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.
- 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: Zero uninsured employee injuries.
Number of Uninsured Employee Injuries (did not achieve the target of zero in FY2018)
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.
Percentage of Uninsured Employers who Took Responsibility for Uninsured Injuries (achieved the target of 100 percent in FY2018)
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.
|A1: Core Service - Ensure compliance with the Workers' Compensation Act.|
Target #1: Investigate 100 percent of alleged uninsured employers.
Percentage of Alleged Uninsured Employers Investigated (achieved the target of 100 percent in FY2018)
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.
Percentage of Alleged Workers' Compensation Act Fraud Investigated (achieved the target of 100 percent in FY2018)
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.
Percentage of Investigations Completed in Six Months (did not achieve the target of 85 percent in FY2018
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.
Number of Employers Educated about the Workers' Compensation Act (did not achieve the target of 600 employers in FY2018)
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.
|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.
Percentage of Disputed Issues Resolved without a Formal Hearing (achieved target of 90 percent in FY2018)
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.
Average Number of Days to Close Appeals Cases (achieved the target of within 360 days in FY2018)
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.
|B1: Core Service - Conduct timely Workers' Compensation hearings.|
Target #1: 100 percent of all written decisions will be issued within 30 days of record closure.
Percent of Written Decisions Issued within 30 Days (did not achieve the target of 100 percent in FY2018)
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.
Average Number of Days between Request for Hearing and Hearing Date (achieved the target of within 90 days in FY2018)
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.
|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.
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)
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.
|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 (achieved the target of 30 days in FY2018)
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)
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.
|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.
Average Number of Days to get Fishermen's Fund Council's Approval (achieved the target of within 90 days in FY2018)
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.
|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 (did not achieve the target reduction of 20 percent in FY2018)
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.
Percent of Pending Retraining Plans Reviewed Quarterly (achieved the target of 100 percent in FY2018)
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