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February 21, 2012: Alaska News:
Notice Of Proposed Changes In The
Regulations Of The Dept. Of Labor And
Workforce Development And Alaska
Workers' Compensation Board
January 28, 2012:Alaska News: Paying
Workers’ Safety and Compensation Fees
January 11, 2012: Alaska News:
WORKERS' COMPENSATION
2010 ANNUAL REPORT ISSUED
December 15, 2011: Alaska News: 3
new bulletins issues
December 01, 2011: Alaska: News The
Department of Labor and Workforce
Development and Alaska Workers’
Compensation Board propose to adopt
regulation changes in Title 8, Chapter 45
of the Alaska Administrative Code,
dealing with Proceedings before the
Alaska Workers’ Compensation Board
and payment for medical fees and
services,
On September 28, 2011, Governor Sean
Parnell signed House Bill 13 into law,
Chapter 32, SLA 11. This legislation
provides that the fees for medical
treatment may not exceed the lowest of
(1) the usual, customary, and reasonable
fees in the community, for treatment or
service provided on or after December
31, 2010, not to exceed the fees
specified in a medical fee schedule
adopted by the Alaska Workers’
Compensation Board (Board) by
reference in regulation; or
(2) the fees for the general public; or
(3) the fees negotiated by the provider
and an employer under Alaska Statute
23.30.097(c).
A copy of the Official Alaska Workers’
Compensation Medical Fee Schedule,
effective December 31, 2010, may be
obtained by contacting
Ingenix/OptumInsight at 800-464-3649,
or online at http://www.shopingenix.
com/SearchResults.aspx?
SearchTerm=alaska.
October 01, 2011: fee schedule
Medical Fee Schedule
The Division of Workers’
Compensation has contracted with
OptumInsight to produce a new medical
fee schedule. The new fee schedule will
be available on or before September 30,
2010.
Optum is now taking advance orders.
Orders may be placed online by going to
http://www.shopingenix.
com/SearchResults.aspx?
SearchTerm=alaska ,
or by calling 1-800-464-3649.
Regulation Change
The Department of Labor and
Workforce Development and Alaska
Workers’ Compensation Board
proposes to adopt regulation changes in
Title 8, Chapter 45 of the Alaska
Administrative Code, dealing with
compensation, medical benefits, and
proceedings before the Alaska
Workers&rsqo; Compensation Board.
The full notice of proposed regulations
can be found online at the State of
Alaska Online Public Notice System.
Notice Of Proposed Changes In The
Regulations Of The Dept. Of Labor And
Workforce Development And Alaska
Workers' Compensation Board
January 28, 2012:Alaska News: Paying
Workers’ Safety and Compensation Fees
January 11, 2012: Alaska News:
WORKERS' COMPENSATION
2010 ANNUAL REPORT ISSUED
December 15, 2011: Alaska News: 3
new bulletins issues
December 01, 2011: Alaska: News The
Department of Labor and Workforce
Development and Alaska Workers’
Compensation Board propose to adopt
regulation changes in Title 8, Chapter 45
of the Alaska Administrative Code,
dealing with Proceedings before the
Alaska Workers’ Compensation Board
and payment for medical fees and
services,
On September 28, 2011, Governor Sean
Parnell signed House Bill 13 into law,
Chapter 32, SLA 11. This legislation
provides that the fees for medical
treatment may not exceed the lowest of
(1) the usual, customary, and reasonable
fees in the community, for treatment or
service provided on or after December
31, 2010, not to exceed the fees
specified in a medical fee schedule
adopted by the Alaska Workers’
Compensation Board (Board) by
reference in regulation; or
(2) the fees for the general public; or
(3) the fees negotiated by the provider
and an employer under Alaska Statute
23.30.097(c).
A copy of the Official Alaska Workers’
Compensation Medical Fee Schedule,
effective December 31, 2010, may be
obtained by contacting
Ingenix/OptumInsight at 800-464-3649,
or online at http://www.shopingenix.
com/SearchResults.aspx?
SearchTerm=alaska.
October 01, 2011: fee schedule
Medical Fee Schedule
The Division of Workers’
Compensation has contracted with
OptumInsight to produce a new medical
fee schedule. The new fee schedule will
be available on or before September 30,
2010.
Optum is now taking advance orders.
Orders may be placed online by going to
http://www.shopingenix.
com/SearchResults.aspx?
SearchTerm=alaska ,
or by calling 1-800-464-3649.
Regulation Change
The Department of Labor and
Workforce Development and Alaska
Workers’ Compensation Board
proposes to adopt regulation changes in
Title 8, Chapter 45 of the Alaska
Administrative Code, dealing with
compensation, medical benefits, and
proceedings before the Alaska
Workers&rsqo; Compensation Board.
The full notice of proposed regulations
can be found online at the State of
Alaska Online Public Notice System.
- The Medical Services Review
Committee (MSRC) assists and
advises the Department of
Labor and Workforce
Development and the Workers’
Compensation Board in matters
involving the appropriateness,
necessity, and cost of medical
and related services provided
under the Workers’
Compensation Act.
- Workers Compensation Decisions
- Medical control: The injured employee may select an initial medical care provider. The
injured employee may make one change of attending physician without the consent of the
employer. The injured employee shall notify the supervisor or human resources of the
change. Any subsequent change of medical provider will require prior approval of the
employer. A referral to a specialist directed by an attending physician is not considered a
change. The employee may select his/her own pharmacy or select a pharmacy from the
Express Scripts pharmacy network. Emergency medical care does not require preapproval
and should be secured at the nearest location.
- The Medical Services Review Committee (MSRC) assists and advises the Department of
Labor and Workforce Development and the Workers’ Compensation Board in matters
involving the appropriateness, necessity, and cost of medical and related services provided
under the Workers’ Compensation Act.
Workers’ Compensation Fishermen's Fund
Velma Thomas, Program Coordinator
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Table of Contents
Claim Form (07-6125)
Physician's Report (07-6126)
Report of Vessel/Site Insurance (07-6119)
Carpal Tunnel Syndrome Questionnaire (07-6123)
Compelling Reasons Questionnaire (07-6124)
You will need a copy of Acrobat Reader to view these forms. Download it free from Adobe.
What is the Fishermen's Fund?
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Established in 1951, the Fishermen's Fund provides for the treatment and care of Alaska
licensed commercial fishermen who have been injured while fishing on shore or off shore in
Alaska.
Benefits from the Fund are financed from revenue received from each resident and nonresident
commercial fisherman's license and permit fee.
The Commissioner of Labor and Workforce Development oversees administration of the
program with the assistance of the Fishermen's Fund Advisory and Appeals Council.
The council is composed of the Commissioner or his designee, who serves as chairman, and
five members appointed by the Governor.
Fishermen's Fund Advisory and Appeals Council
Qualifying for Benefits
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Crewmembers with injury or illness directly connected to operations as a commercial
fisherman must hold valid commercial fishing licenses or limited entry permits before the time
of injury or illness to qualify for benefits. Note: Eligibility of a limited entry permit holder is
based on the embossed date of the permit, not the date on which it was paid or when payment
was received.
Onset of injury or illness must be onshore in Alaska or on Alaska waters.
Initial treatment must be received within 60 days after onset of injury or illness.
An application must be submitted within one (1) year after initial treatment.
Each treatment must be documented by a medical chart note and submitted.
How to File and Avoid Delays
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It is the fisherman's responsibility to see that a claim is filed. If the medical provider agrees to
file a claim with your insurance company, the Fishermen's Fund, or a federal program such as
Medicare, Veterans' Affairs, or the Indian Health Service, it remains the responsibility of the
fisherman to see that the claim is complete and filed appropriately.
Immediately following an injury or illness:
Tell the appropriate medical facility personnel that two reports must be completed:
Fisherman's Report of Injury or Illness
Physician's Report of Injury or Illness
The fisherman and physician must each fully complete their respective report. These two
reports need be completed only once, by the fisherman upon his initial treatment, and by the
initial treating physician. All items must be answered and comments provided. (The reports
are printed back to back and included in the center of this booklet. They are also available from
most doctors, hospitals, clinics, and some harbormaster offices in Alaska, as well as from the
Fishermen's Fund.)
Fishermen’s Fund Fisherman's Report
Completing the Report:
Attach copy of crewmember license or limited entry permit. A copy of the valid license or
permit accompanying your application will expedite your claim as much as two to four
months. (#10.)
Note the vessel owner's Protection and Indemnity (P&I) deductible. (#12.)
Note whether insured by health insurance or covered by a public program such as Medicare,
Veterans Administration (VA), Indian Health Service (IHS). (#13.)
