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Thread: New York State Disability Retirement System

  1. #331
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    I’ll post this in two parts read them, again the i-c putting the i-w through hell with the games they play.



    Each year approximately 500,000 occupational illnesses and injuries are reported to the New York State Workers' Compensation Board. Of these, workers’ compensation insurance carriers challenge several thousand claims for occupational disease for reasons that frequently defy close medical analysis and too often defy common sense.

    With millions of dollars in profit at stake, insurance carriers:

    *Challenge valid occupational disease claims, which results in workers often failing to pursue their cases or eventually settling for less than they are entitled to;

    *Claim that many workers are less disabled than they are or that they are not disabled at all.

    *Raise issues contradicting workers' claims that their injuries and illnesses are a result of work.

    As a consequence, injured and sick workers are often forced into prolonged wrangling with insurance companies in an attempt to get their claims established. The process is so tortured, convoluted and demeaning that many workers do not file for compensation or become so discouraged that they fail to pursue their valid claims. Rather than attempt to use the workers' compensation system, many workers use their own health insurance -- if they have any -- to get needed medical treatment. Many others rely on welfare or social security disability. In either case, the insurance companies and employers externalize the costs of job-related injuries and force the public to pick up these expenses through taxpayer-funded social welfare programs and higher medical insurance premiums.What is particularly unfair is the routine challenge by insurance carriers of workers' claims for occupational disease and frequent disputes over the degree of workers' disabilities in cases that have already been established. The challenges over occupational disease can often mean, de facto, the cutting-off or slashing of wage-replacement benefits and medical treatment before any hearing takes place.

  2. #332
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    Part 2, and I will continue right into the ime in the next part
    In New York State, a pivotal point for injured workers filing workers' compensation claims is the medical evaluation. When a worker is initially injured or made sick at work, the worker notifies the employer, sees a doctor for diagnosis and treatment, and files a claim. Based on the treating physician's report, workers will be entitled to receive wage-replacement benefits and reimbursement for medical treatment for injuries and illnesses related to work.
    Once the claim is filed, the insurance carrier has the right to demand that the injured worker see a doctor chosen by the insurance company. This speciously named evaluation is called an Independent Medical Examination, or "IME." However, IMEs are anything but independent and they frequently don't appear to be "medical" examinations of any kind. They are paid for by -- and conducted on behalf of -- insurance companies, self-insured employers and the State Insurance Fund, a quasi-state agency that provides workers' compensation insurance for approximately 40 percent of the state's employers. Moreover, IMEs are used by these interested parties as ammunition to challenge claims, lawsuits and the evaluations of injured workers' treating physicians.
    Claimants must attend IMEs or risk hampering their own cases. In particular, workers receiving wage-replacement benefits and/or medical treatment may have their benefits slashed or cut off entirely if they fail to appear.
    The results of this initial evaluation conducted by Independent Medical Examiners are critical for injured workers attempting to establish their cases. Based upon the initial IME evaluation, the insurance company can unilaterally, without a hearing, and with no prior notice, slash or completely cut off the wage-replacement benefits and medical treatment an injured worker is receiving. Although the injured worker can later dispute such actions at a hearing, it can take between six weeks and six months for such a hearing to be scheduled after receipt of notice from the insurance company that benefits are being cut. In New York, benefits can be cut too as little as one-sixth of a worker's average weekly wage or $40 per week.

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    Last edited by zinger; September 30th, 2009 at 01:17 PM.

  3. #333
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    part 3 Who are the IME Doctors?

    New York State's Workers' Compensation Law stipulates that medical exams must be conducted by "qualified physicians" or by a "registered nurse or other persons trained in laboratory or diagnostic techniques" who are under the "active and personal supervision of an authorized physician." [Subdivision 4, Section 13 a of the Workers' Compensation Law of New York State, as amended by chapter 922 of the laws of 1990.] Every worker interviewed for this report was seen by a physician.

