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Thread: New York State Disability Retirement System

  1. #511
    Member zinger's Avatar
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  2. #512
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    Set aside with SSD and comp very important if your ready to settle your case and collecting SSD:
    What is a Medicare Set-Aside (MSA)?

    MSA = is a pre-determined dollar amount to be set aside to pay for future injury-related medical and drug expenses of the Medicare beneficiary that would otherwise be paid by Medicare

    •Effectively acts as "primary coverage" for injury-related treatment post-settlement
    •Once the funds are properly depleted, Medicare becomes the primary payer
    •An MSA can be professionally managed or self-administered
    •Structured Settlements = favored method for funding MSAs (less costly for the parties)
    ___________________________________

    For IW's with a WCMSA/setaside arrangement in place, and have received the booklet from Medicare, there is free online help in self administering the account.

    Go here http://www.monarchmedicaresetaside.com/signup.aspx and set up your free account services.
    Look for ◦Medicare beneficiary self-administration tools

    Also what some may not be aware of with the mandates under MSAP/Medicare Secondary Payor Act...
    •Medicare is secondary payer
    •Medicare must be reimbursed for past payments - attorney has ethical & legal obligations to comply •Failure to comply results in heavy fines and loss of benefits to Medicare beneficiary
    ◦U.S. v. Harris = law firms and defendant insurers can be deemed primary payers
    ◦If beneficiary loses benefits from law firm's failure to ensure compliance, law firm may be exposed to a malpractice claim
    _____________

  3. #513
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    Section 32 Settlement and Medicare Set Aside. Remember if you are not happy with the settlement you do not have to except it..


    IW FROM NY / I am finalzing my w/c with the section 32. i have a medicare set a side. They are offering my 10 years @ 103.00 a week. plus 40,000 future medical. the problem that i am having with this settlement is they want to take my settlement of 56500.00 and substarct the furture medical of 40,000 that would leave me with 7800.00 becuase the lawyer would take 5600.00. Is theis correct???????? i thought i would recieve the full 56500.00 plus 40,000 for future medical. Can somoen help me with this... to make sure i am not getting played.
    -----
    If the 40K is taken from the 56K, YOU would be funding the MSA...
    You should receive the PPD indemnity, the 10 yrs @ 103/wk, PLUS the 40K to fund the MSA.
    You do not have to accept any offer to settle you are not happy with.
    Talk to your atty, you may have misunderstood the equation.

    No two settlements will be alike...the PPD indemnity is based on your rating...FM/MSA is based on the potential for future medical needs. Many IW's with similar injuries, similar treatment plans can see HUGE differences in what a C&R or commutation may be. Not a good idea to compare number$ with what others may have agreed to.

  4. #514
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    When a IW gets hurt on the job they have to remember that their company, boss, IME, insurance company, are not your friend. You are alone in this fight, why because you are costing them money. A lot of IW give up the fight because the system just takes a toll on them and their families. If you are in it for the long haul and plan on fighting get a good attorney keep all your paper work together take notes in court and say very little to the IME answer his question but never give anymore information than needed. Remember you are dealing with one of the worst system in the nation. I would go to my attorneys office and court with all my information, because sometimes their will be a question and you could have that information it can be very helpful.

    "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."

  5. #515
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    Your attorney, if you are not happy with him/her you can fire them at any time during your WCC. People are confused that once you have a attorney for your case you have to keep that person.

    How Can You Be Denied Worker's Comp if Approved for SSD.
    If one applied for and received SSD due to a WC injury what would be the case law (OR logic) determining a WC determination finding for other than a PTD? I know they have different guidelines but how would an IC go against the finding of an independent medical's (SSD) federal program?
    It is the same for the State DSS. you can receive SSD and the state can and in most cases reject you for a disability pension.

    WC state laws provide for rating PD, you are TTD/Temp Total Disabled while you treat/recover due to your injury and cannot perform your basic job function. SSA uses a much higher rate to determine you are 100% disabled, and unable to perform ANY type of job, even sedentary. SSA uses all of your physical/mental impairments... WC uses only the work injury.
    generally SSD requires a medical opinion that total disability would be disability for about 12 months.
    many states differentiate between temporary total and permanent total.
    unless you've reached maximum medical improvement such a situation would pay temporary total benefits.

    In comp court it's not the number of doctors that decides the issue (otherwise they wouldn't need judges; just a huge number of doctor reports and whoever had the most would win?!)
    medical evidence has to be the most persuasive. that's a subjective standard and different for every judge.
    what is persuasive to you may not be to a comp judge.

  6. #516
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    Please sign my petition

    Hello!
    I've started the petition "NYS Assembly Speaker Sheldon Silver: Support the Lois Reid bill, A-05561, in the NYS Assembly" and need your help to get it off the ground.
    Will you take 30 seconds to sign it right now? Here's the link:
    http://www.change.org/petitions/nys-...tition_created
    Here's why it's important:
    This bill will correct an injustice when a NYS Employee became totally and permanently disabled, but was denied Disability Retirement benefits because the the NYS and Local Employees Retirement System believed that the employee was disabled, but they did not believe that the disability was permanent. They were wrong. This individual has been totally and continuously disabled for the past 23 years.
    You can sign my petition by clicking here.
    Thanks! Lois Reid

  7. #517
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    It will be a fight, the NYSRS could careless if your disabled or not! It all comes down to money does the state want to pay your pension and your employer probably not. That is why they both fight like hell and give the IW such a hard time for the past 23 years. Like I said before look at all the money the NYSDS will waste on a disabled worker to fight them ( state attorneys, judges, the whole court system) for a bare bones disability pension it makes no sense. Good Luck!!

