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Thread: New York State Disability Retirement System

  1. #271
    Member zinger's Avatar
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    Social Security clogged with disability claims, these mornings Buffalo News. If you are filing for a SSD claim you will be in for a long wait. The Western New York area ranks just about last in waiting. I received and e-mail about two days ago from an I-w she told me her wait time from start to finish 30 months. Then I heard from another i-w that I worked with for number of years and retired on his own. (NYSRS denied his claim) He filed for his SSD and received it in 8 months no appeal. The SSD doctor (ime) told him you should have never been denied your disability benefits from the STATE due to your work injuries. I posted up some of the highlights of the article. Do not let this discourage you from filing your claim you never know what will happen. I do have a list of SSD attorneys just send me a pm and a can forward some to you.


    For all the talk of an impending crisis in Social Security, one already exists: The system is clogged with hundreds of thousands of disputed disability claims, a backlog so big that some people wait years for a hearing.
    Social Security officials blame under funding, understaffing, a dramatic rise in cases and an increasing number of claims involving hard-to-prove ailments, such as back pain, depression and anxiety. Even with a $500 million infusion from the federal stimulus program, it could take years to clear the backlog. Social Security benefits are available to people who can no longer work because of a disability, regardless of whether it was suffered on the job or off. The monthly checks average $1,063.
    Someone seeking benefits must first send an application and wait an average of 106 days for a decision, according to the Social Security Administration. The agency denies nearly two-thirds of the applicants, who then can request a hearing to appeal. Then the real wait begins. Those who received a hearing last fiscal year had waited nearly a year and half on average - twice the wait time in 2000, according to the SSA. More than 765,000 people - about double the number in 1998 - are now waiting for a hearing. Sixty-one percent of applicants who go through an appeal hearing are ultimately approved for disability benefits. Recipients receive benefits if they are deemed mentally or physically unable to work and the condition is expected to last at least a year or will lead to the person's death.
    People injured on the job can often collect workers' compensation, though it generally runs out after a certain amount of time, while Social Security benefits continue as long as the disability persists.

  2. #272
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    From post #264;
    This is very important, if you have received SSD for work injuries and had to go back to work on a trial bases your payments continue during your period of 9 trail months while you are tested on your ability to work. You are not entitled to payments after this period because you are doing substantial work.

    The next part is what happens after the trial work period. You get an extended period of eligibility that begins right after the trial work period. This is a 36-month period when SSD will restart payments for any month(s) your work is not substantial if your health problems still meet the SSD rules, this is called reinstatement.

    On the question, sorry I failed to mention what would happen if you continue to work past the 36 month extension. You can ask for a Deferment from the www.ssa.com if not you would have to submit a new claim and start from the beginning.

    ------------------------------------------------------------------------------------------------------------




    Lots of things going on with the tea party rallies not just here but all over the country. The last rally in this area there were few disabled and injured workers that did attended. I have had i-w contact me that they attended and said they were glad they did. So I am trying to get the word out for more of us to attend the next one. Since a lot of the people that read this site only hit this link they might not know when it will be. WNY Tea Party April 18 if anyone has more information can you post it up here. I believe Jim Ostrowski is the sponsor of this one. I need a location and if it is out side or in.
    I have two friends that live out of town one in ST. Louis MI. They had a tea party about 2 weeks ago he was telling me about 2000 people showed up and are having another at the end of the month and they project about 5000 to attend, in fact the organizer has been on fox news. My other friend lives in the Washington DC area and sent me a short e-mail. (Check out the link)

    “Looks like there may be 2 tea parties in DC on 4/15 - one in front of
    the White House and this one in front of treasury

    New American Tea Party. Not exactly sure on point but will keep
    looking:” Send more information soon try to make it. C


    http://newamericanteaparty.com/2009/...rty-in-washing
    ton-dc-in-front-of-treasury-on-april-15th-tax-day/

    Senior Officer:


    What is going on in these two areas (tea party) are a lot of federal issues I know around here it was state issues. The state issues are very important to the injured and disabled worker no matter if your hurt or not. If you do get hurt on the job you have no idea what you are in for. These politicians have made laws on top of laws, whether it’s Workers Comp or the NYSRS they need reforms.
    Last edited by zinger; April 5th, 2009 at 10:00 PM.