Describe in detail injury or illness and how it was directly connected with commercial fishing.
(#14.)
Be specific as to the geographic location where injury or illness occurred, such as nearest
landmark, miles or hours from a reference point. Give latitude and longitude if known. (#15.)
Sign and date application. (#19.)
Submit the reports immediately. The Fisherman's Report is considered the fisherman's
application for Fund benefits.
Include a permanent mailing address and advise of address changes. Benefits may be denied if
you do not receive and respond to an inquiry.
Please respond completely and promptly. Failure to do any of the above can delay your claim.
When do the Fund's benefits kick in?
The Fund is an emergency fund payer of last resort, which means that benefits are awarded
only after full consideration of other coverage from private health or vessel insurance, and
public programs, including Veterans' Affairs or Medicare. (Medicaid is an exception.)
Processor Activities and Processor/Tender Vessels
A worker whose injury or illness is directly connected to a processing activity does not
qualify for Fund benefits, but may be covered under Workers' Compensation.
A fisherman on a freezer or troller vessel who becomes injured or ill as a result of processing
activities related to freezing the product would generally not be covered.
However, a fisherman injured or becoming ill on a tender vessel is usually covered unless the
incident was directly connected to processing activities.
Withdrawing an Application
Withdrawing an application requires a written request from the applicant fisherman and must
be reviewed by the Fishermen's Fund Advisory and Appeals Council.
Primary Insurance Considerations
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If you have medical insurance, the Fund must have a written statement—Explanation of
Benefits (EOB)—verifying you have filed a claim for each of your medical expenses with your
health insurance carrier.
Vessel or Site P&I (Protection and Indemnity) Insurance
If the fisherman applicant does not indicate the P&I deductible on the application, a Report of
Vessel or Site Insurance will be requested to verify whether P&I coverage exists, and if so, the
amount of the deductible and the name of the vessel owner's insurance carrier or adjuster. If the
deductible is unknown, benefits will be limited to $10,000.
If expenses exceed, or will be expected to exceed, the deductible under a vessel owner's P&I
policy, the fisherman applicant must file with the vessel owner's insurance carrier. These
expenses are usually covered under the P&I policy. Expenses not covered should be submitted
to the Fishermen's Fund. Otherwise, eligible expenses paid from the Fund which exceed the
P&I deductible will be recovered under 8 Alaska Administrative Code (AAC) 055.010 (e) and
by exercising subrogation rights under 8 AAC 055.035.
The vessel owner's deductible payment to the insurance company is considered a contribution
to the insurance liability covered under the policy and is not recoverable from the Fishermen's
Fund.
A vessel owner who pays for transportation or medical expenses for the injured or ill
fisherman may be reimbursed if an agreement exists verifying that the employer advanced the
money or paid any medical treatment on their behalf. A crewmember may be reimbursed if
there is verification that the employer deducted the payments directly from wages due the
injured or ill fisherman. Reimbursement cannot be made without the above supporting
information.
Alternatively, the injured or ill fisherman and the vessel owner may complete the Vessel
Owner–Crewmember Agreement, both signing to attest their understanding that the expenses
paid by the owner were paid as a loan to the crewmembers. The wording of the form may be
revised to fit the circumstances. There is no assurance this agreement in any way complies
with marine law. (Agreement in Appendix C)
Indian Health Service (IHS ) Beneficiaries
A fisherman who is eligible to receive direct care services from an IHS facility is expected to
utilize these services when possible. In the event that an IHS recipient chooses not to use an
IHS facility when it is available, the fisherman must justify to the Council his/her reason for
not using the IHS facility.
The Fund covers (pays for) services for IHS eligible individuals for items and services that are
not covered by IHS; i.e., eyeglasses, chiropractic care, and dentures, if a legitimate claim is
filed. However, direct care services that are covered by the IHS are not eligible for benefits
from the Fund.
If an IHS facility makes a referral to another facility that is not an IHS facility, the Fishermen's
Fund is responsible for the first $10,000. The Fund should be provided with a copy of the
billing form to pay the claim.
When a direct care provider is not available, the Fishermen's Fund will pay emergency or
urgent care at a non-IHS facility. Limitations on a fisherman's time are taken into consideration
when determining "not available."
Fishermen's Fund Physician's Report
Completing the Report:
Questions 1-4 may be answered by attaching medical records and noting, "See attached chart
notes."
Questions 5-14 require very little time to complete, and a clerical assistant may answer most
of them.
Questions 6 and 7 must be answered by the initial treating physician, to confirm that the
injury is directly connected with the commercial fishing operations of the fisherman applicant.
Chart notes or medical records are required, as an attachment to the Physician's Report, but do
not substitute for it. The physician may use the "see attached" notation for numbers 2 & 4 on
the Physician's Report if the form is signed and the fishing-related questions are answered.
The Physician's Report serves many purposes, such as providing the necessary information in
a logical order and concise manner to expedite processing and approvals for payment.
When bills are received for the treatment of an injury or illness for which an application has
not been filed, the fisherman and all medical providers will be sent a letter informing them no
action can be taken until an application has been filed.
Council Review
When the Fishermen's Fund administrator cannot immediately approve an application for
benefits, it must go before the Fishermen's Fund Advisory and Appeals Council for review.
The Council meets twice a year, usually in November and March.
Common reasons for delays that require the Council's review:
1. No response to an inquiry about items on an application.
2. Failure to seek treatment within 60 days of the onset of the injury or illness.
3. No evidence of a license at the time of injury or illness.
4. Injury or illness unrelated or not directly connected to operations of a commercial fisherman
in Alaska.
Just Cause
The Council may approve benefits when just cause is demonstrated for the delay in the
following circumstances:
Initial treatment is received more than 60 days after the onset of injury or illness.
Complete responses to inquiries are not received within 90 days.
An application was received more than 1 year after the initial treatment.
Just cause for the delay should be explained in writing.
Establishing Just Cause for:
Not Seeking Treatment within 60 Days of Injury or illness
Not Filing within One (1) Year of Initial Treatment
Not Responding to an Inquiry within 90 Days.
Not Responding to an Inquiry for, or Receiving an Explanation of Benefits (EOB) within 180
Days
When a fisherman does not meet the timelines established above, and the Council has
determined just cause for the delay exists, the Council may allow the administrator to approve
benefits if:
A written statement is received from a physician or fisherman which: states the late treatment
or surgery was necessary to correct injuries or illnesses such as a hernia, carpal tunnel, or
musculoskeletal condition; and notes the injury was directly connected to the commercial
fishing activity described in the fisherman's application; and states that any delay in treatment
was for the purpose of allowing the physician or fisherman to observe whether remedial
treatments or time would correct the condition.
A letter from the provider (i.e., hospital, medical clinic, etc.) or from an insurance company or
public program noting the delay in filing or responding timely was their fault; or,
Verbal or written evidence from the fisherman applicant that the late filing or response was
due to their medical condition, fishing responsibilities, or an emergency requiring the
fisherman's attention.
Approvals, Denials, Appeals
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Applications must be sent to the administrator.
When a decision indicates, "Your claim cannot be approved by the administrator," it does not
mean the fisherman is denied benefits. Often further information is required to enable approval
by the administrator, or by law the application requires approval by the Council.
Reconsideration or Appeal
In the event the administrator cannot approve an application, all parties will be notified in
writing of the reason. The application will be reviewed and a final determination made at the
next meeting of the Fishermen's Fund Advisory and Appeals Council. Parties will be notified
of the time and place of the meeting and may submit written information supporting the
application or may appear before the Council. A Notice of the Council's decision will be
mailed to all parties, usually within four weeks. A decision may be reconsidered or appealed as
noted below.
In some cases the Council will deny benefits unless certain conditions are satisfied by a certain
time. The fisherman, therefore, must read the Council decision carefully and fulfill all the
conditions to assure the best opportunity for approval.
Under Alaska Statute 44.62.540(a), the fisherman has the right to file a Petition of
Reconsideration to the Council within 15 days after the mailing of the decision.
Under Alaska Administrative Code 8 AAC 055.030(d), the fisherman has the right to appeal
the decision of the Council to the Commissioner of Labor within 45 days after receipt of the
notice of the decision. The appeal must contain a complete statement of the justification
including a description of the relief sought.
A request for reconsideration or appeal must be in writing, signed by the claimant, and filed by
mail or in person at the Office of the Commissioner, Department of Labor and Workforce
Development, PO Box 111149 (1111 West 8th Street), Juneau, AK 99811. Otherwise, the
Council decision is final.
