What's the success rate for an appeal after denial? It's an internal appeal process? If you lose that, what are the odds of winning an Article 78? I've read a blog from a disability attorney that said he had 11 article 78's and lost them all.
I did, just trying to get something POSITIVE as I felt like I was dead in the water after reading it.
Appeals suck, and from what i hear very hard to win, are you going through one now? You can private message me if you want
Q. Why do I need an attorney to represent me before the New York State Workers’ Compensation Board?
A. Your employer and their workers’ compensation insurance carrier are represented by an attorney at every hearing before the New York State Workers’ Compensation Board. Their goal is to minimize, reduce, suspend, or worse yet,eliminate any monetary award which you are seeking. With these intentions in mind, you should have your own attorney to get you the benefits which you are entitled to receive.
Q. What does it cost me to hire a Worker’s Compensation attorney?
A. Under the New York State Workers’ Compensation Law, an injured worker is not permitted to pay an attorney directly for legal representation of them before the New York State Workers’ Compensation Board. An attorney fee is only awarded by the Workers’ Compensation Board when I win your case. The attorney fee is paid directly to the Firm by the Employer or their Insurer. If you are not entitled to any money, there is no attorney fee awarded.
Q. I am currently represented by a different law firm, but I would like you to represent me, what should I do?
A. After meeting with you to confirm how we can help you, we will take care of notifying the other Firm of our representation of you.
Q. What am I entitled to receive under the New York State Workers’ Compensation Law?
A. The law generally provides two (2) main benefits: lost wages, and medical expenses. Lost wages are based upon your average gross weekly wage for the year prior to your accident date or the onset of illness. Subject to the maximum and minimum rates in effect as of the accident date, the maximum compensation rate is two-thirds of your gross average weekly wage.
Medical expenses are also paid by the employer and insurer, including doctor evaluations, tests (e.g., X-Ray, MRI, CT SCAN, Electromyography,, Nerve Conduction Velocity, etc.
Q. Can I be reimbursed for my travel (i.e., mileage) expenses to and from my medical visits (e.g., Doctor, Physical Therapy, Chiropractor, etc.)?
A. YES. An injured worker is entitled to reimbursement for round trip mileage to and from medical visits based on set mileage reimbursement rates established by the New York State Workers’s Compensation Board. For example, each mile traveled in 2009 is to be reimbursed at the rate of 55 cents. Contact my office for the appropriate form to obtain such reimbursement.
Q: What are Social Security Disability Benefits and Supplemental Security Income benefits?
A: The Social Security Administration has two programs that provide benefits based on disability: Social Security Disability Insurance (SSDI), which is based on prior work under Social Security, and Supplemental Security Income (SSI). Under SSI, payments are made on the basis of financial need.
Social Security Disability Insurance (SSDI) is financed with Social Security taxes paid by workers, employers, and self-employed persons. The amount of the monthly disability benefit is based on the Social Security earnings record of the insured worker. The SSDI program provides benefits to the disabled or blind individuals who are considered “insured” because of their contributions to the Social Security trust fund.
Supplemental Security Income (SSI) is a program financed through general revenues. You do not need a work history to qualify for SSI. SSI disability benefits are payable to adults or children who are disabled or blind, have limited income and resources, meet the living arrangement requirements, and are otherwise eligible. The monthly payment varies up to the maximum federal benefit rate, which may be supplemented by the State or decreased by income and resources.
Q: Am I Disabled under the Social Security’s rules?
A: Under the Social Security Act, “disability” means “inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than 12 months.”
In order to qualify for the either SSDI or SSI your condition does not need to be a permanent one, but you should only file if you expect to be unable to work for at least a year.
The Social Security Administration gathers your medical records and carefully considers all of your health problems, as well as your age, education, and work experience. In general, Social Security is supposed to decide whether you are able to do your past work. If Social Security decides that you are unable to do your past work, they are consider whether there is any other work which you can do considering your physical and mental disabilities and your age, education, and work experience.