  3. #273
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    I would just to take minute and wish everyone that reads the posts and their families a very Happy Easter. The disabled, injured workers, disabled vets, and the many people that I have had the pleasure of corresponding with this past year. Happy Easter!

  4. #274
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    Thanks zinger, Same to you and your family. Have a Great Day
    Life, Liberty and the Pursuit Of All That Threaten It
    What if the Hokey-Pokey IS what it's all about?

  5. #275
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    same to you zing & all the girls, and all the infoe you pass a long..... semper fi !

  6. #276
    Member GI joe's Avatar
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    Happy Easter Z. thks. "SINE PARI"

  7. #277
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    This article says it all, about how bad the system is in this state, just like everything else.. It was sent to me by another i-w from the Ithaca, NY area it was in last weeks NY.Times. Remember you do not have to be injured on the job to go through this system. If you are dealing with any insurance company this is what you will be up against. Could be from a fall on someone’s property, car accident etc. I know it is said that the high cost of works compensation fees in this state drive out business and make it very hard for the small business man to stay alive. This is why business don’t want to stay, so take a few minute and read it.

    __________________________________________________ ___________

    A World of Hurt: For Injured Workers, a Costly Legal Swamp

    The worker, a driver for a plumbing company, told the doctor he had fallen, banging up his back, shoulder and ribs. He was seeking expanded workers’ compensation benefits because he no longer felt he could do his job.
    Dr. Samuels, an independent medical examiner in the state workers’ compensation system, seemed to agree. As he moved about a scuffed Brooklyn office last April, he called out test results indicative of an injured man. His words were captured on videotape.
    Yet the report Dr. Samuels later submitted to the New York State Workers’ Compensation Board cleared the driver for work and told a far different story: no back spasms, no tender neck. In fact, no recent injury at all.
    “If you did a truly pure report,” he said later in an interview, “you’d be out on your ears and the insurers wouldn’t pay for it. You have to give them what they want, or you’re in Florida. That’s the game, baby.”
    Independent medical exams are among the most disputed components of New York’s troubled workers’ compensation system. Under that system, workers with bona fide injuries are entitled to medical care and replacement wages, usually paid for by their employer’s insurer.
    The independent exams are designed to flush out workers who exaggerate injuries or get unnecessary care, and there is no question that some of that goes on. As a check on what a worker’s doctor determines, insurers are allowed to order an ostensibly neutral exam by a doctor they select and pay for. They do so regularly, with more than 100,000 exams conducted each year.
    But a New York Times review of case files and medical records and interviews with participants indicate that the exam reports are routinely tilted to benefit insurers by minimizing or dismissing injuries.
    “You go in and sit there for a few minutes — and out comes a six-page detailed exam that he never did,” said Dr. Stephen M. Levin, co-director of the occupational and environmental medicine unit at Mount Sinai Medical Center, who has been picked as the interim medical director at the compensation board. “There are some noble things you can do in medicine without treating. This ain’t one of them.”
    New York uses independent medical examiners far more extensively than many states do, and critics say the practice adds to the mistrust in the system. The examiners’ opinions can empower an insurer to slash benefits, withhold medical treatment or stall a case. Workers say that psychologically, there is something particularly damaging about being dishonestly evaluated by a medical professional.
    “I was in so much pain and felt so hopeless for so long,” said Carol Houlder, a substance abuse counselor who waited a year for surgery on her injured ankle to be approved. “Doctors see you’re in pain and say you’re not. How do they call themselves doctors?”
    Many independent examiners are older, semiretired physicians who no longer treat patients, and claimants and lawyers have asserted that the memories and judgments of some of the doctors have at times been impaired by their age and frailties. The examiners do not need special training, only to have a state license and to be authorized in a specialty.
    “Basically if you haven’t murdered anyone and you have a medical license, you get certified,” said Dr. Alan Zimmerman, 75, a Queens orthopedic surgeon who does the exams. “It’s clearly a nice way to semiretire.”
    Some examiners see dozens of injured workers a day. Often the appointments are booked by brokers who help insurance companies find doctors. Some brokers are not registered with the state, as required, but there has been little enforcement of the rules.
    Insurers, examiners and brokers, however, defend the exams as necessary and largely untarnished by bias. Dr. Brian L. Grant, chairman of Medical Consultants Network, a company based in Seattle that arranges independent exams across the country, said, “We never get pressure from an insurer.”
    Many workers contest independent medical examiner opinions and often prevail. Judges can, and do, dismiss the exam findings. In fact, some lawyers and judges laugh when certain examiners’ names come up at hearings.
