New York State Disability Retirement System

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This was in the news today, it will give you a better idea of who is running in WNY. As for the i-w workers across the state that have contacted me I really don't know to much about other elections. Gov. would not be Cuomo, but it looks that way.


Also County Propossition 1-Referendum on down sizing Would shrink the ECL from 15 to 11.

http://www.buffalonews.com/city/article237223.ece

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With workers comp reforms to get worse in 2011 with insurance companies blame the incumbents for this.
*denotes usless incumbents

I broke this down....... remember to vote on tue.

STATE ASSEMBLY
Member of the State Assembly; District 140

Robin Schimminger, Democratic, Independence, Conservative *
Kevin T. Stocker, Republican
Member of the State Assembly; District 141

Crystal D. Peoples, Democratic, Working Families *
Member of the State Assembly; District 142

Jane L. Corwin, Republican, Independence, Conservative
Member of the State Assembly; District 143

Dennis H. Gabryszak, Democratic, Independence, Conservative, Working* Families
Patrick Mandia, Republican
Member of the State Assembly; District 144

Brian R. Biggie, Republican, Taxpayers
Joseph Golombek, Jr., Conservative
Sam Hoyt, Democratic, Independence, Working Families *
Member of the State Assembly; District 145

Mark J.F. Schroeder, Democratic, Independence, Conservative, Working* Families
Member of the State Assembly; District 146

Daniel M. Kozub, Conservative
Brad M. Rybczynski, Democratic, Working Families
Kevin S. Smardz, Republican, Independence, Taxpayers
Member of the State Assembly; District 148

Gregory M. Vinal, Democratic
James P. Hayes, Republican, Independence, Conservative*

These usless politicians* will not reform the NYSRS disabilities
State Senate
State Senator; District 58
· Timothy M. Kennedy, Democratic, Conservative
· Jack Quinn, Republican, Taxpayers
· William T. Stachowski, Independence, Working Families*
State Senator; District 59
· Patrick M. Gallivan, Republican, Independence, Conservative
· Cynthia M. Appleton, Democratic, Working Families
· David J. DiPietro, Tea
State Senator; District 60
· Mark J. Grisanti, Republican, Conservative
· Antoine M. Thompson, Democratic, Working Families*
State Senator; District 61
· Marc A. Coppola, Democratic
· Michael H. Ranzenhofer, Republican, Independence, Conservative

United States Representative; District 26

These three have done nothing about WNY as being last in the country in SSD
claims review.
Philip A. Fedele, Democratic
Christopher J. Lee, Republican, Independence, Conservative*
United States Representative; District 27

Leonard A. Roberto, Republican, Conservative, Taxpayers
Brian Higgins, Democratic, Working Families *
United States Representative; District 28

Louise M. Slaughter, Democratic, Independence, Working Families*
Jill A. Rowland, Republican, Conservative

http://www.socialsecurity.gov/disability/step4and5.htm

http://www.ssa.gov/

http://www.dol.gov/whd/fmla/index.htm

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County Propossition 1-Referendum on down sizing would SHRINK the ECL from 15 to 11 members


VERY Important Prop 1..... will be on the BACK OF YOUR BALLOT when you go to vote. Turn it over and vote YES or No.

__________________________________________________ _______________

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The following LINKS are SUPERB, and EXPLAIN HOW SSDI works, HOW to fill out the SSDI APPLICATIONS, and HOW and WHO can HELP you fill out the SSDI application and answer the NUMEROUS questions regarding your disability
www.disabilitysecrets.com
http://www.ultimatedisabilityguide.com/index.html
http://www.ultimatedisabilityguide.com/rfc_forms.html

ALSO, there are EXCELLENT BOOKS by Christopher Ball on WC/ and the ENTIRE SSDI PROCESS! It is written in VERY easy to understand terms, http://www.nolo.com/

Involvement in your work injury is not relative to your SSA application. And your work injury is not the only health issue SSA's uses to determine IF you are 100% ''disabled'' under their rules


From and I-W:
"I was 46 when I applied for SSDI. After filling out all the necessary papers myself online I was called to come to the SSA Office. This took approx. 1 month.
When my number was called at the SSA office, The lady pulled my application and we went over it. She told me it looks like you have a good case EXCEPT YOU ARE ONLY 46.
Approx. 2 months later, I got a call from a man from the SSA and he told me my application was being looked at. He also made a point to tell me "YOU HAVE A GOOD CASE. I WILL TELL YOU MR. _______ THE MAGICAL AGE IS 50.
Approx. 3 months later I was required to see a SS approved Physician.
Approx.1 month later I received the dreaded letter DENIED!
I secured a Attorney and appealed. 6 months later I received a court date.
I go to the "place" where I am to see this Judge.
30 minutes into waiting, A lady came in and ask my Attorney to come with her. She said the Judge wanted to see my Attorney only. My wife and I did not know what to think or expect.
10 minutes later, My Attorney came back into the room and said "Well its over. The Judge said to expect his Verdict in approk 4-6 weeks and it would be A favorable decision. I received that letter 4 weeks later.
Approx. 2 months later I received my Back Payment check. 1 week later I received my Rewards letter as SSA calls it. Yeah I got my back pay before the rewards letter.
From the time I applied until I received my Back pay was approx 15 months.
I was approved at 48 years old.
If you are disabled,FIGHT, FIGHT, FIGHT! I got knocked down 1 time but not knocked out. I finally won by Knockout"

