Fishhermen´s Fund

What is the Fishermen’s Fund?

Founded in 1951, the Fishermen’s Fund caters to the medical treatment and care of licensed commercial fishermen in Alaska who sustain injuries while engaged in fishing activities, whether onshore or offshore in Alaska.

Funds for the benefits provided by the Fund are generated from the fees associated with both resident and nonresident commercial fishermen’s licenses and permits.

The oversight of the program’s administration is carried out by the Commissioner of Labor and Workforce Development, who is supported by the Fishermen’s Fund Advisory and Appeals Council.

The council consists of the Commissioner or their representative, acting as the chairperson, and five members appointed by the Governor.


Qualifying for Benefits

To be eligible for benefits, crewmembers with injuries or illnesses directly linked to their role as commercial fishermen must possess valid commercial fishing licenses or limited entry permits at the time of the incident. Important: The eligibility of a limited entry permit holder is determined by the embossed date on the permit, not the date of payment or when the payment was received.

The first medical treatment must be sought within 120 days from the onset of the injury or illness.

The application must be filed within one year following the commencement of the initial treatment.

Every treatment needs to be recorded in a medical chart note and then submitted.

The injury must have taken place either in Alaska or in the waters of Alaska.


Submitting and Preventing Delays

The fisherman is accountable for ensuring the submission of a claim. Even if the medical provider agrees to submit a claim to your insurance company, the Fishermen’s Fund, or a federal program like Medicare, Veterans’ Affairs, or the Indian Health Service, it is still the responsibility of the fisherman to ensure that the claim is thorough and filed correctly.

Promptly after an injury or illness:

  • Promptly seek medical treatment (within 120 days).
  • Inform the relevant medical facility staff that two reports need to be filled out:

Fisherman’s Report of Injury or Illness – Form # 07-6125
Physician’s Report of Injury or Illness – Form # 07-6126

Fishermen and Physician Reports:

The fisherman and the physician are both required to complete their individual reports in full. The completion of these reports is a one-time task – the fisherman does so during their initial treatment, and the initial treating physician also contributes. All questions must be answered comprehensively, and comments should be provided. These reports, conveniently printed on both sides, can be obtained from various sources in Alaska, including doctors, hospitals, clinics, and some harbormaster offices, as well as the Fishermen’s Fund.

Vessel Owner’s Insurance Information:

Make sure to note the information about the vessel owner’s Protection and Indemnity (P&I) insurance policy, found in Box #20. Additionally, fill out a Report of Vessel/Site Insurance Form (07-6119).

Fishermen’s Report of Injury/Illness & Claim Form:

To complete the Fishermen’s Report of Injury/Illness & Claim Form, follow these steps:

  1. Personal and Vessel Owner Information (Boxes #1-13): Provide information about yourself and the vessel owner in the specified boxes.
  2. Crewmember License or Limited Entry Permit (Box #14): Attach a copy of the crewmember license or limited entry permit. This will expedite your claim.
  3. Date and Time of Injury (Box #15): Indicate the date and time when the injury occurred.
  4. Geographic Location of Injury/Illness (Box #16): Provide specific details about the location, such as the nearest landmark, distance from a reference point in miles or hours, and latitude and longitude if known.
  5. Vessel Owner’s P&I Insurance Information (Box #20): Reiterate the vessel owner’s Protection and Indemnity (P&I) insurance policy details and complete the Report of Vessel/Site Insurance Form (07-6119).
  6. Health Insurance Information (Box #21): If applicable, mention your health insurance provider or coverage under public programs like Medicare, Veterans Administration (VA), Indian Health Service (IHS), etc.
  7. Injury/Illness Details (Boxes #17-19 and Boxes #22-25): Describe the injury or illness in detail and explain its direct connection to commercial fishing.
  8. Signature and Date (Box #25): Sign and date the application.
  9. Submission of Reports: Submit the reports promptly to the Fishermen’s Fund. The Fishermen’s Report of Injury/Illness & Claim Form serves as the fisherman’s application for Fund benefits.
  10. Contact Information: Include a permanent mailing address and inform the Fund of any address changes to ensure timely communication. Failure to receive and respond to inquiries may result in the denial of benefits.


Fulfilling Reporting Requirements for Timely Claim Processing

Please ensure thorough and prompt responses to all queries, as neglecting any of the mentioned tasks might lead to delays in processing your claim.