  8. #518
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    The SSA just released its February 2013 summary. 8.8 million disabled Americans received an average monthly SSDI benefit of $1,130 last month.

    fees associated with hiring an attorney or advocate to represent you in my disability claim or appeal.
    Disability attorneys and advocates work on a contingency basis, meaning that they only receive a fee for their services if you are successfully approved for benefits. The amount of the fee is regulated by the SSA and limited to 25% of the past-due benefits that you are awarded up to a maximum of $6,000. If no back-dated benefits are awarded, the attorney/advocate will not receive a fee, nor is he or she permitted to ask you for one.

    There is no cost or obligation to receive a free evaluation to discuss your specific case and potential eligibility for benefits.


    Some of the many different reasons why the SSA denies claims for disability. Some of these include:
    • Claimant currently working
    • Not enough medical evidence of a disabling condition
    • Claimant does not regularly treat with a physician
    • Application not completed properly
    Last edited by zinger; March 22nd, 2013 at 04:13 PM.

  9. #519
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    Hello!

    I've started the petition "NYS Assembly Speaker Sheldon Silver: Support the Lois Reid bill, A-05561, in the NYS Assembly" and need your help to get it off the ground.

    Will you take 30 seconds to sign it right now? Here's the link: (simpler instructions are below this link)

    http://www.change.org/petitions/nys-...tition_created

    Here's why it's important:


    This bill will correct an injustice when a NYS Employee became totally and permanently disabled, but was denied Disability Retirement benefits because the the NYS and Local Employees Retirement System believed that the employee was disabled, but they did not believe that the disability was permanent. They were wrong. This individual has been totally and continuously disabled for the past 23 years.

    You can sign my petition by going to Change.org and searching: NYS Assembly Speaker Sheldon Silver support the Lois Reid bill.

    Thanks! Lois Reid

  10. #520
    Tony Fracasso - Admin
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    Almost 50,000 views. Pretty good Zinger.

  11. #521
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    Quote Originally Posted by WNYresident View Post
    Almost 50,000 views. Pretty good Zinger.
    So many people are interested in this subject or subjects. Why because good information has been hidden from the iw for a long time, and iw workers are very scared when they get hurt on the job. TY WNYR..

  12. #522
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    There are always questions about What is the difference between Social Security Disability (SSDI) and SSI (Supplemental Security Income)?

    To be eligible for SSDI benefits, you must be disabled according to the SSA's definition and have paid Social Security taxes to become insured for benefits. You generally must have paid into the program for at least 5 of the last 10 years. Once approved, the amount of the monthly benefit is based on the Social Security earnings record of the insured worker up to a maximum of $2,533 per month. The average monthly SSDI benefit in February 2013 was $1,130.

    Needs based program:
    To be eligible for SSI disability benefits, you must be disabled according to the SSA's definition and have limited income and resources. This is a needs-based program and you do not need to have paid into the system. Once approved, the amount of the monthly benefit is based on need up to a maximum of $710 per month. The average SSI monthly benefit in February 2013 was $526.

    The review: I myself have been reviewed many times and they are IME's same as a WCC.
    By law, all disability cases must be reviewed periodically to ensure that the person receiving benefits still meets the disability requirements. The timing of these reviews generally depends on the severity of the impairment and the likelihood of improvement.

    General review timing guidelines from the SSA:

    • Improvement expected—If medical improvement can be predicted when benefits start, the first review will be 6 to 18 months later.

    • Improvement possible—If medical improvement is possible but cannot be predicted, the case will be reviewed about every 3 years.

    • Improvement not expected—If medical improvement is not likely, the case will be reviewed about once every 5 to 7 years

  13. #523
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    Another view on firing your WC attorney.

    In theory, you have the right to fire him and hire a new one.

    In reality, it is not that easy or simple, especially if your current lawyer has already received a settlement offer from the Defendants that you are turning down. He will be entitled to a legal fee even if you fire him and the second lawyer will have to share the one fee awarded in the case with the first. Changing lawyers in the middle of a case can turn into a very time consuming endeavor that does not necessarily improve your outcome.

    When clients do not agree with the settlement amount their lawyer is recommending that disagreement is often due to the fact that the client does not have realistic expectations of what a fair settlement should be in the case based on the facts of client's particular case and the applicable law. If your disagreement is due to your own expectations being out of line, then no competent lawyer will be able to make you happy unless you adapt your expectations to reality. And if you do that, there may be no need to change lawyers. So think deeply about that issue before you change lawyers.

  14. #524
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    Each year approximately 600,000 occupational illnesses and injuries are reported to the New York State Workers' Compensation Board. Of these, several thousand claims for occupational disease are challenged by workers' compensation insurance carriers(IC) 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; and
    •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.

  15. #525
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    Social Security Disability Insurance (SSDI):

    Is NOT welfare or a government hand-out. It's a federal insurance program that provides income to workers who have paid into the program and are unable to work due to a disability.
    __________________________________________________ __________________
    How does my work status affect my eligibility for SSDI?

    One of the primary eligibility requirements for SSDI is that you are not currently working and making more than $1,040 per month (or $1,740 if you are blind). Technically, you may be approved if you are currently working and making less than that. However, you will very likely face an uphill battle to get approved. Generally, the most qualified applicants for SSDI are those whose disability prevents them from working at all.
    Last edited by zinger; April 16th, 2013 at 08:00 PM.

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