    Typically, a doctor earns between $100 and $400 per exam, but more complex cases carry higher fees -- sometimes reaching $1,000 -- according to physicians interviewed for this report. "For doctors, IMEs ...mean quick, easy money," according to a January 5, 1997 article in the New York Post entitled "Doctored Diagnosis: How Altered Medical Reports Could Mean Lower Benefits for You." IMEs are highly profitable freelance assignments for some doctors. For others, however, they provide the bread and butter of their practice. ["Doctored Diagnosis: How Altered Medical Reports Could Mean Lower Benefits for You," by William Sherman, The New York Post, January 5, 1997- January 7, 1997.]

    IME doctors can also earn modest sums for appearing at hearings. Because medical evidence is critical to many cases, live testimony by both treating and defense physicians is the rule at formal hearings at which medical evidence is required. The Workers' Compensation Board encourages the use of medical depositions, but in practice they are rare.

    One New York City physician maintained that there are two broad categories of IME physicians: those who "don't believe in work-related diseases" -- whose orientation results in the minimizing of disabilities, and those who "couldn't make it in regular medical practice."

    This doctor and others also stated that physicians with thriving private practices generally do not have enough time -- or the desire -- to perform IMEs.

    According to occupational health physicians interviewed for this report, in some locations, virtually all available doctors in certain areas of specialization conduct IMEs; in other areas, many doctors never perform an IME. In rural or less populated areas of New York State, according to one doctor from upstate New York, "there are a lot fewer specialists to recruit from," and therefore more likelihood that II everyone in town II will be performing IMEs.

    "What strikes me is the incentive for the occupational physician in the community: if they are going to participate [in the conducting of IMEs] they will be doing it on behalf of the insurance carrier. That pool is expanding, whereas the pool of doctors for workers to see appears to be shrinking."
    Doctors, attorneys and injured workers interviewed for this report expressed concern about the lack of specific legal criteria to define who can and cannot perform an IME . They contend this lack of specificity creates opportunities for incompetent doctors to perform the exams.

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  4. #334
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    part 4 the IME.

    Cases have been reported of doctors from other states being flown in to conduct IMEs -- even though they have no license to practice in New York State. Moreover, a number of workers have reported being referred to doctors that they later discovered had been disciplined by authorities in New York and other states, according to information compiled by Injured Workers of New York, a nonprofit advocacy group.

    In BUFFALO, the group contends, carriers are still using one IME physician who was:

    forced to surrender his license in Massachusetts,
    convicted in New York of Medicaid fraud and mis-prescribing drugs,
    fined and disciplined in Pennsylvania for a larceny conviction, and was
    disciplined in North Carolina for immoral or dishonorable conduct, unprofessional conduct, for conviction of a crime involving moral turpitude, and for obtaining medical practice by false representations. [Questionable Doctors Disciplined by State and Federal Governments: New York, by Sidney Wolfe, MD, Kathryn Franklin, Ph.D., Phyllis McCarthy, Alana Bame and Benita Marcus Adler, Public Citizen Health Research Group, 1998.]
    Several interviewees also complained about conflicts of interest that go unchecked. "There are certain academically situated doctors who seem to be willing to take money to play the insurance carrier's position," one doctor noted. "It seems workers should be able to expect more neutrality than that."

  5. #335
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    I here from i-w all the time and the i-c and ime's are very bad news!

    W/C is not a road to be traveled alone, know your Rights and Protect Them, If You Don't Nobody Will!!!


    Who are the IME Brokers?

    Insurance carriers used to maintain long lists of private doctors who were on call to perform IMEs. However, as workers' compensation claims continued to mount, carriers began employing IME brokerage firms. Because carriers must decide quickly whether to honor workers' compensation claims, doctors are under pressure to submit their findings as soon as possible. Consequently, IME brokerage firms are frequently used to speed the process, with doctors phoning in their examination notes to administrative and clerical staff, who complete reports, signing doctor's names and submitting the findings to the insurance company. According to published reports in the Boston Globe, the Buffalo News, the New York Post and other publications, most brokerage firm staff who completed reports had no medical training whatsoever.