Guidelines for Fishermen’s Fund Physician’s Report Completion

Completing the Report:

For Questions 1-4, you can streamline the process by attaching medical records and indicating “See attached chart notes.”

Questions 5-14 are relatively quick to address, and a clerical assistant can handle most of them efficiently.

Questions 6 and 7 must be responded to by the initial treating physician to validate the direct connection between the injury and the fisherman applicant’s commercial fishing operations.

While chart notes or medical records are necessary attachments, they do not serve as substitutes for the Physician’s Report. The physician can use the “see attached” notation for numbers 2 & 4 on the Physician’s Report if the form is signed and fishing-related questions are addressed.

The Physician’s Report plays a multifaceted role, presenting essential information in a logical and concise manner to expedite processing and facilitate payment approvals.

In instances where bills are received for untreated injuries or illnesses without an associated application, a letter will be sent to the fisherman and all medical providers, specifying that no action can be taken until an application is filed.

Understanding Fund Benefits Activation

When do the Fund’s benefits become applicable?

The Fund operates as an emergency fund payer of last resort. This implies that benefits are granted only after thorough consideration of other coverages from private health or vessel insurance, as well as public programs like Veterans’ Affairs or Medicare (with Medicaid being an exception).

 Processor Activities and Processor/Tender Vessels

For workers whose injuries or illnesses are directly linked to processing activities, Fund benefits are not applicable, and coverage may be under Workers’ Compensation.

Fishermen on the freezer or troller vessels, sustaining injuries from processing activities related to freezing the product, are generally not covered.

However, a fisherman injured or falling ill on a tender vessel is typically covered, unless the incident is directly connected to processing activities.


Primary Insurance Considerations

 Fishermen’s Fund Benefits and Eligibility Considerations

Pursuant to the Op. Att’y Gen. dated March 4, 1985, the Fishermen’s Fund functions as an emergency fund payer of last resort, except for Medicaid. Benefits are granted only after a thorough evaluation of other coverages, encompassing private health insurance, vessel insurance, and public programs such as Veteran’s Affairs or Medicare. It is important to note that the Fund does not operate as a workers’ compensation program, as commercial fishermen are exempt under AS 23.30.230(a)(6) of the Alaska Workers’ Compensation Act.

Documentation Requirements for Medical Insurance Holders

In cases where medical insurance is in place, the Fund requires a written statement, specifically the Explanation of Benefits (EOB), confirming that claims for all medical expenses have been filed with the health insurance carrier.


Vessel or Site Protection and Indemnity (P&I) Insurance Procedures

When applying, the fisherman should specify the P&I deductible on the application. If not, a request for a Report of Vessel or Site Insurance will be initiated to confirm the existence of P&I coverage. In cases where the deductible is unknown, benefits will be capped at $10,000.

Claims under the P&I policy should be filed with the vessel owner’s insurance carrier. Expenses not covered can be submitted to the Fishermen’s Fund. If eligible expenses exceed the P&I deductible, recovery will be pursued through subrogation rights under 8 AAC 55.035.

Reimbursement Protocols for Transportation and Medical Expenses

Vessel owners may seek reimbursement for expenses incurred on behalf of an injured fisherman with proper documentation. Likewise, crewmembers may be reimbursed if payments were deducted directly from their wages. The Vessel Owner Crewmember Agreement, signed by both parties, can serve as an agreement for expenses paid by the owner as a loan to the crewmember.

 Indian Health Service (IHS) Beneficiaries and Fund Coverage

Eligible fishermen receiving direct care services from an IHS facility are encouraged to utilize these services. The Fund covers services not provided by IHS, such as eyeglasses, chiropractic care, and dentures, with a legitimate claim. Direct care services covered by IHS are not eligible for Fund benefits.

If an IHS facility refers to a non-IHS facility, the Fund covers the initial $10,000. A copy of the billing form must be submitted for payment.

Council Review Procedures

When immediate approval is not possible, the Fishermen’s Fund application undergoes review by the Advisory and Appeals Council. Council meetings occur biannually, typically in November and March.


Common reasons for review include:

  1. Non-response to inquiries about application items.
  2. Failure to seek treatment within 120 days of the injury or illness onset.
  3. Lack of evidence of a license at the time of injury or illness.
  4. Injury or illness not directly linked to the operations of a commercial fisherman in Alaska.