What is Covered
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Related costs of transportation, medical care, hospitalization, prescriptions, therapy, and
chiropractic care will be paid for an occupational injury or illness if it is "directly connected
with operations as a commercial fisherman" in Alaska waters or on shore preparing or
dismantling boats or gear used in commercial fishing.
Those costs noted above that are necessitated by a cardio-vascular disease may be paid if
"attributable, directly or indirectly, to the fishing endeavor" (AS 23.35.080). A fisherman is
also entitled to "such assistance after discharge from the hospital during period of
convalescence as allowed in consideration of the condition of the Fund" (AS 23.35.090).
The total allowance for any one heart attack is $10,000.
Covered Injuries or Illnesses. Occupational illnesses or diseases which may be covered include:
hernias, varicose veins of the leg; rheumatism, arthritis, musculoskeletal ailments such as
bursitis, traumatic sciatica and tenosynovitis; the respiratory diseases bronchitis, pneumonia,
and pleurisy caused by or aggravated by the fishing endeavor.
With respect to a pre-existing injury, if subsequent aggravation is attributable strictly to that
injury, and does not amount to a new injury, then, as with a recurring disability, benefits will
not be awarded (AS 23.35.130, Opinion of Attorney General).
What is Not Covered? Conditions of Coverage
Noncovered Illnesses and Diseases and Other Conditions. Illnesses or diseases and other
conditions not covered include strep throat, tonsillitis, the common cold, influenza, ulcers,
cancer, appendicitis, insect bites, salmonella, giardia, smoking related conditions, cracked teeth
or loose fillings from eating. Sexually transmitted diseases or drug or alcohol related injuries,
and those caused by not following good hygiene and health practices, or improper care are not
covered. Ear infections caused from diving in a commercial fishery are covered but not when
due to a cold.
Chronic Conditions. Chronic injuries, although aggravated by the fishing endeavor, may not be
covered since they are usually pre-existing and not directly connected to the operations of a
fisherman.
Three-Month Gap in Treatment. The Council must reassess the treatment of an injury or
illness when there is a three-month gap in the treatment. A doctor's statement is required
noting how the treatment was directly connected to the prior commercial fishing injury.
Fifth Injury Within Eight Years to the Same Area of the Spine. A doctor's statement is
required when an application for benefits is received to cover expenses related to the
fisherman's fifth injury or illness for the same area of the spine within eight years. The
statement is necessary to determine whether it is a new acute injury or illness or if it is a
chronic condition, which is not covered.
Dental and Eye. Dentures, glasses or contact lenses lost or broken may be replaced or repaired
only when lost or broken in activities directly connected to operations as a fisherman. A claim
for dental injury without other bodily damage must be supported by a doctor's report that
substantiates the injury's direct connection to operations as a fisherman, or an affidavit may be
required.
Carpal Tunnel. No benefits will be allowed for surgery until all other alternative treatment has
been explored. If surgery is required after exploring these alternatives, the Council must review
the application to see if the need for surgery is caused by the fishing endeavor. If surgery is
required, the fisherman must provide in writing, or present to the Council in person, the
following:
1. The extent of alternative treatment pursued;
2. A ten-year history of work experience including the number of years commercially fishing
and type of fishing;
3. How the injury or illness has affected the ability to fish; and
4. Any other information considered pertinent.
Away from the Boat. An injury or illness occurring away from the boat or fishing site will be
covered as long as it is directly connected to operations as a fisherman, such as injuries
incurred on a dock while hauling gear to the boat or at home repairing commercial fishing gear.
Transportation. Costs are covered to and from the vessel, fishing or gear repair or storage site
to the nearest medical facility where appropriate emergency care can be provided. Additional
transportation costs to receive specialized or skilled care unavailable at the nearest approved
medical facility must be supported by a written statement from the attending physician which
clearly defines the specialized medical skill required and the nearest place where it is available.
Approval of additional transportation costs may require consideration of the financial
condition of the Fund.
Costs incurred for transportation after discharge from the hospital during period of
convalescence may be approved to return the fisherman to the boat, home or another place
that reasonably meets with the fisherman's convenience. (AS 23.35.090-100, 8 AAC 055.010
(d) and AS 23.35.080 & 100.)
To Whom are Benefits Paid?
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Benefits will be paid only to the medical provider or to the fisherman — to the provider if the
bill is outstanding, or to the fisherman if his payment is verified by evidence such as cancelled
checks, receipts, or bills or statements from medical providers.
A vessel owner who pays a bill can be reimbursed if the Fishermen's Fund administrator
receives evidence in writing that there was a prior agreement that the vessel owner would pay
any medical expenses, or would advance payment with an agreement to be reimbursed. The
fisherman will be reimbursed instead of the vessel owner if the fisherman submits evidence
that the vessel owner deducted these expenses from the fisherman's compensation. However,
these reimbursements do not imply that such an agreement or understanding is in compliance
with marine law.
See Appendix C for an example of agreement.
Requesting More Benefits or Time
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Except for compelling reasons, benefits for the care of any one person involving a single injury
or disability will not be paid beyond one year from the date of initial allowance, and cannot
exceed $10,000.
Requests to exceed the benefit limit or the duration of care must be in writing. They must note
the "amount of relief" or additional benefits needed, or the "extent of additional time" required.
Compelling reasons justifying the request must be specified. The Council must approve all
requests.
Compelling reasons to exceed $10,000 are not defined in law but must be sufficient to justify
the requested benefit or time extension and must include:
The financial status of the fisherman.
Impact of injury or illness on the fisherman's ability to earn a living while undergoing required
treatment and to continue to earn a living commercial fishing.
Any other compelling factors that affect the fisherman's ability to pay for related expenses in
excess of $10,000, or that result in conditions that require follow-up treatment beyond one
year.
Please remember to note:
How much additional relief or money is needed in excess of what the fisherman can pay and/or
the amount of extended time wanted beyond one year.
Appendix A
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Alaska Statutes Title 23
Labor and Workers' Compensation
AS 23.35.010. Creation of Fishermen's Fund Advisory and Appeals Council.
There is within the Department of Labor and Workforce Development a Fishermen's Fund
Advisory and Appeals Council.
AS 23.35.020. Appointment and Composition of Council.
The council is composed of the commissioner of labor and workforce development or a person
designated by the commissioner and five members appointed by the governor for overlapping
five year terms. The governor shall appoint one member from each of the following districts:
District 1: Wrangell and areas south;
District 2: Areas north of Wrangell to include Yakutat;
District 3: Areas west of Yakutat to East Coast of Alaska Peninsula, including Prince William
Sound, Cook Inlet, and Kodiak;
District 4: Areas west of Alaska Peninsula to Cape Newenham, including Bristol Bay;
District 5: Areas north of Cape Newenham, including Kuskokwim, Yukon, Kotzebue, and the
Arctic.
Sec. 23.35.030. Commissioner or designee as chair.
The commissioner of labor and workforce development or the person designated by the
commissioner serves as the chair of the council.
AS 23.35.040. Duties of Commissioner and Council.
(a) The council shall
(1) review all denials of benefits made by the person responsible for the administration of the
fund; and
(2) make all initial determinations regarding claims for additional benefits under AS 23.35.140.
(b) Under regulations adopted by the department, the commissioner shall hear all appeals from
the council's denial of benefits and denials of claims for additional benefits under AS
23.35.140. The commissioner's decision is final and may be appealed as provided under AS
44.62 (Administrative Procedure Act).
AS 23.35.050. Regulations.
The department may adopt regulations to carry out the purposes of this chapter, including
those that are necessary or advisable to protect the fund by limiting or suspending payments
from the fund. The regulations must be uniform in application.
AS 23.35.060. Creation and Administration of Fishermen's Fund.
(a) There is created a fund, designated as the "fishermen's fund." The Department of Revenue
is the custodian of the fund and the Department of Labor and Workforce Development shall
administer it. The fund shall be composed of
(1) 39 percent of the money derived by the state from all commercial fishermen's licenses, not
to exceed a maximum of $50 for each license holder for each year; and
(2) money appropriated to carry out the purpose of this chapter.
(b) The legislature may appropriate up to 50 percent of the interest income earned by the state
on the balance of the fishermen's fund for a grant for statewide marine safety training and
education programs.
AS 23.35.070. Benefits.
A fisherman, upon becoming disabled, is entitled to receive benefits as follows: Immediately
after the fisherman sustains an injury or disability arising out of an accident directly connected
with operations as a fisherman, either ashore in the state or in Alaska water, or suffers an
occupational disease, the fisherman is entitled to emergency treatment, transportation to the
nearest place where approved medical facilities are available, medical care, and hospitalization.
