Second Independent Medical Evaluation (SIME) in Alaska: How to Prepare and What to Expect

Few moments in an Alaska workers' compensation claim are more frustrating than receiving a Controversion Notice cutting off your medical care and disability checks right after a 15-minute examination by an insurance company doctor. While your own treating orthopedic surgeon in Anchorage, Fairbanks, or Juneau insists you need surgery or physical therapy due to your work injury, the insurer's Employer Medical Evaluation (EME) physician inevitably claims your condition is merely a 'pre-existing degenerative process' or that you have already reached 'medical stability.'

When your treating physician and the insurance carrier's hired medical expert lock horns in a direct medical dispute, Alaska law provides a powerful tie-breaking mechanism: the Second Independent Medical Evaluation (SIME). Ordered and managed directly by the Alaska Workers' Compensation Board (AWCB), a SIME places your case before a vetted specialist from the Board's neutral roster. Knowing how to trigger a SIME within the strict 60-day window, how to assemble your medical binder, and how to challenge an unfavorable SIME report can make or break your claim.

When Does the AWCB Order a SIME? (Alaska Stat. § 23.30.095(k) vs. Alaska Stat. § 23.30.110(g))

In Alaska workers' compensation practice, there are two separate statutory pathways for the Alaska Workers' Compensation Board, Anchorage, the Alaska Workers' Compensation Board, Fairbanks, or the Alaska Workers' Compensation Board, Juneau to order an independent medical examination:

1. Party-Requested SIME for a Medical Dispute (Alaska Stat. § 23.30.095(k)): Whenever a direct medical dispute arises between the employee's attending physician and the employer's independent medical evaluation (EME) physician regarding (1) causation, (2) degree of permanent impairment, (3) necessity or efficacy of continuing treatment, (4) medical stability, or (5) functional capacity to return to work, either party may petition the Board-or both parties may stipulate-to order a SIME conducted by a physician on the Board's official SIME roster.
2. Board-Initiated SIME to Fill an Evidentiary Gap (Alaska Stat. § 23.30.110(g)): Even if a party missed a procedural deadline or there is no formal EME report yet, the Board has independent statutory authority under Alaska Stat. § 23.30.110(g) to order an injured worker to submit to a physical examination by a duly qualified Board physician whenever the panel finds a significant gap in the medical evidence or needs expert clarification to decide a claim fairly.

Legal Weight of a SIME Doctor's Report in an AWCB Hearing

Because SIME physicians are vetted and appointed by a joint selection panel of claimant and defense attorneys under 8 Alaska Admin. Code § 45.092(b), injured workers often wonder whether the SIME doctor's report automatically decides the winner of the case. Under Alaska law, the answer is nuanced: a SIME report carries tremendous practical persuasive weight as the opinion of the 'Board's neutral expert,' but it is not legally binding on the Board panel.

Under Alaska Stat. § 23.30.122 and Alaska Stat. § 23.30.128(b), the Alaska Workers' Compensation Board has the sole power to determine the credibility of a witness, and the Board's findings regarding the weight to be accorded medical testimony and reports-including a SIME report-are conclusive even when the medical evidence conflicts. As the Alaska Supreme Court confirmed in Tobar v. Remington Holdings LP, 447 P.3d 747 (AK Supreme Court 2019) and Weaver v. ASRC Federal Holding Co., 464 P.3d 1242 (AK Supreme Court 2020), the Board has full authority to weigh all medical opinions in the record and may reject a SIME physician's conclusion if the SIME doctor relied on an incomplete medical history, misunderstood the physical mechanics of the job injury, or was persuasively rebutted by the treating surgeon.

Who Pays for the SIME? (Exam Fees, Travel, Hotel, and Lost Wages)

One of the greatest advantages of the Alaska SIME system for injured workers is that you pay $0 out of pocket, even when you are the party requesting the SIME over the insurance company's objection. Under Alaska Stat. § 23.30.095(k) and 8 Alaska Admin. Code § 45.092(j), the employer and its workers' compensation insurer are legally required to pay:

• 100% of the SIME Physician's Fees: Including the physical examination, review of hundreds of pages of medical records, any additional X-rays, MRIs, or EMG nerve studies ordered by the SIME doctor, and supplemental deposition fees (often totaling $4,000 to $9,000+).
• Round-Trip Travel and Lodging (8 Alaska Admin. Code § 45.180): Because many specialized SIME doctors practice in Anchorage or out-of-state in Seattle or Portland, the insurer must arrange and prepay your round-trip commercial airfare, hotel room, ground transportation (taxis/rideshares between the airport, hotel, and clinic), and daily meal per diem.
• Temporary Disability Wages During Travel: Under Alaska Stat. § 23.30.095(k), if you are currently working and must miss shifts to travel to and attend the SIME, the insurer must pay Temporary Total Disability (TTD) wage replacement for the time lost.

Crucial Warning About Missing Your SIME Appointment: Under Alaska Stat. § 23.30.095(k) and Alaska Stat. § 23.30.110(g), if you fail or refuse to attend a scheduled SIME without timely notice and good cause, your compensation benefits will be suspended, and the Board can order the SIME doctor's 'no-show cancellation fee' (often $1,500+) deducted directly from your future workers' compensation award.