Approval of Benefits Under Just Cause

The Council may grant approval for benefits when a valid reason is demonstrated for the delay, as outlined in the following scenarios:

  1. Initial treatment is obtained more than 120 days after the onset of injury or illness.
  2. Comprehensive responses to inquiries are not received within 90 days.
  3. An application is received more than 1 year after the initial treatment.


Explanation of Just Cause:

For Delay in Seeking Treatment within 120 Days of Injury or Illness For Not Filing within One (1) Year of Initial Treatment For Not Responding to an Inquiry within 90 Days For Not Responding to an Inquiry for, or Receiving an Explanation of Benefits (EOB) within 180 Days

In cases where a fisherman fails to adhere to the established timelines, and the Council acknowledges just cause for the delay, the administrator may be authorized to approve benefits under the following conditions:

  1. A written statement is provided by a physician or the fisherman. This statement should affirm that the delayed treatment or surgery was necessary for correcting injuries or illnesses, such as a hernia, carpal tunnel, or musculoskeletal condition. It should also indicate a direct connection between the injury and the commercial fishing activity described in the fisherman’s application. Furthermore, the statement must clarify that any treatment delay aimed to observe whether remedial measures or time would rectify the condition.
  2. A letter from the provider (e.g., hospital, medical clinic) or from an insurance company or public program acknowledging their fault for the delay in filing or responding promptly.
  3. Verbal or written evidence from the fisherman applicant, indicating that the delayed filing or response was attributable to their medical condition, fishing responsibilities, or an emergency demanding the fisherman’s immediate attention.


Application Review and Appeals Process

Applications Submission

Applications must be forwarded to the administrator for processing.


Denials and Further Considerations

If a decision states, “Your claim cannot be approved by the administrator,” it does not automatically imply denial of benefits for the fisherman. Additional information may be needed for the administrator’s approval, or according to regulations, the application might necessitate approval by the Council.


Appeals Procedure

When the administrator is unable to approve an application, all concerned parties will receive written notification specifying the reason. A comprehensive review and final determination will occur during the next meeting of the Fishermen’s Fund Advisory and Appeals Council. Parties will be informed of the meeting details and can submit supporting written information or present their case before the Council. The Council’s decision will be mailed to all parties, typically within four weeks. The decision may be reconsidered or appealed as outlined below.


Conditions for Approval

In certain instances, the Council may stipulate conditions that must be met within a specified time for benefits to be granted. It is imperative for the fisherman to carefully read and fulfill all conditions outlined in the Council’s decision for the best chance of approval.


Right to Appeal

Pursuant to Alaska Administrative Code 8 AAC 55.030(d), the fisherman retains the right to appeal the Council’s decision to the Commissioner of Labor within 30 days of the notice mailing. The appeal should include a comprehensive justification and a description of the relief sought. The Council’s decision becomes final unless appealed to the commissioner within the stipulated 30 days.


Appeal Submission

The appeal must be in writing, signed by the claimant, and submitted by mail or in person to the Office of the Commissioner, Department of Labor and Workforce Development, PO Box 111149 (1111 West 8th Street), Juneau, AK 99811.


Finality and Further Appeal

The Commissioner’s decision is considered final and may be subject to appeal under the Alaska Administrative Procedures Act (AS 44.62).


Coverage Overview

Related Expenses:

Costs associated with transportation, medical care, hospitalization, prescriptions, therapy, and chiropractic care will be covered for occupational injuries or illnesses directly associated with the operations of a commercial fisherman in Alaska waters. This also extends to onshore activities involving the preparation or dismantling of boats or gear used in commercial fishing.

Cardiovascular Disease-Related Costs:

For costs linked to cardiovascular diseases, coverage may be extended if they are “attributable, directly or indirectly, to the fishing endeavor” (AS 23.35.080). Additionally, a fisherman is entitled to assistance during the convalescent period after hospital discharge, considering the condition of the Fund (AS 23.35.090). The maximum allowance for a single heart attack is $10,000.

Covered Injuries and Illnesses:

Occupational illnesses or diseases eligible for coverage include hernias, varicose veins, rheumatism, arthritis, musculoskeletal conditions (e.g., bursitis, traumatic sciatica, tenosynovitis), and respiratory diseases (bronchitis, pneumonia, pleurisy) caused or aggravated by fishing activities.