In this section, "Alaska water" means the inland and territorial water of the state and the
fishery conservation zone adjacent to the state established by 16 U.S.C. 1811 (sec. 101,
Fisheries Conservation and Management Act of 1976).
AS 23.35.080. Emergency Treatment For Cardio-Vascular Diseases.
The department may pay the costs, within the maximum limitations, of emergency treatment,
transportation, medical care, and hospitalization, necessitated by a cardio-vascular disease, if
the department determines that the disease is attributable, directly or indirectly, to the fishing
endeavor.
AS 23.35.090. Assistance After Discharge.
A fisherman is also entitled to such assistance after discharge from the hospital during period
of convalescence as the department allows in consideration of the condition of the fund.
AS 23.35.100. Transportation, Hospital, Nursing, Medical, and Surgical Expenses.
The department may pay out of the fund all reasonable transportation charges incurred under
AS 23.35.080 and 23.35.090, including cost of returning the fisherman to the boat or home of
the fisherman or to another place that reasonably meets with the fisherman's convenience, and
the reasonable hospital, nursing, medical, and surgical expense incurred in the examination,
treatment, and care of the fisherman.
AS 23.35.110. Contracts For Care.
In carrying out this chapter, the department may enter into contracts or other arrangements
with hospitals and doctors in the state for furnishing care on an annual basis to persons
entitled to benefits. Contracting under this section is governed by AS 36.30 (State
Procurement Code)
AS 23.35.120. Cooperation With Other Agencies.
In providing care the department shall provide the type and quality of treatment that will
restore the fisherman to health and productivity, if possible. The department may enter into
cooperative arrangements with agencies of the federal government, other states and territories,
and private clinics and rehabilitation centers for the care and treatment of fishermen.
AS 23.35.130. Duration of Care.
Except for compelling reasons, compensation may not be paid for the care of any one person
involving a single injury or disability beyond a period of one year from the date of initial
allowance.
AS 23.35.140. Limitation On Benefits.
(a) Except for compelling reasons,
(1) compensation may not be paid for medical care or hospitalization furnished before the
ascertainable time of injury, or before authorization in the case of disability caused by an
occupational disease;
(2) the total allowance for any one injury or disablement is $10,000.
(b) The total allowance for any one heart attack is $10,000.
Sec. 23.35.145. Claim of vessel owner.
If a fisherman files a claim for benefits under this chapter and also files a claim against the
protection and indemnity insurance policy of the vessel owner, the vessel owner is entitled to
receive a benefit, not to exceed the amount of the actual loss, that is the lesser of
(1)50 percent of the amount of the protection and indemnity insurance policy deductible; or
(2)$5,000.
AS 23.35.150. Definitions. In this chapter
(1) "approved medical facilities" and "medical care" include the facilities of, or the care and
treatment prescribed or performed by, a practitioner of chiropractic licensed by the state under
AS 08.20;
(2) "council" means the Fishermen's Fund Advisory and Appeals Council;
(3) "fisherman" means a person who is licensed by the state to engage in commercial fishing
under AS 16.05.480 or who is the holder of a permit issued under AS 16.43 and who, at the
time injury is sustained or illness is contracted, is actually so engaged or is occupied in Alaska
in preparing or dismantling boats or gear used in commercial fishing;
(4) "fund" means the Fishermen's Fund;
(5) "occupational disease" means hernia; varicose veins of the leg; the respiratory diseases,
bronchitis, pleurisy, and pneumonia caused by or aggravated by the fishing endeavor, but
excluding the common cold and influenza; rheumatism, arthritis, and those musculoskeletal
diseases (such as bursitis, traumatic sciatica, and tenosynovitis) directly caused by or
aggravated by the fishing endeavor; and does not include a disease not common to both sexes,
venereal disease, or a condition arising out of an attempt of a fisherman to injure self or another.
Appendix B
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Alaska Administrative Code
Chapter 55. Fishermen's Fund
8 AAC 055.010. Benefits.
(a) To be eligible for benefits from the fund, a person must be a fisherman who, at the time an
injury is sustained or illness is contracted, is licensed in his own name by the state to engage in
commercial fishing under AS 16.05.480 or AS 16.43, and who is actually so engaged in Alaska
water or is occupied in the state preparing or dismantling boats or gear used in commercial
fishing.
(b) Benefits for respiratory diseases are limited to bronchitis, pleurisy and pneumonia caused
by or aggravated by the fishing endeavor.
(c) Unless required as a result of accidental bodily injury caused by the fishing endeavor,
benefits may not be awarded for the following items:
(1) the services of a dentist;
(2) dental prosthetic appliances or the fitting of them;
(3) eye refractions and hearing examinations;
(4) eye glasses and hearing aides or the fitting of them.
(d) Transportation to return a fisherman to his home may be allowed to the extent that the
costs are in addition to those which the claimant would normally have encountered had he not
been injured.
(e) Compensation from the fund is limited to medical expenses that are not otherwise covered
by public or private insurance. The fund may require information regarding insurance coverage,
including an insurance benefits statement, and may hold a claim in abeyance pending the
receipt of required information.
(f) If expenses exceed, or will be expected to exceed, the deductible under the vessel owner's
protection and indemnity insurance policy, the applicant must file for benefits with the vessel
owner's insurance carrier. The vessel owner's deductible payment to the protection and
indemnity insurance company may not be recovered from the fund.
(Eff. 3/28/74, Register 49; am 4/11/81, Register 78; am 7/28/93, Register 127; am 3/22/2003,
Register 165)
Authority: AS 23.35.050, AS 23.35.070, AS 23.35.100, AS 23.35.150
8 AAC 055.020. Pleadings.
(a) Proceedings before the council are commenced by filing an application, with the
administrator, in writing which consists of the following:
(1) a certificate of eligibility completed by the fisherman on a form prescribed by the
administrator; and
(2) a physician's report of injury or illness completed by the attending physician on a form
prescribed by the administrator.
(b) A separate application shall be filed for each separate and independent occupational injury
or occupational illness for which benefits are claimed.
(c) Benefits may not be awarded unless the following conditions are either met or excused by
the council for just cause:
(1) the applicant receives treatment within 60 days after the date of occupational injury or
onset of occupational illness and the claim application is submitted within one (1) year after
initial treatment;
(2) the applicant responds within 90 days after the date of inquiry to inquiries seeking
clarification of any item on an application or of any item on a billing for services performed or
goods supplied;
(3) price lists and fee determinations are submitted by the provider of care to the administrator
within 30 days after the date requested; and
(4) costs are submitted by the provider of care or fisherman within one (1) year after the date
they are incurred.
(d) A petition is a request for an extension of duration of care, waiver of benefit limitations,
assistance after discharge from a hospital or additional transportation allowances. Petitions for
extension of duration of care or waiver of benefit limitations must cite those reasons the
petitioner believes justify granting the relief sought. The council may consider the condition of
the reserve balance of the fund and the petitioner's insurance coverage relating to the claimed
injury in determining whether to grant the petition. Petitions for assistance after discharge
from the hospital must include the dates during which hospitalization occurred. Petitions for
additional transportation allowances may be considered only for the purpose of providing
specialized medical skills which are unavailable at the nearest approved medical facility. The
petition must include a written statement from the attending physician which clearly defines
the specialized medical skill required for the petitioner and the nearest place where it is
available.
(e) Petitions under (d) of this section shall be submitted to the council for review and
recommendations.
(f) The administrator shall notify, in writing, each petitioner or other party of the council's
decision on the petition submitted under (d) of this section. The decision of the council is final.
(g) Each applicant and petitioner is required to promptly inform the administrator of any
changes to the applicant's or petitioner's address. (Eff. 3/28/74, Register 49;am4/11/81,
Register 78; am 9/10/98, Register 147; am 12/30/99, Register 152)
Authority: AS 23.35.050, AS 23.35.070, AS 23.35.100, AS 23.35.130, AS 23.35.140
8 AAC 055.030. Appeals.
(a) The administrator shall submit a written notice to each fisherman whose application cannot
be accepted based on criteria set out in the law and regulations stating the reason why the
payment cannot be made.
(b) The council shall review each application which has not been approved for payment by the
administrator. Each fisherman who has an application pending before the council shall be
notified in writing by the administrator of the time and place of a council session at least 10
days before the session. Each fisherman may submit additional evidence to the council in
support of his claim. The evidence may be presented in writing, by personal appearance, or by
both methods.