Like I always said you Fight and never give up! That is exactly what the i-c, your employer want you to do, then they win and you lose....

http://www.ssa.gov/

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I receive a lot of mail about IME and going to the exam and what to expect if it’s your first exam. Like I always said the ime is not your friend so do not give any more information than what is asked. IME’s work for the ic and the ic works for your employer.

- Should I record the exam? And do I make the doctor aware of it?
- What type of person would be best to bring with me to my exam?
- Do I need to bring any of my records with me?
- What are some of the things that IME doctors are allowed/not allowed to ask?
- Can I stop the exam at any time?
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- WC is not a democratic process... just because you have more favorable Dr's opinions doesn't mean the carrier won't use their Dr IME to change or stop your benefits.
- Be sure the Dr IME has agreed before you video or tape anything.
Your friend is not a party to this claim, as such has NO right to input anything a Dr may request from an IW. The IME could stop the evaluation and issue a report based on what actually was presented. Not favorable to you at all. If that were to be the case... the carrier could stop all benefits until a fully cooperative evaluation and report is accomplished.
-
- IME can ask anything necessary to form an opinion on your condition. Most of the opinion is based on your medical records. Any physical evaluation could only be based on your presentation that day.
No you can't stop the evaluation. Doing so could be cause to see your benefits affected.

That is exactly what an IME evaluation is. An evaluation on your condition THAT DAY. The Dr can't predict going forward, nor tell anything about you or your condition or injury except by the medical records submitted and reviewed.
The bulk of the opinion will be made by record review. Not the face/face exam.
IME is an opinion, even if it's a biased one, you have no patient/doctor relationship with this person.
A good WC law judge will take fact into account and hear both sides & will usually develop their own opinion., just be honest during the exam. I have seen many ime’s and have gone to lots of exams and I was always honest with my answers.

I talk about SSD on my last post and would like to clear a few things up about WC and SSD. I don’t want to confuse anyone.
SSA does NOT care about your WC benefits... the two systems are not related...one benefit is not dependant upon the other.

SSDI/SSI and WC are viewed as "public social'' disability benefits... the only difference is who pays the premiums or benefits.

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Yes workers comp (NYS) has made some drastic changes as of Dec.1, 2010. Doctors have been telling me this was on the way, and again the insurance companies win.
What’s happing? Now if you get hurt on the job your treatment visits will be limited.
Lets say you are seeing your doctor for treatment for a injury, after two months the I-c can stop paying for the visits if they feel the treatments are not helping. They can send you for more treatment to another doctor or PT or a pain management doctor what ever they feel like doing. What the i-c is stopping are the long treatment visits to your doctor.

There will be a free open forum on these new changes.
A worker’s Compensation question an answer session with a
Doctor and a lawyer.
You can call for a reservation and information @716-677– 2969

I would encourage any i-w to attend.

Call your local representatives and complain about the changes. Again NYSWC system takes another step backwards when it comes to the i-w.

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Going to post some more information to the news laws on WCS. A thanks too a friend with the help on the new laws and her opinion on them.

Your er (employer) and the ic (insurance company) dislike paying for palliative treatment, for the iw (injured worker) physical therapy for ''aches and pains" where maybe an aspirin would do.
The reason the ER/IC's fight so hard to get the laws written more to their favor is due mostly to the medical costs, Dr's who write the Rx for PT weeks on end. Pain meds where not so many are necessary. Patients who demand MRI because that's the only diagnostic they know. As the population ages, "X-ray" fades out of the terminology and CT scan/MRI takes the place. So does the dollar $.

Looks like NY has taken the same route to control medical costs in a WC claim as what Calif did with SB899 in April 2004, they have adopted MTUS/Medical Treatment Utilization Schedules.
OR, treatment guidelines. Your treating physician must provide a stated goal of functional restoration, and return to gainful employment, when recommending a treatment plan intended to "cure or relieve from the effects of your injury or illness".

In the past, Dr has been writing Rx for PT going on and on and on, over treating IW's with PT, and prolonging the RTW/Return To Work. At some point we reach a 'stable' condition or MMI and become "you is what you is" status.
The goal in WC is treat the injury to stability, and RTW.