    Dr. Kenneth E. Seslowe, an orthopedic surgeon who mainly does independent medical exams, is mocked at hearing offices by attorneys as Dr. Says-No, because they feel he consistently finds no disability. Asked about this, Dr. Seslowe said, “I really don’t have time for this.”
    But even when the opinions are discounted, resolution can take months, years, even decades, and many workers, tired of the ordeal of five, six, seven exams, eventually give up.
    Some examiners, of course, do furnish honest, well-reasoned opinions. And sorting out the yawning breach between what a worker’s doctors and an independent medical examiner conclude is complicated by the fact that some injuries and their impact on a person’s ability to work — especially soft-tissue injuries like those to the back and neck — are hard to document with indisputable tests.
    Zachary S. Weiss, the chairman of the workers’ compensation board, said that he found the disparities in medical opinions shocking and that use of independent examiners was “off the charts.” But Mr. Weiss, who was appointed in late 2007, said he was unsure what would rectify the problems.
    After nearly a dozen years without a medical director, the board has finally filled that job temporarily. It has introduced new, more detailed forms, which many doctors find maddening. It is also working on fresh guidelines that it hopes will better calibrate an injured worker’s care and work limits.
    Dr. Robert E. Bonner, the medical director of the Hartford, an insurance company, said it was clear that the landscape had polarized. “Physicians regrettably have moved away from being neutral observers,” he said. “They’ve moved toward one camp or the other.”
    Doctor vs. Doctor
    When New York companies complain about the high cost of doing business in the state, they often cite fraudulent workers’ compensation claims as a key factor.
    Though experts say talk of worker fraud is frequently overstated, it is widely acknowledged that some doctors collaborate with workers or their lawyers to magnify injuries or provide treatment for years without making someone better. Law firms representing workers often have cozy relationships with doctors to whom they refer patients, and vice versa.
    A few years ago, Dr. Rafeak Muhammad, a Queens ophthalmologist, was barred from taking workers’ compensation patients after acknowledging that he had treated several long after it was necessary. He declared them unable to work when in fact they could.
    David Donaldson, senior vice president at the domestic claims subsidiary of A.I.G., one of the state’s largest workers’ compensation insurers, said, “Our position on I.M.E.’s is we’re looking for someone who is going to give us a coldly objective view of the injury.”
    Critics, however, contend that independent medical examiners who reliably dispute workers’ doctors are hired more often by insurers. Some workers cynically refer to them as “insurers’ medical examiners.”
    Shu-Ying Xu, 66, a home health aide, said she met with an independent examiner in October 2006 so he could review the back, neck and leg injuries she suffered when she tried to prevent a patient from falling.
    She said the exam took two minutes and was so quick that the doctor, Wayne Kerness, an orthopedic surgeon, did not ask her anything.
    As a result, she said, when the doctor filed his report he said she spoke English. She does not.
    He said she took no medications. She said she took nine.
    He said her disability was mild and she could resume work.
    She said that she was in debilitating pain and that the Social Security Administration had already concluded that by its standards, she was totally disabled.
    “She can’t even hold a gallon of milk,” said Peter Chang, her son. He had come along to the exam to translate. Since no questions were asked, he said he had nothing to do.
    After checking his notes, Dr. Kerness said it was an error to have said that Ms. Xu spoke English. Otherwise, he stood by the report. “What can I say?” he said. “People can say whatever they want.”
    He added: “I have my share of people I’ve found totally disabled and even recommended treatment that has been overlooked. I think I’m pretty heterogeneous.”
    A judge ultimately ruled that Ms. Xu’s benefits should continue.
    For decades, independent medical examiners were essentially unregulated. Reports were sometimes altered by brokers and exams often were done at airports, hotels or in the garages of doctors’ homes. In 2000, a doctor examined five patients in a Long Island bar.
    In 2001, the state introduced rules. Among them: doctors had to register with the board, work in a medical office and let workers record or videotape their exams. Claimants are permitted to bring along anyone they choose to witness or film the sessions.
    While the law has helped, the process remains riddled with flaws. Lawyers and injured workers say many of the examiners still do brief, perfunctory, one-sided exams.
    A small study conducted a few years ago at the Central New York Occupational Health Clinical Center in Syracuse found that the clinic’s doctors and independent medical examiners virtually never agreed on whether a worker was disabled. When it can be proven that medical examiners have acted inappropriately, the compensation board revokes their certification — which has happened more often in recent years. But investigations are time consuming and only a dozen or so result in revocations each year.
    William Gurin, the board’s fraud inspector general, says his unit’s limited resources are best focused on more fertile areas of fraud, such as employers who underreport their work force to save on insurance premiums.
    Similarly, the board struggles to regulate businesses, from storefront exam factories to multistate networks, that help produce independent exams. Decades ago, insurers hired doctors directly. Now the job is increasingly done by third-party brokers called entities.