(c) The administrator shall notify, in writing, each fisherman and party with an application
before the council of the council's decision on the application.
(d) A fisherman may appeal the decision of the council. The council's decision is final unless
appealed to the commissioner within 45 days after mailing of the notice of the council's
decision. The appeal must be in writing and must include a description of the relief sought.
The commissioner's decision will be based on a consideration of the whole record and will state
the facts relied upon. The decision of the commissioner is final. (Eff. 3/28/74, Register 49; am
4/11/81, Register 78; am 9/10/98, Register 147)
Authority: AS 23.35.040, AS 23.35.050
8 AAC 055.035. Right to Subrogation.
If the department pays benefits from the fund, the department, to the extent of the value of
the benefits, is subrogated to the rights of the fisherman for a claim against a third party arising
from an injury, disability, occupational disease, or cardiovascular disease covered by AS
23.35.010 -23.35.150 and this chapter and to the proceeds of an insurance policy covering an
injury, disability, occupational disease, or cardiovascular disease covered by AS 23.35.010 -
23.35.150 and this chapter. (Eff. 12/26/86, Register 100)
Authority: AS 23.35.050
8 AAC 055.040. Definitions.
In this chapter unless the context requires otherwise
(1) "administrator" means the individual responsible for the administration of the Fishermen's
Fund program;
(2) "council" means the Fishermen's Fund Advisory and Appeals Council;
(3) "fund" means the Fishermen's Fund. (Eff. 3/28/74, Register 49)
Authority: AS 23.35.050
Velma Thomas, Program Coordinator
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Table of Contents
Claim Form (07-6125)
Physician's Report (07-6126)
Report of Vessel/Site Insurance (07-6119)
Carpal Tunnel Syndrome Questionnaire (07-6123)
Compelling Reasons Questionnaire (07-6124)
You will need a copy of Acrobat Reader to view these forms. Download it free from Adobe.
What is the Fishermen's Fund?
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Established in 1951, the Fishermen's Fund provides for the treatment and care of Alaska
licensed commercial fishermen who have been injured while fishing on shore or off shore in
Alaska.
Benefits from the Fund are financed from revenue received from each resident and nonresident
commercial fisherman's license and permit fee.
The Commissioner of Labor and Workforce Development oversees administration of the
program with the assistance of the Fishermen's Fund Advisory and Appeals Council.
The council is composed of the Commissioner or his designee, who serves as chairman, and
five members appointed by the Governor.
Fishermen's Fund Advisory and Appeals Council
Qualifying for Benefits
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Crewmembers with injury or illness directly connected to operations as a commercial
fisherman must hold valid commercial fishing licenses or limited entry permits before the time
of injury or illness to qualify for benefits. Note: Eligibility of a limited entry permit holder is
based on the embossed date of the permit, not the date on which it was paid or when payment
was received.
Onset of injury or illness must be onshore in Alaska or on Alaska waters.
Initial treatment must be received within 60 days after onset of injury or illness.
An application must be submitted within one (1) year after initial treatment.
Each treatment must be documented by a medical chart note and submitted.
How to File and Avoid Delays
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It is the fisherman's responsibility to see that a claim is filed. If the medical provider agrees to
file a claim with your insurance company, the Fishermen's Fund, or a federal program such as
Medicare, Veterans' Affairs, or the Indian Health Service, it remains the responsibility of the
fisherman to see that the claim is complete and filed appropriately.
Immediately following an injury or illness:
Tell the appropriate medical facility personnel that two reports must be completed:
Fisherman's Report of Injury or Illness
Physician's Report of Injury or Illness
The fisherman and physician must each fully complete their respective report. These two
reports need be completed only once, by the fisherman upon his initial treatment, and by the
initial treating physician. All items must be answered and comments provided. (The reports
are printed back to back and included in the center of this booklet. They are also available from
most doctors, hospitals, clinics, and some harbormaster offices in Alaska, as well as from the
Fishermen's Fund.)
Fishermen’s Fund Fisherman's Report
Completing the Report:
Attach copy of crewmember license or limited entry permit. A copy of the valid license or
permit accompanying your application will expedite your claim as much as two to four
months. (#10.)
Note the vessel owner's Protection and Indemnity (P&I) deductible. (#12.)
Note whether insured by health insurance or covered by a public program such as Medicare,
Veterans Administration (VA), Indian Health Service (IHS). (#13.)
Describe in detail injury or illness and how it was directly connected with commercial fishing.
(#14.)
Be specific as to the geographic location where injury or illness occurred, such as nearest
landmark, miles or hours from a reference point. Give latitude and longitude if known. (#15.)
Sign and date application. (#19.)
Submit the reports immediately. The Fisherman's Report is considered the fisherman's
application for Fund benefits.
Include a permanent mailing address and advise of address changes. Benefits may be denied if
you do not receive and respond to an inquiry.
Please respond completely and promptly. Failure to do any of the above can delay your claim.
When do the Fund's benefits kick in?
The Fund is an emergency fund payer of last resort, which means that benefits are awarded
only after full consideration of other coverage from private health or vessel insurance, and
public programs, including Veterans' Affairs or Medicare. (Medicaid is an exception.)
Processor Activities and Processor/Tender Vessels
A worker whose injury or illness is directly connected to a processing activity does not
qualify for Fund benefits, but may be covered under Workers' Compensation.
A fisherman on a freezer or troller vessel who becomes injured or ill as a result of processing
activities related to freezing the product would generally not be covered.
However, a fisherman injured or becoming ill on a tender vessel is usually covered unless the
incident was directly connected to processing activities.
Withdrawing an Application
Withdrawing an application requires a written request from the applicant fisherman and must
be reviewed by the Fishermen's Fund Advisory and Appeals Council.
Primary Insurance Considerations
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If you have medical insurance, the Fund must have a written statement—Explanation of
Benefits (EOB)—verifying you have filed a claim for each of your medical expenses with your
health insurance carrier.
Vessel or Site P&I (Protection and Indemnity) Insurance
If the fisherman applicant does not indicate the P&I deductible on the application, a Report of
Vessel or Site Insurance will be requested to verify whether P&I coverage exists, and if so, the
amount of the deductible and the name of the vessel owner's insurance carrier or adjuster. If the
deductible is unknown, benefits will be limited to $10,000.
If expenses exceed, or will be expected to exceed, the deductible under a vessel owner's P&I
policy, the fisherman applicant must file with the vessel owner's insurance carrier. These
expenses are usually covered under the P&I policy. Expenses not covered should be submitted
to the Fishermen's Fund. Otherwise, eligible expenses paid from the Fund which exceed the
P&I deductible will be recovered under 8 Alaska Administrative Code (AAC) 055.010 (e) and
by exercising subrogation rights under 8 AAC 055.035.
The vessel owner's deductible payment to the insurance company is considered a contribution
to the insurance liability covered under the policy and is not recoverable from the Fishermen's
Fund.
A vessel owner who pays for transportation or medical expenses for the injured or ill
fisherman may be reimbursed if an agreement exists verifying that the employer advanced the
money or paid any medical treatment on their behalf. A crewmember may be reimbursed if
there is verification that the employer deducted the payments directly from wages due the
injured or ill fisherman. Reimbursement cannot be made without the above supporting
information.
Alternatively, the injured or ill fisherman and the vessel owner may complete the Vessel
Owner–Crewmember Agreement, both signing to attest their understanding that the expenses
paid by the owner were paid as a loan to the crewmembers. The wording of the form may be
revised to fit the circumstances. There is no assurance this agreement in any way complies
with marine law. (Agreement in Appendix C)
Indian Health Service (IHS ) Beneficiaries
A fisherman who is eligible to receive direct care services from an IHS facility is expected to
utilize these services when possible. In the event that an IHS recipient chooses not to use an
IHS facility when it is available, the fisherman must justify to the Council his/her reason for
not using the IHS facility.
The Fund covers (pays for) services for IHS eligible individuals for items and services that are
not covered by IHS; i.e., eyeglasses, chiropractic care, and dentures, if a legitimate claim is
filed. However, direct care services that are covered by the IHS are not eligible for benefits
from the Fund.
If an IHS facility makes a referral to another facility that is not an IHS facility, the Fishermen's
Fund is responsible for the first $10,000. The Fund should be provided with a copy of the
billing form to pay the claim.
When a direct care provider is not available, the Fishermen's Fund will pay emergency or
urgent care at a non-IHS facility. Limitations on a fisherman's time are taken into consideration
when determining "not available."
Fishermen's Fund Physician's Report
Completing the Report:
Questions 1-4 may be answered by attaching medical records and noting, "See attached chart
notes."
