

Target #2: Process open cases at the Appeals Commission within 360 days. Methodology: The average number of days from the filing of an appeal or petition for review to the issuance of a final order or decision. Average Number of Days to Close Appeals Cases (achieved the target of within 360 days in FY2018) Fiscal Year Ave Days to close a case # of published decisions FY 2018 232 14 FY 2017 173 8 FY 2016 264 12 FY 2015 219 12 FY 2014 178 12 FY 2013 251 21 FY 2012 185 8 FY 2011 288 18 FY 2010 269 24 FY 2009 230 29 Analysis of results and challenges: The Commission’s FY2018 docket also contained cases filed in previous fiscal years. The average time period from the filing of an appeal or petition for review to the issuance of a final order or decision in cases closed on the FY2018 docket was 232 days, with 84 percent of those cases being closed in less than 360 days from the filing of the appeal or petition for review. In addition to continuing a high level of compliance with the statute, the Commission has been able to close most cases filed with the Commission within 360 days of receiving the case.

Target #1: 100 percent of all written decisions will be issued within 30 days of record closure. Methodology: N/A Percent of Written Decisions Issued within 30 Days (did not achieve the target of 100 percent in FY2018) Fiscal Year YTD Total FY 2018 78% FY 2017 90% FY 2016 90% FY 2015 86% FY 2014 77% FY 2013 82% FY 2012 65% FY 2011 78% FY 2010 70% FY 2009 82% Analysis of results and challenges: The Alaska Workers' Compensation Board hears claims regarding disputes of entitlement to benefits under the Alaska Workers' Compensation Act. After the hearing record closes, the division has 30 days to complete its work and write a formal decision and order based on the board's determination. Those determinations will either allow or disallow an injured worker various benefits under the Alaska Workers' Compensation Act. The division in FY2018 did not meet this target of 100 percent. While the average number of days after record closure to decision issuance was 20 days, more difficult cases with typically enormous factual records in some instances took significantly longer for a variety of reasons. The division will continue to work toward the goal of issuing all decisions within 30 days of record closure.

Target #2: Hearings will be scheduled within an average of 90 days from receipt of readiness for hearings. Methodology: N/A Average Number of Days between Request for Hearing and Hearing Date (achieved the target of within 90 days in FY2018) Fiscal Year Average FY 2018 82 FY 2017 78 FY 2016 71 FY 2015 74 FY 2014 72 FY 2013 75 FY 2012 78 FY 2011 86 FY 2010 79 FY 2009 158 Analysis of results and challenges: The division has met this target in FY2018. Frequently, self-represented parties or parties represented by non-attorney representatives request hearings prematurely, when they are not actually ready for a hearing and further discovery or medical examinations still need to occur. Once parties are truly ready to go to a hearing, the division offers parties requesting a hearing the first available hearing date in all circumstances. In most instances, it is up to the parties or their representatives whether or not they accept that earliest hearing date. Frequently, one or both parties do not accept the earliest available hearing date, due to other commitments and innumerable other reasons. A recent shift to enforcing strictly existing statutes and regulations regarding appeals and other remedies from prehearing conference discovery determinations should bring this gap down significantly going forward.

Target #1: Issue final Workers' Compensation Appeals Commission decisions within an average of 90 days of record closure. Methodology: The average number of days from record closure to issuance of a final decision is for published final decisions only, and is not adjusted for cases with decisions on reconsideration, decisions on remand from the Alaska Supreme Court, or unpublished orders. Average Number of Days from Record Closure to Issuance of a Published Worker's Compensation Appeals Commission Decision (achieved the target of within 90 days in FY2018) Fiscal Year # of Decisions Written Ave # days FY 2018 14 63 FY 2017 8 80 FY 2016 12 91 FY 2015 12 23 FY 2014 12 27 FY 2013 21 46 FY 2012 8 62 FY 2011 18 75 FY 2010 24 86 FY 2009 29 63 FY 2008 35 73 Analysis of results and challenges: In FY2018, the Commission issued 14 published written final decisions of which 93 percent were made within 90 days of record closure. The overall average for published written final decisions was 63 days from record closure. In FY2018, the Commission issued 107 unpublished orders in addition to the 14 published final decisions. There was also one memorandum decision on a petition for review that was published.

Target #1: Requests for reimbursement from the Fishermen's Fund will be paid within 30 days of receipt. Methodology: Includes new and existing claims that have been found eligible for Fish Fund benefits and were processed. Average Number of Days to Process a Fishermen's Fund Claim (achieved the target of 30 days in FY2018) Fiscal Year # of days # of claims paid FY 2018 30 269 FY 2017 26 286 FY 2016 27 294 FY 2015 46 290 FY 2014 47 371 FY 2013 60 333 FY 2012 69 373 FY 2011 50 447 FY 2010 76 629 FY 2009 38 698 FY 2008 33 705 Analysis of results and challenges: In FY2018, the number of claims received by the Fishermen’s Fund totaled 323 with 213 claims approved (207 by fund administration and six by the Fishermen's Fund Council). Of the new claims received and existing claims, 269 were eligible for Fish Fund benefits and were processed. For the year, there were 1,015 bill payments issued by the Fund. The Fund has been diligent in improving processing of first payments on claims under $10,000. The Fund has actively worked with injured fishermen and providers to ensure that submitted claims contain all required documentation upon initial presentation through the first 90 days via phone call or email. In FY2010, the Fishermen’s Fund benefit limit was raised from $2,500 to $10,000 by the legislature. The new limit change also spurred changes to new claim requirements and documentation that fishermen must submit to the Fund to process new claims. Claims filed by fisherman are cyclical with the fishing season. The Fund receives 50 percent of its claims between July and October. The Fund approved 144 claims within 30 days or less. Claim approval on 63 claims was delayed for the following reasons: 1. The Fund did not receive medical bills, medical chart notes and explanation of benefits with the claim. 2. The Fund was unable to verify a valid license or permit. 3. The Fund requested additional information.