How to Submit Medical Records and Questions to the SIME Physician

Strict procedural rules govern how a SIME is requested and how medical records reach the SIME physician. Under 8 Alaska Admin. Code § 45.092(g)(2)-strictly enforced by the Alaska Supreme Court in Patterson v. Matanuska-Susitna Borough School District, 523 P.3d 945 (AK Supreme Court 2022)-a party seeking a SIME must file a formal Petition (Form 07-6111, Alaska, Division of Workers' Compensation, Petition) together with a completed Form 07-6147, Alaska, Division of Workers' Compensation, Second Independent Medical Evaluation (SIME) Form within 60 days after receiving the medical reports that create the dispute. Missing the 60-day deadline waives your right to demand a SIME under Alaska Stat. § 23.30.095(k).

Step-by-Step SIME Medical Binder Rules (8 Alaska Admin. Code § 45.092(h))

To preserve the neutrality of the SIME doctor, neither you nor the insurance adjuster is allowed to mail records directly to the SIME physician or hand loose clinic notes to the doctor during the appointment. Instead, 8 Alaska Admin. Code § 45.092(h) requires all medical records to be routed through the Board:

1. File Medical Summaries and Complete Record Affidavits: By the deadline set at your Prehearing Conference, each party must compile all relevant medical records in chronological order, file them with the Board using Form 07-6103, Alaska, Division of Workers' Compensation, Medical Summary, and execute Form 07-6148, Alaska, Division of Workers' Compensation, Affidavit of Complete SIME Records certifying under oath that no relevant medical records have been omitted.
2. Submit Diagnostic Imaging Films and CDs: Actual MRI, CT, and X-ray digital discs (not just the radiologist's paper summary) must be delivered to the Board's SIME coordinator so the SIME specialist can personally view the images.
3. Draft Proposed SIME Questions: At the Prehearing Conference, the Workers' Compensation Officer allows both the injured worker (or their attorney) and the employer's attorney to submit a targeted list of medical questions (typically 5 to 10 questions per side) to be included in the Board's official cover letter to the SIME physician.
4. Prohibition on Ex Parte Contact: Outside of answering the SIME doctor's questions during the physical exam itself, direct communication with the SIME physician by either party is strictly forbidden under 8 Alaska Admin. Code § 45.092(f).

How to Prepare for Your SIME Appointment

• Review Your Chronological Injury Timeline: Before walking into the clinic, review how the accident happened, when each symptom first appeared, and what prior injuries you had before the work accident. Inconsistencies between what you tell the SIME doctor and what appears in the 500-page Board binder can destroy your credibility.
• Bring a Witness to the Physical Examination: Under 8 Alaska Admin. Code § 45.090(b), an injured employee has the right to have a witness (such as a spouse, friend, or legal assistant) present during the physical examination portion of a medical evaluation, and may audio-record the examination if disclosed in advance.
• Never Exaggerate or Minimize Symptoms: SIME physicians routinely test for 'Waddell's signs' and symptom magnification, observing how you walk through the parking lot, sit in the waiting room, and climb onto the exam table. Be completely honest and specific about what activities trigger pain.

Can You Appeal or Challenge a Negative SIME Finding?

If the SIME physician issues a report agreeing with the insurance company's EME doctor, your case is not over. Because a SIME report is an evidentiary exhibit rather than a final Board order, you do not file an external 'appeal' of the report itself. Instead, your attorney challenges and neutralizes the negative SIME report before the Alaska Workers' Compensation Board, Anchorage using four legal tools:

• 1. File Form 07-6174 (Request for Cross-Examination): Under Commercial Union Cos. v. Smallwood, 550 P.2d 1261 (AK Supreme Court 1976) and 8 Alaska Admin. Code § 45.052, you have the right to cross-examine the author of any medical report relied upon at a hearing by filing Form 07-6174, Alaska, Division of Workers' Compensation, Request for Cross-Examination. Your attorney can depose the SIME physician under oath to expose where the doctor misread an MRI, overlooked key chart notes, or applied the wrong legal standard of causation.
• 2. Serve Supplemental Written Questions (8 Alaska Admin. Code § 45.092(i)): Within strict post-report deadlines, parties may submit written follow-up interrogatories through the Board asking the SIME doctor to clarify or reconsider their opinion in light of specific records.
• 3. Obtain a Rebuttal Addendum from Your Treating Physician: Your attending surgeon can review the SIME report and author a clinical rebuttal explaining why their hands-on, longitudinal observations over many months of treating you are more reliable than a one-time SIME exam.
• 4. Appeal an Adverse Final AWCB Decision: If the Board panel ultimately adopts the negative SIME report in its final Decision and Order after your hearing, you have 30 days under Alaska Stat. § 23.30.127(a) to appeal the Board's decision to the Alaska Workers' Compensation Appeals Commission, Anchorage, and subsequently to the Alaska Supreme Court, Anchorage under Alaska Stat. § 23.30.129.

How Long Does the SIME Process Take in Alaska?

Because SIME specialists have busy surgical schedules and the Board must assemble, Bates-stamp, and mail the master medical binder at least 14 to 21 days before the exam, the SIME process typically adds 3 to 6 months to an Alaska workers' compensation timeline. Once you attend the physical exam, the SIME physician generally submits their written report to the Board within 21 to 45 days, after which either party may file Form 07-6107, Alaska, Division of Workers' Compensation, Affidavit of Readiness for Hearing to set the final merits hearing.

Because drafting the SIME questions and cross-examining the SIME physician often determines the outcome of your entire claim, working with an experienced Alaska workers' compensation lawyer from our directory ensures your medical evidence is properly presented at no upfront cost to you.

Frequently Asked Questions (FAQ)