What if I am denied for Social Security benefits?
If you think Social Security was wrong in denying you SSDI or SSI benefits you can fight the decision by asking for a hearing. Our firm will appeal the unfavorable decision.
How does A Law Firm get paid?
If you are found eligible for SSD or SSI, the Social Security Administration will withhold 25% of your past due benefits to pay your attorney’s fees out of the back benefits due to you and your dependents. Most of the time, the Social Security Administration will send a check directly to us.
This is what a bureaucrat does:
Works within the system. Says please and thank you. Follows rules, AVOIDS independent thinking and, above all else, protects the status QUO!
This is what a leader does: Leads all the time, no matter what the consequences.
We have no leaders that run the NYS workers' comp system and the NYS Retirement System disabilities The NYSRS is nothing more than a mass of bureaucracy. (is an organization of non-elected officials of a government or organization who implement the rules, laws, and functions of their institution ..) No leaders can look into this system!
But Why.... politicians are not allowed to look into your case with the retirement system for some help in moving your case along OR JUST LOOKING FOR SOME ANSWERS.
The bureaucrat and the bureaucracy run both systems and the appeal system, all three are broke.
No one leader(politician?) that would ever grab the bull by the horn and start cleaning up the systems. But they have a lot of bureaucrats! I like to call them ass kissers.
Last edited by zinger; April 3rd, 2012 at 01:05 AM.
lump sum or weekly payments as a settlement?
Atty fees are based on your total award.
If you take the lump sum... the fees are paid up front.
If you take the weekly payments... the fees are generally taken "off the far end", meaning you get fewer weeks total to commute the atty fees.
Or, you may be paid a lesser amount weekly to commute the atty fees, "off the side"...
In any event, the atty fees will be paid lump sum, awarded by the court, and based on the work performed... generally a % you agreed to or by statute.
Here in ANOTHER GREAT web-site that actually PROVIDES the "CRITERIA", the Five-step APPROVAL PROCESS, qualifying conditions and OTHER conditions that aren't on their "list", SSDI'S DEFINITIONS of "sedentary", "light", etc, the GRID SYSTEM, and OTHER FACTORS and CHARTS that the SSDI reviewers USE when reviewing your MEDICAL RECORDS and your ANSWERS to the QUESTIONS asked by SSDI on the application~
Civil Service Section 71 Leave of Absence
A leave of absence will hold your job for a year so you don't get fired.
When your doctor or your wc doctor tells you are a candidate for a disability retirement with the NYSRS make sure you tell them you don't have a year to wait or get jerked around. The odds are in your favor that you will get rejected by NYSRS. You are looking at another year of waiting on a appeal with the state. WC doctors know the wait and how bad of a system the state has make sure you tell them.
"My doctors say I am months away from any recovery, and the workers comp doc has even said before I was a candidate for disability retirement" from and IW.
If your doctor has deemed that you are a good canidate for medical retirement you could pursue that path while you heal and prepare for the new goals you could start working on for your life but never think your going to get a retirement from the state. Remember the state is broke and they have cut back on awards, what they like to do is reject you file an appeal and they hope you get lost.
If you are denied on appeal with the SSA ALJ, the next step is actually filing a law suit against SSA in federal court. You have exhausted the administrative appeals process, now a "real" judge will hear the case, and make a decision.
Federal court is not the same as ALJ ...many SSA attys would try to discourage an applicant from moving to federal court.
There are four levels in the Social Security Administration's (SSA) review and award system for disability. There is an additional level that takes you out of the SSA system to Federal Court, although only a small percentage of applicants will pass through all five levels.
Level Four – Appeals Council. If the hearing ends in a denial, you have 60 days to ask for a review by the Appeals Council. At this level, the Appeals Council will review the disability hearing decision to determine if it was rendered properly according to the law. Only 2 percent of third appeals result in a favorable decision for the applicant. The SSA estimates the average time to receive a decision on this third appeal in 2010 was 345 days according to the SSA.