Pre-existing Injuries:

For pre-existing injuries, benefits will not be awarded for subsequent aggravations strictly attributable to that injury, akin to a recurring disability (AS 23.35.130 and AS 23.35.140, Opinion of Attorney General).

Conditions and Injuries Not Covered:

Non-covered illnesses and diseases encompass strep throat, tonsillitis, the common cold, influenza, ulcers, cancer, appendicitis, insect bites, salmonella, giardia, smoking-related conditions, cracked teeth, or loose fillings from eating. Additionally, sexually transmitted diseases, drug or alcohol-related injuries, those resulting from neglect of hygiene practices, or improper care are not covered. Ear infections from diving in a commercial fishery are covered but not if caused by a cold.

Chronic Conditions:

Chronic injuries, despite being aggravated by fishing endeavors, may not be covered if they are pre-existing and not directly linked to a fisherman’s operations.

Three-Month Gap in Treatment:

The Council must reassess treatment if there is a three-month gap, requiring a doctor’s statement establishing a direct connection to the prior commercial fishing injury.

Dental and Eye Care:

Dentures, glasses, or contact lenses may be replaced or repaired only if lost or broken during activities directly connected to fishing operations. Claims for dental injuries without other bodily damage need a doctor’s report supporting the direct connection to fishing operations, or an affidavit may be necessary.

Injuries Away from the Boat:

Injuries or illnesses away from the boat or fishing site are covered if directly connected to fishing operations, such as injuries on a dock while hauling gear to the boat or at home repairing commercial fishing gear.

Transportation Costs:

Covered costs include transportation to and from the vessel, fishing or gear repair sites to the nearest medical facility for appropriate emergency care. Additional transportation costs for specialized care require a physician’s statement defining the required specialized medical skill and the nearest place where it is available. Approval may consider the financial condition of the Fund.

Convalescence Transportation:

Transportation costs incurred after hospital discharge during convalescence may be approved to return the fisherman to the boat, home, or another convenient location.

Benefits Not Awarded for:

  1. Injuries not directly connected to commercial fishing.
  2. Injuries resulting from the fisherman’s willful intent to harm themselves or others.
  3. Injuries/illnesses occurring while the fisherman is intoxicated or under the influence of non-prescribed drugs (8 AAC 55.010(c)(3)).


Recipients of Benefits

Reimbursement of Vessel Owner’s Deductible:

The Fishermen’s Fund has the provision to reimburse 100 percent of the vessel owner’s deductible, with a cap at a maximum of $5,000. To secure reimbursement, the vessel owner must provide the necessary documentation to the Fishermen’s Fund.

Benefit Recipients:

Benefits will be disbursed either to the medical provider or directly to the fisherman. Payment to the provider occurs when outstanding bills need settlement. Conversely, the fisherman receives payment when evidence, such as cancelled checks, receipts, or bills/statements from medical providers, verifies their payment. In cases where a vessel owner settles a bill, reimbursement can occur if the Fund administrator receives written evidence of a pre-existing agreement or advance payment understanding.

Reimbursement to the fisherman takes precedence if evidence indicates that the vessel owner deducted expenses from the fisherman’s compensation. However, such reimbursements do not imply compliance with marine law, as outlined in Appendix C for an illustrative agreement.


Requesting Additional Benefits or Time Extension

Duration and Limitations:

Benefits for the care of an individual with a single injury or disability, except for compelling reasons, will not extend beyond one year from the initial allowance date and cannot surpass $10,000. To seek an extension of benefits or a duration of care extension, the fisherman needs to submit a separate written request along with a completed Compelling Reasons Questionnaire (Form 07-6124).

Submission Requirements:

The written request must specify the “amount of relief” or additional benefits required, or the “extent of additional time” needed. All requests must be specific and justified with compelling reasons. The Council’s approval is mandatory for all such requests.

Compelling Reasons Criteria:

While law doesn’t explicitly define compelling reasons to exceed $10,000, the justification must be sufficient and consider:

  1. The financial status of the fisherman.
  2. The impact of the injury or illness on the fisherman’s ability to earn a living during treatment and continue commercial fishing.
  3. Any other factors significantly affecting the fisherman’s ability to cover expenses exceeding $10,000 or necessitating follow-up treatment beyond one year.

Note Requirements:

The request should explicitly detail how much additional relief or money is needed beyond the fisherman’s capability and/or the extended time required beyond one year.