Questions 5-14 require very little time to complete, and a clerical assistant may answer most
of them.
Questions 6 and 7 must be answered by the initial treating physician, to confirm that the
injury is directly connected with the commercial fishing operations of the fisherman applicant.
Chart notes or medical records are required, as an attachment to the Physician's Report, but do
not substitute for it. The physician may use the "see attached" notation for numbers 2 & 4 on
the Physician's Report if the form is signed and the fishing-related questions are answered.
The Physician's Report serves many purposes, such as providing the necessary information in
a logical order and concise manner to expedite processing and approvals for payment.
When bills are received for the treatment of an injury or illness for which an application has
not been filed, the fisherman and all medical providers will be sent a letter informing them no
action can be taken until an application has been filed.
Council Review
When the Fishermen's Fund administrator cannot immediately approve an application for
benefits, it must go before the Fishermen's Fund Advisory and Appeals Council for review.
The Council meets twice a year, usually in November and March.
Common reasons for delays that require the Council's review:
1. No response to an inquiry about items on an application.
2. Failure to seek treatment within 60 days of the onset of the injury or illness.
3. No evidence of a license at the time of injury or illness.
4. Injury or illness unrelated or not directly connected to operations of a commercial fisherman
in Alaska.
Just Cause
The Council may approve benefits when just cause is demonstrated for the delay in the
following circumstances:
Initial treatment is received more than 60 days after the onset of injury or illness.
Complete responses to inquiries are not received within 90 days.
An application was received more than 1 year after the initial treatment.
Just cause for the delay should be explained in writing.
Establishing Just Cause for:
Not Seeking Treatment within 60 Days of Injury or illness
Not Filing within One (1) Year of Initial Treatment
Not Responding to an Inquiry within 90 Days.
Not Responding to an Inquiry for, or Receiving an Explanation of Benefits (EOB) within 180
Days
When a fisherman does not meet the timelines established above, and the Council has
determined just cause for the delay exists, the Council may allow the administrator to approve
benefits if:
A written statement is received from a physician or fisherman which: states the late treatment
or surgery was necessary to correct injuries or illnesses such as a hernia, carpal tunnel, or
musculoskeletal condition; and notes the injury was directly connected to the commercial
fishing activity described in the fisherman's application; and states that any delay in treatment
was for the purpose of allowing the physician or fisherman to observe whether remedial
treatments or time would correct the condition.
A letter from the provider (i.e., hospital, medical clinic, etc.) or from an insurance company or
public program noting the delay in filing or responding timely was their fault; or,
Verbal or written evidence from the fisherman applicant that the late filing or response was
due to their medical condition, fishing responsibilities, or an emergency requiring the
fisherman's attention.
Approvals, Denials, Appeals
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Applications must be sent to the administrator.
When a decision indicates, "Your claim cannot be approved by the administrator," it does not
mean the fisherman is denied benefits. Often further information is required to enable approval
by the administrator, or by law the application requires approval by the Council.
Reconsideration or Appeal
In the event the administrator cannot approve an application, all parties will be notified in
writing of the reason. The application will be reviewed and a final determination made at the
next meeting of the Fishermen's Fund Advisory and Appeals Council. Parties will be notified
of the time and place of the meeting and may submit written information supporting the
application or may appear before the Council. A Notice of the Council's decision will be
mailed to all parties, usually within four weeks. A decision may be reconsidered or appealed as
noted below.
In some cases the Council will deny benefits unless certain conditions are satisfied by a certain
time. The fisherman, therefore, must read the Council decision carefully and fulfill all the
conditions to assure the best opportunity for approval.
Under Alaska Statute 44.62.540(a), the fisherman has the right to file a Petition of
Reconsideration to the Council within 15 days after the mailing of the decision.
Under Alaska Administrative Code 8 AAC 055.030(d), the fisherman has the right to appeal
the decision of the Council to the Commissioner of Labor within 45 days after receipt of the
notice of the decision. The appeal must contain a complete statement of the justification
including a description of the relief sought.
A request for reconsideration or appeal must be in writing, signed by the claimant, and filed by
mail or in person at the Office of the Commissioner, Department of Labor and Workforce
Development, PO Box 111149 (1111 West 8th Street), Juneau, AK 99811. Otherwise, the
Council decision is final.
What is Covered
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Related costs of transportation, medical care, hospitalization, prescriptions, therapy, and
chiropractic care will be paid for an occupational injury or illness if it is "directly connected
with operations as a commercial fisherman" in Alaska waters or on shore preparing or
dismantling boats or gear used in commercial fishing.
Those costs noted above that are necessitated by a cardio-vascular disease may be paid if
"attributable, directly or indirectly, to the fishing endeavor" (AS 23.35.080). A fisherman is
also entitled to "such assistance after discharge from the hospital during period of
convalescence as allowed in consideration of the condition of the Fund" (AS 23.35.090).
The total allowance for any one heart attack is $10,000.
Covered Injuries or Illnesses. Occupational illnesses or diseases which may be covered include:
hernias, varicose veins of the leg; rheumatism, arthritis, musculoskeletal ailments such as
bursitis, traumatic sciatica and tenosynovitis; the respiratory diseases bronchitis, pneumonia,
and pleurisy caused by or aggravated by the fishing endeavor.
With respect to a pre-existing injury, if subsequent aggravation is attributable strictly to that
injury, and does not amount to a new injury, then, as with a recurring disability, benefits will
not be awarded (AS 23.35.130, Opinion of Attorney General).
What is Not Covered? Conditions of Coverage
Noncovered Illnesses and Diseases and Other Conditions. Illnesses or diseases and other
conditions not covered include strep throat, tonsillitis, the common cold, influenza, ulcers,
cancer, appendicitis, insect bites, salmonella, giardia, smoking related conditions, cracked teeth
or loose fillings from eating. Sexually transmitted diseases or drug or alcohol related injuries,
and those caused by not following good hygiene and health practices, or improper care are not
covered. Ear infections caused from diving in a commercial fishery are covered but not when
due to a cold.
Chronic Conditions. Chronic injuries, although aggravated by the fishing endeavor, may not be
covered since they are usually pre-existing and not directly connected to the operations of a
fisherman.
Three-Month Gap in Treatment. The Council must reassess the treatment of an injury or
illness when there is a three-month gap in the treatment. A doctor's statement is required
noting how the treatment was directly connected to the prior commercial fishing injury.
Fifth Injury Within Eight Years to the Same Area of the Spine. A doctor's statement is
required when an application for benefits is received to cover expenses related to the
fisherman's fifth injury or illness for the same area of the spine within eight years. The
statement is necessary to determine whether it is a new acute injury or illness or if it is a
chronic condition, which is not covered.
Dental and Eye. Dentures, glasses or contact lenses lost or broken may be replaced or repaired
only when lost or broken in activities directly connected to operations as a fisherman. A claim
for dental injury without other bodily damage must be supported by a doctor's report that
substantiates the injury's direct connection to operations as a fisherman, or an affidavit may be
required.
Carpal Tunnel. No benefits will be allowed for surgery until all other alternative treatment has
been explored. If surgery is required after exploring these alternatives, the Council must review
the application to see if the need for surgery is caused by the fishing endeavor. If surgery is
required, the fisherman must provide in writing, or present to the Council in person, the
following:
1. The extent of alternative treatment pursued;
2. A ten-year history of work experience including the number of years commercially fishing
and type of fishing;
3. How the injury or illness has affected the ability to fish; and
4. Any other information considered pertinent.
Away from the Boat. An injury or illness occurring away from the boat or fishing site will be
covered as long as it is directly connected to operations as a fisherman, such as injuries
incurred on a dock while hauling gear to the boat or at home repairing commercial fishing gear.
Transportation. Costs are covered to and from the vessel, fishing or gear repair or storage site
to the nearest medical facility where appropriate emergency care can be provided. Additional
transportation costs to receive specialized or skilled care unavailable at the nearest approved
medical facility must be supported by a written statement from the attending physician which
clearly defines the specialized medical skill required and the nearest place where it is available.
Approval of additional transportation costs may require consideration of the financial
condition of the Fund.
Costs incurred for transportation after discharge from the hospital during period of
convalescence may be approved to return the fisherman to the boat, home or another place
that reasonably meets with the fisherman's convenience. (AS 23.35.090-100, 8 AAC 055.010
(d) and AS 23.35.080 & 100.)
To Whom are Benefits Paid?
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Benefits will be paid only to the medical provider or to the fisherman — to the provider if the
bill is outstanding, or to the fisherman if his payment is verified by evidence such as cancelled
checks, receipts, or bills or statements from medical providers.