    Today, independent medical examination companies act as go-betweens, scheduling doctors to examine men and women who have filed workers' compensation claims. They are also responsible for generating doctors' reports and interacting with insurance carrier claims examiners. In this hugely profitable business, doctors' fees range from less than $100 up to $1,000 per exam, according to published reports. Their final reports influence decisions worth tens of thousands of dollars to the insurer and to injured and sick workers.

    Most experts agree that, because IME firms are paid by insurance companies, or self-insured employers, they have an incentive to play down job-related injuries. Widely published reports also reveal that some of these firms routinely change the doctors' wording, or press physicians to revise their reports.

    Needless to say, the impact on the disability awards received by injury and illness victims is incalculable. These alterations result in denial, delay or diminishment of workers' compensation payments for crucial treatment, not to mention wage-replacement benefits.
    Last edited by zinger; October 14th, 2009 at 12:37 AM.

  6. #336
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    For the i-w dealing with Special Funds Conservation Committee ( special funds) they do have a contact information change.

    Effective October 13,2009
    Special Funds Conseravation Committee
    2875 Union Rd Suite 3510
    Cheektowaga, NY 14227

    New Phone 716-686-5700
    Nedw Fax 716 686-2945

    They also have a web site if you are new to special funds.
    http://www.specialfunds.org/

  7. #337
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    New York facts about workers’ compensation reform?
    In Uncategorized on October 14, 2009 What are the facts about workers’ compensation reform?

    Fact number 1: New York has the third lowest maximum workers’ compensation benefit in the country.

    Fact number 2: Most of New York’s injured workers get a lower benefit than the federal poverty line for a family of four.

    Fact number 3: Workers’ compensation claims and costs are down in New York.

    Fact number 4: Arbitrary time-limits on workers’ compensation hurt workers.

    Fact number 5: Time-limiting workers’ compensation awards hurts working women.

    Fact number 6: Workers’ compensation benefits are already ‘capped.’

    Fact number 7: Employers who under-report payroll raise workers’ compensation insurance rates for all employers.

    Fact number 8: Worker fraud is a myth–insurer fraud is a reality.
    ----------------------------------------------------------------------
    Everyone will complain about the i-w and fraud or fakers, what about ime's and fraud with the insurer (IC) .


    --------------------------------------------------------------------------------
    Last edited by zinger; October 16th, 2009 at 04:24 PM.

  8. #338
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    For permanent or temporary partial disability, or for permanent or temporary total disability due to an accident or disablement resulting from an occupational disease that occurs on or after July 1, 2007 the new minimum benefit is $100 or actual wages, if less, and the new maximum benefit is shown below:

    July 1, 2007 $500
    July 1, 2008 $550
    July 1, 2009 $600
    July 1, 2010 2/3 of NY State Average Weekly Wage.

  9. #339
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    SSI(Social security insurance) and SSDI(Social security disability insurance) are 2 different thing aren't they. My father has had a accident @ his work place and same as yourrs comp board board and dr has given him a permanent disable note. He has hearing on 22th he has applied for ssi. And that's his third interview thought he isn't well and much able to travel but he has to. As this system works.

    So let's see what we go through.

  10. #340
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    SSD , NYSWC , NYSRS, are treated differently per the definition of all three. Its a sad thing when your found to be totally disabled and unable to work from the federal government SSD, but at the state level (NYSWC and NYSRS) they tell you to continue to seek employment, anything that it is available even though your incapable of completing a simple task for four days a work week but one of the days you are able to accomplish this task! This is production? No, it’s a form of punishment/harassment where there is no common sense.
    I too am tired of the NYSWC and NYSRS and their horrible treatment of injured workers.
    From an injured worker in WNY area.

  11. #341
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    This is a list of your area reps. Contact them about the systems that is in the last post. The best thing you can do is when you get your award papers from SSA/SSD fax them over to these people and ask why I keep getting denied your benefits from the NYSRS disabilities. Another thing you can do is fax over some of your medical reports to these people again ask why. Do the politicians know what is going on within the NYSWC and NYSRS systems? The only thing they care about right now are the insurance companies that fight you and their own war chest (campaign).