Target #2: 20 percent of injured workers eligible for reemployment benefits complete a viable retraining plan. Percent of Eligible Injured Workers Who Completed a Retraining Plan (did not achieve the 20 percent target in FY2018) Fiscal Year # Eligible # Completing Plan % Completing FY 2018 135 -8.78% 14 0% 10.4% FY 2017 148 -20.43% 14 +7.69% 9.5% FY 2016 186 -15.07% 13 -7.14% 5.9% FY 2015 219 +1.86% 14 +7.69% 6.4% FY 2014 215 +7.5% 13 -23.53% 6.0% FY 2013 200 -6.54% 17 -5.56% 8.5% FY 2012 214 -23.3% 18 +5.88% 8.4% FY 2011 279 +8.14% 17 -55.26% 6.1% FY 2010 258 -17.31% 38 -5% 14.7% FY 2009 312 +39.91% 40 -11.11% 12.8% Analysis of results and challenges: The number of employees eligible for reemployment plans continued a downward trend in FY2018, while the number of completed plans was unchanged. As a result, the percentage of completed plans increased slightly. In FY2018, 56 injured workers determined eligible for reemployment benefits exited the reemployment benefits system by selecting the job dislocation benefit; an additional 67 injured workers found eligible settled reemployment benefits in a Compromise and Release agreement at some point after eligibility and prior to plan completion. These two factors significantly limit the number of injured workers available to participate in a retraining plan. Also, as training costs continue to rise it becomes more difficult for rehabilitation specialists to develop retraining plans within the $13,300 statutory limit. Finally, for workers that have been in the workforce for a number of years, the statutory two-year time limit on retraining plans is not always sufficient and time expires prior to plan completion for an additional subset of workers.

Target #1: Keep the number of days it takes to get the Fishermen's Fund Advisory & Appeals Council's approval to within 90 days. Methodology: N/A Average Number of Days to get Fishermen's Fund Council's Approval (achieved the target of within 90 days in FY2018) Fiscal Year Average Days FY 2018 70 FY 2017 62 FY 2016 60 FY 2015 91 FY 2014 60 FY 2013 90 FY 2012 98 FY 2011 30 FY 2010 54 FY 2009 54 Analysis of results and challenges: FY2018: 29 claims sent to Council FY2017: 29 claims sent to Council FY2016: 39 claims sent to Council FY2015: 49 claims sent to Council The Council reviews all claims denied by the Fund Administrator, all applications for benefits that exceed the Fund Administrator’s statutory limit of $10,000, and all requests to extend duration of care. The Council meets twice a year. The Council may deny a claim with conditions. These conditions could be a request for more information or documentation from the fisherman, especially if the request is a substantial dollar amount or extension of care beyond statutory limits.

Target #1: Reduce the percentage of retraining plans that are returned to the rehabilitation specialists by 20 percent per year until no plans need to be returned. Methodology: N/A Percent of Retraining Plans Returned to Rehabilitation Specialists (did not achieve the target reduction of 20 percent in FY2018) Fiscal Year # Plans Submitted # of Plans Returned Percent Returned FY 2018 52 11 21.2% FY 2017 65 9 13.8% FY 2016 71 5 7.04% FY 2015 88 6 6.82% FY 2014 74 4 5.41% FY 2013 80 7 8.75% FY 2012 124 27 22% FY 2011 163 38 23% FY 2010 116 20 17% FY 2009 155 23 15% Analysis of results and challenges: In FY2018, there were fewer plans submitted and more plans reviewed resulting in a corresponding increase in plans returned to rehabilitation specialists. Some retraining plans need to be returned to the rehabilitation specialists because the plans do not meet the requirements of the law. Nearly all plans submitted for review by the Reemployment Benefits Administrator (RBA) are suspended or denied; plans about which neither party has concerns are signed rather than submitted for review. Conversely, parties that do not sign plans typically have valid concerns that are borne out by RBA review. For high wage earners with a high remunerative wage it can be impossible to meet the requirements of the law that the plan meet the remunerative wage. Even if there is theoretically a means (occupational goal) to meet the wage, statutory time (two years) and more so cost ($13,300) limitations can be the barrier. The mental and physical capacities of the injured worker can also provide barriers to developing a plan that meets the requirements of the law. Rehabilitation specialists are left more and more with the option of submitting a plan they know would not pass RBA review, hoping the parties will agree to it anyway.

Target #2: Review of all pending retraining plans will be performed quarterly. Methodology: N/A Percent of Pending Retraining Plans Reviewed Quarterly (achieved the target of 100 percent in FY2018) Fiscal Year % of Plans Reviewed FY 2018 100% FY 2017 75% FY 2016 100% FY 2015 100% FY 2014 100% FY 2013 100% FY 2012 100% FY 2011 82% FY 2010 67% FY 2009 25% Analysis of results and challenges: The Reemployment Benefits Administrator reviewed all pending retraining plans quarterly in FY2018. Except for one quarter when the position was vacant in FY2017, the Administrator has reviewed all pending training plans on a quarterly basis for the past seven fiscal years.

Current as of July 19, 2019