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.
- 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|
|Mission Results||Core Services|
|Mission Results||Core Services|
|A: Result - All employers comply with AS 23.30, the Alaska Workers' Compensation Act.|
Target #2: All uninsured employers take responsibility for uninsured injuries.
Analysis of results and challenges: During FY2020, out of the total 20 confirmed uninsured injuries, a total of 8 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. The remaining 16 uninsured injured workers opted to not 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.
|A1: Core Service - Ensure compliance with the Workers' Compensation Act.|
Target #1: Investigate all alleged uninsured employers.
Analysis of results and challenges: The Special Investigations Unit (SIU) conducted 412 compliance checks and found 294 of those alleged uninsured employers in compliance. The remaining 118 alleged uninsured employers were referred for further investigation. SIU began FY2020 with 91 pending failure to insure investigations, and opened or reopened another 253 cases for a total of 344 investigations worked during FY2020.
These investigations typically begin within a day or two and 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.
Out of 344 active investigations, SIU closed 228 in FY2020. Of the 228 investigations closed, 160 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 employers coverage reinstatement resulted in a small enough lapse that pursuing a penalty would not be cost effective). Out of 184 remaining investigations, 62 cases resulted in penalties assessed to employers via stipulated settlement (59) or formal decision and order issued by the Alaska Workers' Compensation Board (3). A total of 71 employers were petitioned for failure to insure in FY2020. Six petitions were withdrawn due to either POC found or business closure.
There were 116 remaining investigations actively pending at the close of FY2020.
Target #2: Investigate all alleged Workers' Compensation Act fraud.
Analysis of results and challenges: The Special Investigations Unit received 205 fraud allegations in FY2020. Of the 205 fraud allegations, 22 were alleged claimant fraud, 81 were alleged employer fraud, 6 were alleged care provider fraud, 0 were alleged attorney/non-attorney rep fraud, 6 were alleged insurance company/agent fraud, 84 were other agency assist requests, 3 were both agency assist and claimant fraud and 3 were not related to workers' compensation fraud.
Target #3: 75% of investigations are completed within six months.
Analysis of results and challenges: The Special Investigations Unit (SIU) investigated a total of 344 formal failure to insure matters, including those carried over from FY2019 and new matters opened in FY2020. Of the 228 failure to insure investigations closed, 170 were closed within 180 days from the actual date opened to the actual date closed.
Target #4: Educate employers about the Workers' Compensation Act requirements.
Analysis of results and challenges: During FY2020, the Special Investigations Unit (SIU) conducted 8 formal education presentations with a total of 282 attendees, responded to 290 documented public inquiries, and conducted a total of 35 onsite visits for a total of 607 educated employers. Not being able to travel to communities outside the regional areas or provide in-person presentations during the COVID-19 pandemic had a dramatic impact on SIU's decreased proactive education activity during FY2020.
|B: Result - Improved delivery of efficient, low cost and legal informal and formal dispute resolution.|
Target #1: Resolve at least 90 percent of disputed issues without a formal hearing.
Analysis of results and challenges: The Division of Workers' Compensation continues to achieve 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 FY2020, the division's mediation program mediated 67 cases, in comparison to 123 cases decided by formal hearings and written decisions.
The division is challenged by non-attorney representatives who attempt to assist injured workers and provide incorrect advice, miss deadlines or complicate simple cases. The division recommends a statutory amendment that forbids persons who are not licensed attorneys from representing claimants. The division is also challenged by self-represented claimants with mental health concerns that interfere with their ability to effectively utilize advice given on how to pursue their rights under the Workers' Compensation Act. The division will seek guardianship for claimants with mental illness that renders them incompetent to protect and pursue their rights under the Act. The division will continue to provide increased training opportunities to help self-represented claimants and non-attorney representatives more effectively and efficiently navigate the process.
Target #2: Process open cases at the Appeals Commission within 250 days.
Analysis of results and challenges: The Commission's FY2020 docket contained cases filed in FY2020 and cases filed in previous fiscal years, as well as cases remanded from the Alaska Supreme Court. 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 FY2020 docket was 177 days, with 94 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 64 percent of cases filed with the Commission within 250 days of receiving the case
|B1: Core Service - Conduct timely Workers' Compensation hearings.|
Target #1: All written decisions will be issued within 30 days of record closure.