Level Five – Federal Court. There is also an additional appeal available which is pursued by less than one percent of claimants -- Federal District Court (FDC). Approximately 70 percent of these are denied with a small amount receiving a decision in FDC that resulted in an award. The remainder of those are remanded (sent back) to the hearing level for an additional hearing.
Award: If your claim is awarded, the general guidelines regarding when to expect payment, including retroactive payments (if applicable), are two to four weeks for claims awarded at levels one and two, and one to three months for claims awarded at levels three and four. These time frames represent an average or general guideline – specific time frames may be shorter or longer.
"Job creators are God and workers are Satan."
The issue revolves around an increase in benefits to injured workers. Included in the 2007 reform, the increase was a necessary step, but it was supposed to be matched by steps to control spiraling costs. As News reporter Tom Precious noted in a recent story, the state hasn’t been nearly as prompt at instituting the controls as it has in increasing the benefits.
This comes right from the NYSRS. If you are awarded SSD for a job related injury and are waiting or thinking about filing for disability retirement with the state.
"The SSA (feds) have different standards for determining eligibility for disability benefits than those of the NYSRS. To be eligible for a disability retirement benefit, an applicant must be found permanently disabled for the performance of his or hers work duties in that position. While SSA(feds) does not require a finding of permanence.
To be eligible for an accidental disability benefit in addition to having been injured as a result of sustaining an accident in the performance of duty, a member must be found permanently disabled for the performance of duties.
The only means for reconsideration of the decision is the appeals process provided by sec 74 of the retirement and NYS social security law."
Now you are injured on the job receive SSA for that work related injury but NYS will tell you they have their own laws and that SSA means nothing.
What the state has done is to protect itself, they made their own SS laws and BS just to fight you. The system is the most corrupt system second only to CA.
The appeal after the judges decision:
In NYS , either party has 30 days from the judges filed decision date , to file an appeal . Most IC's will wait for the last day to file an appeal . If the judge made and ordered an award in your favor , the IC has 10 days to mail a check . If you do not receive a check within 10 - 15 days , it's usually an indicator that they are appealing
How Are New York State Settlements Computed
An SLU benefit award is measured in terms of weeks. A particular loss-of-use percentage is first stated by a medical expert. This percentage is then converted into a corresponding number of weeks' worth of Workers' Compensation benefits according to the schedule printed at Appendix II of the June 1996, Workers' Compensation Guidelines. Finally, the injured worker's own maximum weekly benefit is multiplied by the number of weeks indicated on the schedule. The resulting benefit is the worker's SLU for the particular injury suffered.
# of weeks for each body part:
Toes and fingers each have a schedule individually also.
Example: I had a torn rotator cuff and torn labrum in my shoulder, my doctor rated my SLU as 65% of my right arm, The WCB doctor rated me at 57.5%. The WCB Judge split the difference and determined my SLU at 62%
I earn $1100 per week but the max comp weekly benefit is $400, so I received
312 weeks X $400 X .62 = $77,376. Any wages or comp payments made in lieu of wages are then deducted from that amount, as are attorney fees and they cut you a check for the difference.
Spinal injuries and certain long-term unresolved injuries generally are not given a SLU but are "Classified" as Perm Partial Disability or Perm Total Disability and given a %. The % is multiplied by the difference of your previous job that you can no longer perform and the new job which you now have due to your disability (or no job at all). Again, this is subject to the $400/wk max payment. Example: I lose my same job making $1100/wk due to my disability and get a permanent partial disability rating of 50%. I would receive $200/wk indefinitely (Injuries after 7/06 change the period of time you will receive benefits). you generally have to look for suitable work if your disability is partial, but not always.
I can offer more specific information with case particulars, but those are the very basics.
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