    Assemblywoman
    Jane L. Corwin
    142nd Assembly District

    Contact Information

    DISTRICT OFFICE
    8180 Main Street
    Clarence, NY 14221
    716-839-4691

    Assembly Districts WNY

    Robin Schimminger District 140 this covers Tonawanda and the City of Tonawanda
    3514 Delaware Ave, Kenmore, NY 14217
    Phone: 716-873-2540
    Fax: 716-873-2540
    Email: Schmmr@assembly.state.ny.us

    Crystal Peoples District 141 this covers east side of Buffalo
    790-792 E. Delavan, Buffalo, NY.14215
    Phone: 716-897-9714
    Fax:
    Email: Peoplec@assembly.state.ny.us



    Dennis Gabryszak District 143 this covers Cheektowaga , Lancaster
    2560 Walden Ave, Suite 109 Cheektowaga, NY 14225
    Phone: 716-686-0080
    Fax: 716-686-0083
    Email: Gabryszakd@assembly.state.ny.us

    Sam Hoyt District 144 this covers Grand Island, West Side of Buffalo
    936 Delaware Ave Buffalo NY 14209
    Phone: 716-855-9630
    Fax: 716
    Email: Hoyts@assembly.state.ny.us

    Mark Schroeder District 145 this covers S. Buffalo OP. WS. Lackawanna
    2019 Seneca St. Buffalo, NY 14210
    Phone: 716-826-0152
    Fax: 716-826-1347
    Email: schroem@assembly.state.ny.us

    Jack Quinn District 146 this covers N. Collins, Collins, Holland, Colden, Boston, Eden,
    Hamburg, Evens, Brant
    3812 South Park Ave, Blasdell, NY 14219
    Phone: 716-826-1878
    Fax: 716-826-0808
    Email: Quinnj@assembly.state.ny.us

    Jim Hayes District 148 this covers Amherst, Pendleton
    5555 Main St , Williamsville, NY 14221
    Phone: 716-634-1895
    Fax: 716-634-1250
    Email: hayesj@assembly.state.ny.us

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    Last edited by zinger; October 21st, 2009 at 01:34 PM.

  12. #342
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    Quote Originally Posted by nyitgeek View Post
    SSI(Social security insurance) and SSDI(Social security disability insurance) are 2 different thing aren't they. My father has had a accident @ his work place and same as yourrs comp board board and dr has given him a permanent disable note. He has hearing on 22th he has applied for ssi. And that's his third interview thought he isn't well and much able to travel but he has to. As this system works.

    So let's see what we go through.
    nyitgeek, Supplemental Security Income (SSI) is the award that your dad would receive to help him live income. SSD the award that you would receive from SSA for being disabled due to work injuries or other disabilities.
    Last edited by zinger; October 21st, 2009 at 11:38 PM.

  13. #343
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    Is age a factor please read.

    50' is not a magic number..but the closer an applicant is to 50, or once awarded SSDI benefits, the criteria changes somewhat as the applicant is not more 'disabled', but has a lessor ability of performing ''gainful ''.

    While qualifying for SSDI and being declared ''disabled'' under SSA rules is the main factor, the ability to perform ANY type of job is the reason to be disabled and apply in the first place.

    Lots of applicants are approved on the first go round in the process...it's only those that experience difficulty that you hear about. If you fit the requirement/rules...and provide the necessary documentation...it would stand to reason you would receive benefits. Denial is not automatic.

    When you are 50 and above, the criteria for being found disabled "relaxes". Thats why the word "Magical" is used.

    To be approved at 38 without a Attorney and the 1st go round shows you cannot work any type of job and SSA believes your Disability is so obvious you cannot be retrained at any work level.