    Entities are paid by insurers — around $500 or $600, say, for an orthopedic exam — and they in turn pay the doctor. Often, doctors submit dictated notes or checklists to clerical staff at the firms, who then draft the reports. Other times the notes go to transcription companies. The people preparing the reports may have no medical training.
    Since 2001, the state has required entities to be registered. About 170 have signed up. But a fair amount of independent exam work is performed by companies that have never registered.
    It was an unregistered company, Wine Medical Management, that arranged an independent medical exam of Santos Padilla, an injured worker, in 2006. The exam was to be done by Dr. Kerness, but it was canceled, and Mr. Padilla was seen by another doctor.
    But somehow the compensation board received a report signed by Dr. Kerness recounting an exam that had never happened.
    Dr. Kerness blamed the bogus submission on a clerical error by Wine. He said the company, using a signature stamp, had affixed his name to a report he had not seen.
    Wine went out of business last year. A former manager at Wine, Laura Urban, blamed the discrepancy on a transcription company that prepared the reports. Ms. Urban moved to Commander Management, another entity that was doing unregistered work until the board ordered it to cease.
    The board is looking into the Padilla episode, and has pledged to crack down on unregistered I.M.E. entities. Only a handful have ever had their certifications revoked, usually not for creating shoddy reports but for failing to pay their doctors.
    Robert Grey, a claimant lawyer, said the board should track the opinions of independent medical examiners and compare them to ultimate verdicts, and then exclude doctors who were constantly found not credible.
    Currently, the best protection for a worker is to tape an exam. But few do. The board does virtually nothing to promote the practice, and some doctors do not like it. When a woman brought a camera to an appointment upstate, the doctor called the police to toss her out.
    Ms. Houlder, 63, who hurt her ankle, videotaped her exam by Dr. M. Pierre Rafiy, a 77-year-old Long Island orthopedic surgeon.
    In the videotape, Dr. Rafiy grasps Ms. Houlder’s right ankle and says it is swollen. In the written report, he stated that there was no swelling and no disability and that she could return to work.
    When subsequently deposed, he backtracked, saying it had been a secretary’s mistake to say no disability. He did not correct anything else.
    Asked about the exam in an interview, Dr. Rafiy said: “I have no way to know if she had real pain. You have to remember, a lot of people don’t want to work. They lie a lot.”
    Examiners, or Advocates
    Dr. Samuels, 79, with a radiant smile and a burst of snowy hair, stopped doing surgery years ago. Until recently he commonly filled his days performing insurance exams on workers, sometimes as many as 50 in an afternoon, he said in his small office in Borough Park, Brooklyn.
    “You obviously can’t spend a lot of time with that volume pushing up your back,” he said. “You have to assume there are going to be errors. Look, there are a lot of holes in this thing.”
    At times, evidence shows, Dr. Samuels’s official reports were quite different from what he appeared to find during an exam.
    Consider his 2007 examination of Johanne Aumoithe, a pastry chef who said she had hurt her arm and neck. On a videotape that Ms. Aumoithe recorded on her cellphone, Dr. Samuels comments that she had limited range of motion. His written report concluded the opposite.
    Asked about the discrepancy in an interview, Dr. Samuels chuckled and said he could not even recall the people he saw yesterday. The way he worked, he said, was to submit a checklist to a Queens company called All Borough Medical, which transformed it into a narrative.
    “I never write a sentence,” he said. “It’s really crazy, but that’s how it’s done.”
    He often inserted numbers in the checklist — say, a measure of hand strength — after the person left, rather than as he performed the tests.
    Was he sure they were correct? “I’m not sure of anything,” he said. “They’re just a guess in the first place.”
    The law requires a doctor to attest to the accuracy of a finished report before signing it, but Dr. Samuels said he rarely read them. He doubted he had read the Aumoithe report. “I just sign them,” he said.
    If he seldom read them, how did he know they were correct?
    “I don’t,” he said. “That’s the problem. If I read them all, I’d have them coming out of my ears and I’d never have time to talk to my wife. They want speed and volume. That’s the name of the game.”
    Dr. Samuels said he generally received about $100 for one of these exams.
    The state does not regulate how much a doctor can make for an independent medical exam, though it does limit what a treating physician may charge an injured worker, and generally that is much lower for roughly equivalent work. Some examiners said insurers pay them by the session, say $1,500 to be available from 8 a.m. to 4 p.m. and handle whatever workers are sent to them.
    An occupational medicine doctor deposed by Scott Clippinger, a claimant lawyer, said he charged $550 an hour for an independent medical exam. In 2006, Mr. Clippinger complained to the state board that the imbalance in fees “allows the carriers to purchase opinions.” He asked the state why it was not following a clause in state law that says that independent medical exams “shall be paid according to the fee schedule.”
    The board’s response was that while the law “does provide that I.M.E. fees shall be paid according to the fee schedule, the fee schedule does not specify a particular fee for an I.M.E.”