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 FY2020 did not meet this target of 100 percent. While the average number of days after record closure to decision issuance was 29.7 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.
Average Number of Days between Request for Workers' Compensation Hearing and Hearing Date
Analysis of results and challenges: The division did not meet this target in FY2020. 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 strictly enforcing existing statutes and regulations regarding appeals and other remedies from prehearing conference discovery determinations should bring this gap down significantly going forward.
|B2: Core Service - Operate a timely and efficient appeals program.|
Target #1: Issue final Workers' Compensation Appeals Commission decisions within an average of 90 days of record closure.
Analysis of results and challenges: In FY2020, the Commission issued 15 published written decisions of which 67 percent were made within 90 days of record closure. Three decisions were issued in 91 days, one decision was issued in 92 days, and one decision was issued in 100 days. The overall average for published written final decisions was 85 days from record closure.
In FY2020, the Commission issued 111 unpublished orders in addition to the 15 published decisions.
|C: Result - More Alaskans available for jobs.|
Target #1: Requests for reimbursement from the Fishermen's Fund will be paid within 30 days of receipt.
Average Number of Days to Process a Fishermen's Fund Claim
Analysis of results and challenges: In FY2020, the number of claims received by the Fishermen's Fund totaled 263 with 142 claims approved for benefits (133 by fund administration and 10 by the Fishermen's Fund Council). The average number of days from filed petition for benefits to approval on claims approved by the fund administration was 36 days. The average number of days from approval to payment of benefits was 3 days on claims approved by the fund administration.
The Fund processed benefit payments for 197 claims (includes new and existing claims). A total of 650 bill payments were 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 and provided vessel owners reimbursement of a portion of their Protection & Indemnity (P&I) insurance deductible, if the injured fishermen filed a claim with the P&I insurer. In FY2019, the Legislature agreed to increase the reimbursable portion of the P&I deductible payment to $5,000 and this change will become effective in FY2020.
- For FY2020, P&I insurance coverage paid benefits on 35 of the 263 claims submitted to the Fund.
Claims filed by fisherman are cyclical with the fishing season. The Fund receives 50 percent of its claims between July and October. The fund administration approved 133 claims of which78 claims were paid within 30 days or less. Delayed decisions and payments were issued on 55 claims for the following reasons:
1. The Fund did not receive required medical bills, 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 and the information was not provided.
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
Analysis of results and challenges: The number of employees eligible for reemployment plans decreased in FY2020, while the number of completed plans also decreased. As a result, the percentage of completed plans increased. In FY 2020, 39 injured workers determined eligible for reemployment benefits exited the reemployment benefits system by selecting the job dislocation benefit under AS 23.30.041(g)(2); an additional 57 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 under AS 23.30.041(l). 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.
|C1: Core Service - Process Fishermen's Fund claims timely.|
Target #1: Keep the number of days it takes to get the Fishermen's Fund Advisory & Appeals Council's approval to within 90 days.
Analysis of results and challenges: The Fishermen's Fund 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.
For FY2020, the Council reviewed 11 claim appeals, 9 were approved and 2 denied. The Council also reviewed 23 claims denied by the Fund Administration.
For FY2020, the average number of days from filed petition for benefits to approval on claims approved by the Fishermen's Fund Council was 53 days. The average number of days from approval to payment of benefits was 16 days on claims approved by the Fishermen's Fund Council.
|C2: Core Service - Administer a vocational rehabilitation benefits and training program for injured workers.|
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.
Percent of Retraining Plans Returned to Rehabilitation Specialists
Analysis of results and challenges: In FY2020, there were fewer plans submitted, but more plans returned to rehabilitation specialists. This is primarily a function of the number of disputed plans that require Reemployment Benefits Administrator (RBA) review. Nearly all plans submitted for review by the RBA are suspended or denied because they do not meet statutory requirements; plans about which neither party has concerns are agreed to without RBA review. For high wage earners it can be impossible to meet the requirements of the law that the plan meet the remunerative wage (60% of the wage prior to injury). 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. Of course, 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.
Analysis of results and challenges: Except for three quarters when the position was vacant in FY2017, FY2019 and FY2020, the Reemployment Benefits Administrator has reviewed all pending training plans on a quarterly basis for the past nine fiscal years. The Administrator position was vacant July 2019 – September 2019, which resulted in 75% of all pending retraining plans being reviewed quarterly in FY2020.
Current as of December 9, 2020