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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
- 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.
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:
Fisherman's Report of Injury or Illness
Physician's Report of Injury or Illness
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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:
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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.)
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Note the vessel owner's Protection and Indemnity
(P&I) deductible. (#12.)
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Note whether insured by health insurance or covered
by a public program such as Medicare, Veterans Administration
(VA), Indian Health Service (IHS). (#13.)
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Describe in detail injury or illness and how it
was directly connected with commercial fishing. (#14.)
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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.)
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Sign and date application. (#19.)
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Submit the reports immediately. The Fisherman's
Report is considered the fisherman's application for Fund benefits.
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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.
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
(f) 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
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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.
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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.
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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.
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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:
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Initial treatment is received more than 60 days
after the onset of injury or illness.
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Complete responses to inquiries are not received
within 90 days.
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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:
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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.
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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,
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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.
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.
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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.
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Under Alaska Administrative Code 8 AAC 55.030(d), the fisherman has the right to appeal the decision of the Council to the Commissioner of Labor within 30 days after mailing of the notice of the council’s decision. The appeal must contain a complete statement of the justification including a description of the relief sought.
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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.
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.)
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.
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:
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The financial status of the fisherman.
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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.
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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.
Alaska Statutes Title 23
Labor and Workers' Compensation
Alaska Administrative Code
Chapter 55. Fishermen's Fund
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