  8. #278
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    continued:
    Dr. Edward Toriello, a Queens orthopedic surgeon who cares mainly for his own patients, said he is paid nearly twice as much for an independent medical exam than he is for seeing a workers’ compensation patient he treats ($250 versus $140).
    Like many who perform the exams, he views the compensation system as bloated with charlatans. Dr. Toriello, who does about 30 such exams a week, estimates that 80 to 85 percent of the time he finds no disability or need for medical treatment in workers whose doctors have found otherwise. He says the disparity is explained by the “comp mentality.”
    “I think it’s human nature to help your patient,” he said. “I think a lot of doctors say: ‘I don’t need the aggravation. It doesn’t hurt to keep him out of work.’ ”
    Dr. Zimmerman, of Queens, said he believed that 75 percent of people getting workers’ compensation did not deserve it, but also said he was not surprised to hear that insurance lawyers in Queens said his opinions were overwhelmingly disregarded by judges.
    “Judges come up with wrong decisions a huge amount of time,” he said. “The lawyers work it so that anyone who scratches their toenail deserves equal treatment as someone who fell out of a 40-story building.”
    Sometimes, a review of cases shows, there are stark discrepancies between the testimony independent medical examiners give at trial and their reports.
    Twice in 2005, for example, Dr. Francis O’Malley, a Long Island orthopedic surgeon, testified that a disability was more serious than indicated by his reports.
    In one case, Dr. O’Malley testified that a man who had hurt his back lifting packages had a “marked” partial disability. The report described the injury as a less severe “moderate” disability.
    When confronted with the discrepancy, Dr. O’Malley testified, “I don’t know what’s going on.”
    The reports were filed on Dr. O’Malley’s behalf by Hooper Holmes, a national medical services company that operated an I.M.E. entity. The company said that it always submitted exactly what doctors gave it and that it believed Dr. O’Malley, who is 78, was confused. Dr. O’Malley did not return calls for comment.
    In the case of William Cassone, the plumbing company driver whose father taped his examination, the exam by Dr. Samuels was arranged by All Borough Medical, an unregistered I.M.E. entity, which got the assignment from another registered entity.
    Mr. Cassone had been injured years earlier but was being examined because, as he says on the videotape, he had suffered a second, recent injury.
    But Dr. Samuels’s report made no mention of the second injury and deemed Mr. Cassone able to work. When Mr. Cassone got the report, he said, “I was screaming so much I left the house and slept in the car.”
    Dr. Samuels later swore in a deposition that the report was accurate. A few weeks later, though, the board received an addendum signed by Dr. Samuels saying he had viewed the videotape and, yes, he had been told of the second injury. Still, he found no evidence of disability.
    All Borough declined to comment on the case and its business.
    Dr. Samuels said in a recent interview that he had never seen the addendum or the videotape and doubted he had read the original report. He said All Borough must have prepared the addendum without his knowledge.
    “This is the first I’ve heard of this,” he said. “Listen, there’s a lot of hanky-panky that goes on.”
    Mr. Cassone’s lawyer, Michael Pyrros, told a judge at a hearing that he was concerned there might have been fraud involved in the conduct of Dr. Samuels, the I.M.E. entity and the insurer. When the Cassone case next came before a judge, late last summer, a deal was reached between lawyers to grant Mr. Cassone benefits. Fraud allegations were dropped against the insurer.
    Dr. Samuels, who was told to appear at the hearing, did not show up. According to a letter from his lawyer, he was unwell. His behavior was never addressed. Soon after, he retired, his official record unblemished.
    More Articles in New York Region » A version of this article appeared in print on April 1, 2009, of the New York edition
    d:

  9. #279
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    When I was going through my hellish experience of dealing with NYSRS it is the same way as the story you just read about with the WC system. Same bad ime etc.etc. I did look for political help from MY area representative like I said before. I sent letters to all of them that are listed on this page. No response from ten of them and the only one assemblyman that did go out of his way to look into it came from out of my district. Remember when you contact your representative fax your SSD award letter any medicinal reports that said you are disabled and your WC decision papers stating you are disabled at what degree %. NYSRS will not release any medical information to your representatives so if they get it from you they have an idea of what is going on. And why you are being denied your benefits. Let them see that the laws need to be changed.

    About a month ago I was helping a disabled person filling out some paper work (SSD claim). I had to make a call into the SSA for some information for this person, and had a chance to talk to a depreciative for a while. She was very helpful and polite, I asked her about getting your award SSD for work injuries and being denied from the NYS system. (disability). The persons reply, that should never happen.

    schimmr@assembly.state.ny.us

    peoplec@assembly.state.ny.us,

    gabryszakd@assembly.state.ny.us,

    hoyts@assembly.state.ny.us,

    schroem@assembly.state.ny.us,

    hayesj@assembly.state.ny.us,

    quinnj@assembly.state.ny.us,

    stachows@senate.state.ny.us,

    volker@senate.state.ny.us,

    athompso@senate.state.ny.us,

    maziarz@senate.state.ny.us,

    mranz@legalsurvival.com
    __________________________________________________ _____________



    So the best thing for you to do about this broken system is continue to contact your local reprehensive on this matter. Politicians know how bad this system is and continue to do nothing about it. Most of you that live in WNY know who your reps are, but I been hearing from i-w from all over the state and encourage them to contact their representatives. The best way to find them is go to the following site
    http://www.state.ny.us/
    Legislative
    New York State Senate
    New York State Assembly
    New York State Congressional Delegation

  10. #280
    Member zinger's Avatar
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    When I was going through my hellish experience of dealing with NYSRS it is the same way as the story you just read about with the WC system. Same bad ime etc.etc. I did look for political help from MY area representative like I said before. I sent letters to all of them that are listed on this page. No response from ten of them and the only one assemblyman that did go out of his way to look into it came from out of my district. Remember when you contact your representative fax your SSD award letter any medicinal reports that said you are disabled and your WC decision papers stating you are disabled at what degree %. NYSRS will not release any medical information to your representatives so if they get it from you they have an idea of what is going on. And why you are being denied your benefits. Let them see that the laws need to be changed.

    About a month ago I was helping a disabled person filling out some paper work (SSD claim). I had to make a call into the SSA for some information for this person, and had a chance to talk to a representative for a while. That person was very helpful and polite, I asked about getting your award SSD for work injuries and being denied from the NYS system. (disability). The persons reply, that should never happen.

    schimmr@assembly.state.ny.us

    peoplec@assembly.state.ny.us,

    gabryszakd@assembly.state.ny.us,

    hoyts@assembly.state.ny.us,

    schroem@assembly.state.ny.us,

    hayesj@assembly.state.ny.us,

    quinnj@assembly.state.ny.us,

    stachows@senate.state.ny.us,

    volker@senate.state.ny.us,

    athompso@senate.state.ny.us,

    maziarz@senate.state.ny.us,

    mranz@legalsurvival.com
    __________________________________________________ _____________



    So the best thing for you to do about this broken system is continue to contact your local reprehensive on this matter. Politicians know how bad this system is and continue to do nothing about it. Most of you that live in WNY know who your reps are, but I been hearing from i-w from all over the state and encourage them to contact their representatives. The best way to find them is go to the following site
    http://www.state.ny.us/
    Legislative
    New York State Senate
    New York State Assembly
    New York State Congressional Delegation

  11. #281
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    How Are New York State Settlements Computed?
    these are the very basics.