A vessel owner who pays a bill can be reimbursed if the Fishermen's Fund administrator
receives evidence in writing that there was a prior agreement that the vessel owner would pay
any medical expenses, or would advance payment with an agreement to be reimbursed. The
fisherman will be reimbursed instead of the vessel owner if the fisherman submits evidence
that the vessel owner deducted these expenses from the fisherman's compensation. However,
these reimbursements do not imply that such an agreement or understanding is in compliance
with marine law.
See Appendix C for an example of agreement.
Requesting More Benefits or Time
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Except for compelling reasons, benefits for the care of any one person involving a single injury
or disability will not be paid beyond one year from the date of initial allowance, and cannot
exceed $10,000.
Requests to exceed the benefit limit or the duration of care must be in writing. They must note
the "amount of relief" or additional benefits needed, or the "extent of additional time" required.
Compelling reasons justifying the request must be specified. The Council must approve all
requests.
Compelling reasons to exceed $10,000 are not defined in law but must be sufficient to justify
the requested benefit or time extension and must include:
The financial status of the fisherman.
Impact of injury or illness on the fisherman's ability to earn a living while undergoing required
treatment and to continue to earn a living commercial fishing.
Any other compelling factors that affect the fisherman's ability to pay for related expenses in
excess of $10,000, or that result in conditions that require follow-up treatment beyond one
year.
Please remember to note:
How much additional relief or money is needed in excess of what the fisherman can pay and/or
the amount of extended time wanted beyond one year.
Appendix A
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Alaska Statutes Title 23
Labor and Workers' Compensation
AS 23.35.010. Creation of Fishermen's Fund Advisory and Appeals Council.
There is within the Department of Labor and Workforce Development a Fishermen's Fund
Advisory and Appeals Council.
AS 23.35.020. Appointment and Composition of Council.
The council is composed of the commissioner of labor and workforce development or a person
designated by the commissioner and five members appointed by the governor for overlapping
five year terms. The governor shall appoint one member from each of the following districts:
District 1: Wrangell and areas south;
District 2: Areas north of Wrangell to include Yakutat;
District 3: Areas west of Yakutat to East Coast of Alaska Peninsula, including Prince William
Sound, Cook Inlet, and Kodiak;
District 4: Areas west of Alaska Peninsula to Cape Newenham, including Bristol Bay;
District 5: Areas north of Cape Newenham, including Kuskokwim, Yukon, Kotzebue, and the
Arctic.
Sec. 23.35.030. Commissioner or designee as chair.
The commissioner of labor and workforce development or the person designated by the
commissioner serves as the chair of the council.
AS 23.35.040. Duties of Commissioner and Council.
(a) The council shall
(1) review all denials of benefits made by the person responsible for the administration of the
fund; and
(2) make all initial determinations regarding claims for additional benefits under AS 23.35.140.
(b) Under regulations adopted by the department, the commissioner shall hear all appeals from
the council's denial of benefits and denials of claims for additional benefits under AS
23.35.140. The commissioner's decision is final and may be appealed as provided under AS
44.62 (Administrative Procedure Act).
AS 23.35.050. Regulations.
The department may adopt regulations to carry out the purposes of this chapter, including
those that are necessary or advisable to protect the fund by limiting or suspending payments
from the fund. The regulations must be uniform in application.
AS 23.35.060. Creation and Administration of Fishermen's Fund.
(a) There is created a fund, designated as the "fishermen's fund." The Department of Revenue
is the custodian of the fund and the Department of Labor and Workforce Development shall
administer it. The fund shall be composed of
(1) 39 percent of the money derived by the state from all commercial fishermen's licenses, not
to exceed a maximum of $50 for each license holder for each year; and
(2) money appropriated to carry out the purpose of this chapter.
(b) The legislature may appropriate up to 50 percent of the interest income earned by the state
on the balance of the fishermen's fund for a grant for statewide marine safety training and
education programs.
AS 23.35.070. Benefits.
A fisherman, upon becoming disabled, is entitled to receive benefits as follows: Immediately
after the fisherman sustains an injury or disability arising out of an accident directly connected
with operations as a fisherman, either ashore in the state or in Alaska water, or suffers an
occupational disease, the fisherman is entitled to emergency treatment, transportation to the
nearest place where approved medical facilities are available, medical care, and hospitalization.
In this section, "Alaska water" means the inland and territorial water of the state and the
fishery conservation zone adjacent to the state established by 16 U.S.C. 1811 (sec. 101,
Fisheries Conservation and Management Act of 1976).
AS 23.35.080. Emergency Treatment For Cardio-Vascular Diseases.
The department may pay the costs, within the maximum limitations, of emergency treatment,
transportation, medical care, and hospitalization, necessitated by a cardio-vascular disease, if
the department determines that the disease is attributable, directly or indirectly, to the fishing
endeavor.
AS 23.35.090. Assistance After Discharge.
A fisherman is also entitled to such assistance after discharge from the hospital during period
of convalescence as the department allows in consideration of the condition of the fund.
AS 23.35.100. Transportation, Hospital, Nursing, Medical, and Surgical Expenses.
The department may pay out of the fund all reasonable transportation charges incurred under
AS 23.35.080 and 23.35.090, including cost of returning the fisherman to the boat or home of
the fisherman or to another place that reasonably meets with the fisherman's convenience, and
the reasonable hospital, nursing, medical, and surgical expense incurred in the examination,
treatment, and care of the fisherman.
AS 23.35.110. Contracts For Care.
In carrying out this chapter, the department may enter into contracts or other arrangements
with hospitals and doctors in the state for furnishing care on an annual basis to persons
entitled to benefits. Contracting under this section is governed by AS 36.30 (State
Procurement Code)
AS 23.35.120. Cooperation With Other Agencies.
In providing care the department shall provide the type and quality of treatment that will
restore the fisherman to health and productivity, if possible. The department may enter into
cooperative arrangements with agencies of the federal government, other states and territories,
and private clinics and rehabilitation centers for the care and treatment of fishermen.
AS 23.35.130. Duration of Care.
Except for compelling reasons, compensation may not be paid for the care of any one person
involving a single injury or disability beyond a period of one year from the date of initial
allowance.
AS 23.35.140. Limitation On Benefits.
(a) Except for compelling reasons,
(1) compensation may not be paid for medical care or hospitalization furnished before the
ascertainable time of injury, or before authorization in the case of disability caused by an
occupational disease;
(2) the total allowance for any one injury or disablement is $10,000.
(b) The total allowance for any one heart attack is $10,000.
Sec. 23.35.145. Claim of vessel owner.
If a fisherman files a claim for benefits under this chapter and also files a claim against the
protection and indemnity insurance policy of the vessel owner, the vessel owner is entitled to
receive a benefit, not to exceed the amount of the actual loss, that is the lesser of
(1)50 percent of the amount of the protection and indemnity insurance policy deductible; or
(2)$5,000.
AS 23.35.150. Definitions. In this chapter
(1) "approved medical facilities" and "medical care" include the facilities of, or the care and
treatment prescribed or performed by, a practitioner of chiropractic licensed by the state under
AS 08.20;
(2) "council" means the Fishermen's Fund Advisory and Appeals Council;
(3) "fisherman" means a person who is licensed by the state to engage in commercial fishing
under AS 16.05.480 or who is the holder of a permit issued under AS 16.43 and who, at the
time injury is sustained or illness is contracted, is actually so engaged or is occupied in Alaska
in preparing or dismantling boats or gear used in commercial fishing;
(4) "fund" means the Fishermen's Fund;
(5) "occupational disease" means hernia; varicose veins of the leg; the respiratory diseases,
bronchitis, pleurisy, and pneumonia caused by or aggravated by the fishing endeavor, but
excluding the common cold and influenza; rheumatism, arthritis, and those musculoskeletal
diseases (such as bursitis, traumatic sciatica, and tenosynovitis) directly caused by or
aggravated by the fishing endeavor; and does not include a disease not common to both sexes,
venereal disease, or a condition arising out of an attempt of a fisherman to injure self or another.
Appendix B
Back to TOC
Alaska Administrative Code
Chapter 55. Fishermen's Fund
8 AAC 055.010. Benefits.
(a) To be eligible for benefits from the fund, a person must be a fisherman who, at the time an
injury is sustained or illness is contracted, is licensed in his own name by the state to engage in
commercial fishing under AS 16.05.480 or AS 16.43, and who is actually so engaged in Alaska
water or is occupied in the state preparing or dismantling boats or gear used in commercial
fishing.