    You can be turned down at 38 BUT be accepted at 53 with the same disabilty. Read this:




    Why is age 50 so important in a SSDI case?
    It goes without saying, the older you are, the better chance you have of being awarded disability. Age 50 is the “cut off” point for claimants filing for social security disability. If you had two claimants with nearly identical disabilities and backgrounds and only one of them is older than 50, the older claimant is more likely to receive benefits than the younger claimant. Claimants younger than 50 simply have a harder burden to overcome, although it is not impossible.

    Why is it harder for younger claimants to receive disability benefits? If you are disabled it does not matter how old you are, right? Well not exactly. The social security administration has stated that even if a claimant cannot perform substantially all sedentary work, it does not mean that they are entitled to receive benefits. The reason being your background may dictate you working in another field. The SSA will look at your age, education, work experience, etc and determine if you have any transferable work skills that enable you to work despite your disability. This becomes important when you have a disability that prohibits you from doing substantially all sedentary work and you are below age 50. The SSA believes that claimants under age 50 have not yet reached an age that is old enough to limit their ability to adjust to other work. Is it fair, probably not especially if you are 47 and have the same disability as a claimant who is 51. But in defense of the SSA policy, there has to be some point where advanced age significantly becomes a factor.

    Claimants under age 50 are put up against the task of having to rebut the testimony of a vocational expert at their hearing. This is a difficult task for many claimants. Vocational experts have often times heard several cases and have years of experience. Social security disability attorneys deal with vocational experts on a daily basis. If you find yourself in this situation, you are better off having counsel on your side to handle the cross examination of a vocational expert.

  14. #344
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    A few weeks ago in Buffalo News there was good article on SSD and the long wait it takes to have a hearing in this area, I’ll highlight some of the story. The SSA is making some progress in its efforts to cut the backlog of disability cases in the Buffalo area. But it’s not enough according SS Administration law judges who came to Buffalo area for a conference this week. Many people with serious illnesses or injuries still wait two years or more for a hearing; this is a source of frustration on the injured and disabled. These people have a right to have their cases heard within a reasonable time frame. One law judge from the Buffalo district states that the current waiting time is not acceptable. (I know many of you have complained to your congressmen form this area on this issue.)




    There is an example of a case where a man who waited for a long time for his case to be heard, and before the case could even be heard he died. The educational conference was held in Buffalo last week for about 130 Administrative Law Judges from all over the country. Two of the officials said that the system in which they work is in a “crisis.” Sixty four percent of first filings are rejected, prompting appeals.




    Some of the other problems that were brought up by the Judges where.




    . Far too many applicants about two out of three are turned down.




    . Long waiting time for disability app. and many of them are desperately ill.




    . There are no goals or quotas for judges. “I don’t think you’ll find anyone who feels the waiting times are acceptable.”




    Ø The Judges feel they are pressured from the SSA to rush cases through the system. They feel that there should be more time on some cases researching them.





    Long waiting times for disability applicants have been the subject of controversy in WNY for years. In 2007, the SSA office based in Buffalo took an average of 668 days nearly two years to process a SSD claim. The Buffalo office ranked 7th worst of the 144 offices in the nation. There has been some improvement for this area in wait time. The Buffalo office now takes an average of 582 days to process a claim. Work injuries are ranked at the top of the list for claims filed for SSD. Nurses and aids rank high with back injuries due to lifting. One judge said we see some really sad cases

  15. #345
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    Just a few more interesting items from today’s article on SSD. There are about 1300 law judges who hear SSD cases throughout the nation. Each judge hears about 500 cases a year. Each judges salaries range fro $125,000 to $165,000 a year. The SSA expects disability claims to skyrocket within the next year, in part because of the rescission.


    Judge Abbott and two other judges believe that a major problem exists with the way disability claims are handled when they are first filed. When a claim in NYS are initially reviewed by the Office of Disability Determinations, which is contracted to conduct the reviews for the feds. Abbott recalled a client whose feet where amputated after a workplace accident in a factory. The i-w applied for SSD and his initial application was turned down. A month later the i-w hired a lawyer and filed for an appeal, his claim was herd and was approved. To me, it’s almost criminal to make a person wait for a hearing in a situation like this. When people get turned down on there

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