    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:
    Arm 312
    Leg 288
    Eye 160
    Hand 244
    Foot 205
    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.

  12. #282
    Member zinger's Avatar
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    COBRA:
    Just want to pass some more information along about the cobra subsidy.
    Companies were required to notify former workers about the subsidy by April 18.
    It is estimated that more than 7 million unemployed workers will qualify and some will not and the reasons are.

    Their former employer has gone out of business. If an employer terminates it’s group health plan, former employees are ineligible for COBRA . That makes them ineligible for the subsidy. The federal COBRA law only applies to companies with 20 or more employees. Some 39 states and Washington D.C. have enacted “mini Cobra” laws that require small companies that provide group coverage to allow former employees to continue the coverage. But, gaps between state and federal laws remain ,leaving laid off employees with a reduced subsidy or none at all.

    Jobless workers who haven’t received a notice or have questions about their eligibility
    Should contact the company that administers their employee benefits program. The Dept. of labor also has a fact sheet about the subsidy at.

    www.dol.gov/ebsa/cobra/.html.

  13. #283
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    Alan Hevsi the former N.Y. State Comptroller it seems that names appears on the Internet or in the newspapers a lot lately. Mr. Hevsi was forced out of office in 2007 after being convicted of defrauding the state by having state employees serving as personal aids to his wife. The comptroller’s office handles the NYSRS disability and hearings divisions. When he was in office I had written letters to the comptrollers office about how reforms are needed to the disability and hearing systems. I stated in the letters thousands of injured and disabled workers are being denied their benefits after receiving federal SSD. But as you might expect no answer from Hevsi’s office. So Mr. Hevsi has a sickly wife, he used state employees to care for her, a crime. Then the comptroller’s office will deny the injured worker their benefits and put them and their families through hell! (to this day nothing has changed) As I seen in the Buffalo News Mr. Hevsi pension is $166,487.00 from New York State and his current salary is $151,000.00 so his pension and paycheck is $317,487.00. Last month I had received some emails from injured workers in different parts of the state that are in the NYSRS that were denied their disability benefits from the state. They can no longer work, and were awarded SSD and NYS Workers’ Comp. Benefits. The NYS Social Security Laws need to be changed; they protect the state not the injured and disabled worker. But a guy like Alan Hevsi walks away with a $166, 487.00 pension and just a slap on the wrist. But if that was you or I it would have been jail time.

    Remember to fax your medical reports to your area rep. along with your SSD award statement from the feds. If you have your decision paper form the comp board on your award send that too. Then asking in a short note why you were refused disability benefits.
    -----------------------------------------------------------------------------------------------------------

    On the question: Once you receive your SSD award you will receive your Medicare part A card shortly after. This is the confusing part if you have to go back to work on a trial basis Medicare is still good. I believe it will be your secondary insurance; Your health insurance from your employer is still the primary. I know this makes no sense, but the i-w will have to deal with it tell the NYSRS disability gets reformed.

    -------------------------------------------------------------------------------------------------------------
    This post came from another site and was sent to me by the injured worker.

    Quote:
    Quoting lonce That's surprising to me. With NY State the criteria is dependent upon your current position, unlike SSD.
    -----------------------------------------------------------------------------------------------------------------------------------
    HurtBoy
    The NYSRS is ok ; it is the self serving mindless droids working there that are the problem.
    Their mind set is everyone that can breath is ok to work.
    After-all they do it everyday .
    File an appeal in a timely manner and contact your NYS Assembly person.
    The NYSERS is ran by bureaucrats and if you can get their bosses looking at them then they usually try hard to make the spot light go dim.
    Like I said call your Assembly person , the Comptroller , the Governor's Office and anyone else that you may know.
    Did you lose your Empire Plan coverage?
    do not give up keep on your state senator and assemblyman let them know how bad this system is.