(b) Benefits for respiratory diseases are limited to bronchitis, pleurisy and pneumonia caused
by or aggravated by the fishing endeavor.
(c) Unless required as a result of accidental bodily injury caused by the fishing endeavor,
benefits may not be awarded for the following items:
(1) the services of a dentist;
(2) dental prosthetic appliances or the fitting of them;
(3) eye refractions and hearing examinations;
(4) eye glasses and hearing aides or the fitting of them.
(d) Transportation to return a fisherman to his home may be allowed to the extent that the
costs are in addition to those which the claimant would normally have encountered had he not
been injured.
(e) Compensation from the fund is limited to medical expenses that are not otherwise covered
by public or private insurance. The fund may require information regarding insurance coverage,
including an insurance benefits statement, and may hold a claim in abeyance pending the
receipt of required information.
(f) If expenses exceed, or will be expected to exceed, the deductible under the vessel owner's
protection and indemnity insurance policy, the applicant must file for benefits with the vessel
owner's insurance carrier. The vessel owner's deductible payment to the protection and
indemnity insurance company may not be recovered from the fund.
(Eff. 3/28/74, Register 49; am 4/11/81, Register 78; am 7/28/93, Register 127; am 3/22/2003,
Register 165)
Authority: AS 23.35.050, AS 23.35.070, AS 23.35.100, AS 23.35.150
8 AAC 055.020. Pleadings.
(a) Proceedings before the council are commenced by filing an application, with the
administrator, in writing which consists of the following:
(1) a certificate of eligibility completed by the fisherman on a form prescribed by the
administrator; and
(2) a physician's report of injury or illness completed by the attending physician on a form
prescribed by the administrator.
(b) A separate application shall be filed for each separate and independent occupational injury
or occupational illness for which benefits are claimed.
(c) Benefits may not be awarded unless the following conditions are either met or excused by
the council for just cause:
(1) the applicant receives treatment within 60 days after the date of occupational injury or
onset of occupational illness and the claim application is submitted within one (1) year after
initial treatment;
(2) the applicant responds within 90 days after the date of inquiry to inquiries seeking
clarification of any item on an application or of any item on a billing for services performed or
goods supplied;
(3) price lists and fee determinations are submitted by the provider of care to the administrator
within 30 days after the date requested; and
(4) costs are submitted by the provider of care or fisherman within one (1) year after the date
they are incurred.
(d) A petition is a request for an extension of duration of care, waiver of benefit limitations,
assistance after discharge from a hospital or additional transportation allowances. Petitions for
extension of duration of care or waiver of benefit limitations must cite those reasons the
petitioner believes justify granting the relief sought. The council may consider the condition of
the reserve balance of the fund and the petitioner's insurance coverage relating to the claimed
injury in determining whether to grant the petition. Petitions for assistance after discharge
from the hospital must include the dates during which hospitalization occurred. Petitions for
additional transportation allowances may be considered only for the purpose of providing
specialized medical skills which are unavailable at the nearest approved medical facility. The
petition must include a written statement from the attending physician which clearly defines
the specialized medical skill required for the petitioner and the nearest place where it is
available.
(e) Petitions under (d) of this section shall be submitted to the council for review and
recommendations.
(f) The administrator shall notify, in writing, each petitioner or other party of the council's
decision on the petition submitted under (d) of this section. The decision of the council is final.
(g) Each applicant and petitioner is required to promptly inform the administrator of any
changes to the applicant's or petitioner's address. (Eff. 3/28/74, Register 49;am4/11/81,
Register 78; am 9/10/98, Register 147; am 12/30/99, Register 152)
Authority: AS 23.35.050, AS 23.35.070, AS 23.35.100, AS 23.35.130, AS 23.35.140
8 AAC 055.030. Appeals.
(a) The administrator shall submit a written notice to each fisherman whose application cannot
be accepted based on criteria set out in the law and regulations stating the reason why the
payment cannot be made.
(b) The council shall review each application which has not been approved for payment by the
administrator. Each fisherman who has an application pending before the council shall be
notified in writing by the administrator of the time and place of a council session at least 10
days before the session. Each fisherman may submit additional evidence to the council in
support of his claim. The evidence may be presented in writing, by personal appearance, or by
both methods.
(c) The administrator shall notify, in writing, each fisherman and party with an application
before the council of the council's decision on the application.
(d) A fisherman may appeal the decision of the council. The council's decision is final unless
appealed to the commissioner within 45 days after mailing of the notice of the council's
decision. The appeal must be in writing and must include a description of the relief sought.
The commissioner's decision will be based on a consideration of the whole record and will state
the facts relied upon. The decision of the commissioner is final. (Eff. 3/28/74, Register 49; am
4/11/81, Register 78; am 9/10/98, Register 147)
Authority: AS 23.35.040, AS 23.35.050
8 AAC 055.035. Right to Subrogation.
If the department pays benefits from the fund, the department, to the extent of the value of
the benefits, is subrogated to the rights of the fisherman for a claim against a third party arising
from an injury, disability, occupational disease, or cardiovascular disease covered by AS
23.35.010 -23.35.150 and this chapter and to the proceeds of an insurance policy covering an
injury, disability, occupational disease, or cardiovascular disease covered by AS 23.35.010 -
23.35.150 and this chapter. (Eff. 12/26/86, Register 100)
Authority: AS 23.35.050
8 AAC 055.040. Definitions.
In this chapter unless the context requires otherwise
(1) "administrator" means the individual responsible for the administration of the Fishermen's
Fund program;
(2) "council" means the Fishermen's Fund Advisory and Appeals Council;
(3) "fund" means the Fishermen's Fund. (Eff. 3/28/74, Register 49)
Authority: AS 23.35.050
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December 19, 2011: Workers'
Compensation Legal Research Directory
Alaska Administrative Code (Regulations)
The effective date of the following
regulations is December 22, 2011. They will
be published in Register 200, January 2012.
Definition of Previously Rehabilitated – 8
AAC 45.900
Physicians Reports – 8 AAC 45.086
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Compensation Legal Research Directory
Alaska Administrative Code (Regulations)
The effective date of the following
regulations is December 22, 2011. They will
be published in Register 200, January 2012.
Definition of Previously Rehabilitated – 8
AAC 45.900
Physicians Reports – 8 AAC 45.086
Alaska Statutes (Alaska State Legislature
BASIS)
Recent Alaska Supreme Court Cases
(Recent Supreme Court Cases from AK
Court home page)
Board Decisions and Orders
• Standard Search
• Highlighted Search
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West Virginia
Workers' Compensation Medical Services Review Committee
________________________________________
Nov. 2009 Report of the Workers’ Compensation Medical Services Review
Committee
The Medical Services Review Committee (MSRC) assists and advises the
Department of Labor and Workforce Development and the Workers’
Compensation Board in matters involving the appropriateness, necessity, and
cost of medical and related services provided under the Workers’
Compensation Act.
The medical services review committee shall consist of nine members to be
appointed by the commissioner as follows:
(1) one member who is a member of the Alaska State Medical Association;
(2) one member who is a member of the Alaska Chiropractic Society;
(3) one member who is a member of the Alaska State Hospital and Nursing
Home Association;
(4) one member who is a health care provider, as defined in AS 09.55.560;
(5) four public members who are not within the definition of "health care
provider" in AS 09.55.560; and
(6) one member who is the designee of the commissioner and who shall serve
as chair.
Meetings for the MSRC are periodically throughout the year and are open to
the public. Questions or comments concerning the MSRC can be sent to the
attention of the Director, Division of Workers’ Compensation.
________________________________________
Nov. 2009 Report of the Workers’ Compensation Medical Services Review
Committee
The Medical Services Review Committee (MSRC) assists and advises the
Department of Labor and Workforce Development and the Workers’
Compensation Board in matters involving the appropriateness, necessity, and
cost of medical and related services provided under the Workers’
Compensation Act.
The medical services review committee shall consist of nine members to be
appointed by the commissioner as follows:
(1) one member who is a member of the Alaska State Medical Association;
(2) one member who is a member of the Alaska Chiropractic Society;
(3) one member who is a member of the Alaska State Hospital and Nursing
Home Association;
(4) one member who is a health care provider, as defined in AS 09.55.560;
(5) four public members who are not within the definition of "health care
provider" in AS 09.55.560; and
(6) one member who is the designee of the commissioner and who shall serve
as chair.
Meetings for the MSRC are periodically throughout the year and are open to
the public. Questions or comments concerning the MSRC can be sent to the
attention of the Director, Division of Workers’ Compensation.