  14. #284
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    Workers' compensation, the oldest form of social insurance, was introduced in the United States a century ago to grant medical care and monetary awards to employees hurt on the job, while avoiding costly and protracted litigation. Despite an ongoing reform effort, New York State's workers' compensation system serves no one well and is arguably the most adversarial of any state in the nation much like the NYSRS (disability)
    Injured workers who enter the befuddling system -- they are typically those low on the socio-economic scale -- often find themselves trapped in nightmarish delays. Justice can take months or years, and leave many injured workers unable to support themselves and their families on the modest benefits. Workers get shepherded to so-called independent medical examiners that are often anything but independent, since they are picked and paid directly by insurance companies. Employers say they face pressures to reduce injuries because compensation insurance premiums remain a major drain on profits and they do not believe the system is doing enough to ferret out fraudulent claims. To minimize workers' comp costs, many employers discourage injured employees from filing claims and retaliate against those who do, injecting a climate of fear into a system specifically created to reduce acrimony and litigation over workplace injuries.
    The state legislature enacted a reform plan in March 2007 that sought to tackle some of the system's problems. The maximum weekly wage replacement benefit was increased, after remaining unchanged for 15 years. To reduce business's costs, the plan placed a 10-year cap on how long workers with permanent partial disabilities could receive weekly benefits. The plan also put in motion steps to, among other things, reduce delays in the adjudication process, better rehabilitate workers so they can resume jobs, and create more precise guidelines for doctors assessing workers' injuries. For the most part, these goals have yet to be attained. When it comes to bad ime’s and insurance companies, and the two worst systems in the nation the politicians are at fault. Why, one reason because the of the lobbyists for the insurance companies that keep bad ime’s in the system$$. As for the NYSRS(disability laws) the politicians have yet to do anything about a very broken system, one idea would be LEGISLATION!!!!! But I guess they have yet to figure that out

    http://www.state.ny.us
    Legislative
    New York State Senate
    New York State Assembly
    Last edited by zinger; April 30th, 2009 at 10:46 PM.

  15. #285
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    Kirsten Gillibrand
    New York city office
    780 Third Ave.
    NY, NY
    Fax 212 –688-7444
    Tel 212-688-6262

    Brian Higgins
    Erie County Office
    Larkin at Exchange
    726 Exchange Street
    Suite 601
    Buffalo, NY 14210
    Phone: 716-852-3501





    I listed some address of our area representatives since i-w going through the NYSRS disability system have asked. Both state senators have a labor dept. so you can contact them and complain about this system. Remember these are Federal Senators but they will look into the state affaires. Tell their office you have received SSD and NYSWC for the same injures the state turns their back on. I personally had no luck with Schumer two letters and never received a reply from his office. Clinton’s office when she was senator was a big help and contacted the states comptroller’s office trying to find out some answers. Brian Higgins office is another contact let these people know you are receiving federal money (SSD); all three of these people have contacts in the state system. Also two letters went to Higgins and never a received a reply. But these are politicians “working for the people”. Don’t give up keep on them ask questions and fax instead of snail mail.

    ------------------------------------------------------------------------------------------------------------

    This is the reason legitimate injured workers have to jump through so many hoops.


    New York, NY ---Former Nurse's Aide Charged With Comp Fraud

    - A former nursing home employee from Tioga County has been charged with workers’ compensation fraud for allegedly obtaining $8,858 from the New York State Insurance Fund illegally.

    Susan Thornton, 49, of Spencer, NY, faces felony charges of violating the Workers’ Compensation Law and offering a false instrument for filing following her arrest by the New York State Police and NYS Insurance Frauds Bureau on March 10.

    Investigators from NYSIF’s Division of Confidential Investigations said Ms. Thornton began receiving workers’ compensation benefits for a back injury she reported in 1993 after attempting to lift a patient while she was employed as a nurse’s aide at the Oak Hill Manor Nursing Home in Ithaca, NY, in Tompkins County.

    Investigators said Ms. Thornton returned signed statements to NYSIF indicating she had not returned to any form of work. In an attempt to obtain a lump sum settlement of her claim, Ms. Thornton also stated that she had not performed any work or received compensation from any employment since her injury, investigators said.

    During the investigation, assisted by the Insurance Dept. Frauds Bureau and the Office of the Workers’ Compensation Board Fraud Inspector General, it is alleged that Ms. Thornton was self-employed cleaning houses, while receiving wage replacement benefits to which she was not entitled totaling $8,858.

    As a result of her arrest, NYSIF estimated the potential future savings on Ms. Thornton’s claim to be $40,239.

    Criminal complaints and indictments are accusations only. Defendants are presumed innocent until proven guilty.
    Last edited by zinger; May 5th, 2009 at 10:24 PM.

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