Bottom line in these changes is taking away the presumption of the treating physician, and giving the ER/IC's the ability to have a Dr of their choice (a UR/Utilization Review process) "treat" you along with your Dr. When the two disagree on the treatment plan.... you go to IME or WC court.

We NEED to change the system back toward the center of things. Post election is a good time for these discussions as the legislatures will begin addressing WC soon... we hope.

http://www.wcb.state.ny.us/content/m.../sn046_456.jsp

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The NYSDR System is one of the most corrupt, and bureaucracy filled system in the state and it continues on that path. The retirement’s disability system is run by the state Comptroller DiNapolli who was just won election this past November. DiNapoli won after being appointed by the legislature to replace the disgraced Alan Hevesi, another crook.
How many first responders (NYPD, NYFD, NYPA, NYTAPD) during the 9/11 attacks has the NYS Comptrollers screwed out of disability pension rights and led these people on for years! Now the federal government had to step in to offer these people some help.

THE BUREAUCRACY:

AP news Dec. 31 2010
Now Dinapolli hires this guy The former head of New York's Department of Environmental Conservation has landed a new state government job, with the help of a longtime colleague.

Former Democratic Assemblyman Pete Grannis, who was fired from Gov. David Paterson's administration in October, has been named first deputy comptroller in the office of Comptroller Thomas DiNapoli, another ex-Assemblyman and fellow Democrat.

Grannis was ousted from the DEC, He'll make $165,000 a year in his new post.

To open up the spot, current first deputy comptroller Mary Louise Mallick will move to a $162,000 per year job as senior policy advisor.

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More on the changes to the states wcs and why the changes. continuing from #412

WC is all about liability. Yours, the employer (ER)/IC's... who ever is in line to pay the bills.
We are going to see more and more demands by IC's in general health coverage for Dr/providers to explain why a requested diagnostic or treatment is recommended. IE. an MRI when a simple X-ray will do. Why is MRI after MRI after MRI necessary when we see a second or third Dr for "opinion". ?

People see or hear the word "insurance" included in a conversation and think "oh well, they'll pay"... if you had a high deductible like we choose to lower the premiums on auto/homeowner/renter liability coverage, we'd think twice before opting for that $1800 MRI when the $40 X ray would tell the same story.

The reason the ER/IC's fight so hard to get the laws written more to their favor is due mostly to the medical costs, Dr's who write the Rx for PT weeks on end. Pain meds where not so many are necessary. Patients who demand MRI because that's the only diagnostic they know. As the population ages, "X-ray" fades out of the terminology and CT scan/MRI takes the place. So does the dollar $.

when it comes to ime's the ic now rules for us people.
The terminology differs by state, IME, AME, PQME etc, and how IME's are provided. Some allow for the ER/IC to simply choose a Dr for evaluation, one who has not previously had involvement with the treatment plan of the IW. Some have panels where the WC medical units assign a IME. IME/QME's are contracted by the state, and paid by the state through assements on the parties. Self insured ER's and IC's who pay the benefits in WC claims. IMHO... the state assigned IME's are a more equitable process. That said though, you will always have a Dr performing medical evaluations that carry a bias heavier toward one side vs the other.

Even in a state such as Calif, there the medical/legal evaluation system is controlled by law, there are provisions for the IW to select the specialty and name/Dr who will perform the evaluation to resolve a disputed medical issue. That doesn't guarantee the Dr will be "IW friendly".

There is no perfect system in any state today. But when the question is posed "What would you suggest ?"... specifically, no one yet has stepped forward with anything approaching equity to both sides.

I think we need a thread to discuss those suggestions IW"s think would be in the best interests of the IW, and the ER/IC's to change the sytem back toward the center of things. Post election is a good time for these discussions as the legislatures will begin addressing WC soon... we hope.

"So why are some doctors performing costly and risky fusion surgeries which often do nothing to relieve the patient's (iw) back pain and may leave him or her worse off than before the surgery? Money! They can't make millions in royalties by ordering conservative treatments like physical therapy.


http://richmond.injuryboard.com/medi...oogleid=287156

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Sorry about the double post. and mix up.

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email I recieved the other day.

I went to my DC today and he is pulling his hair out of his head with all the paper work now. f going to the my DC I will have a re- Are they also trying
to weed out fraud with this system too?


YES, there is an over abundance of provider fraud. PT, Chiro that bill for visits that are not there, Dr who over Rx for PT/Chiro... PT/Chiro that have treating physician financial interests...all lead to WC fraud. Most of the time IW's are not aware of the overtreatment, "their Dr" says it's needed. Who is an IW to question their Dr. If you/we were paying the bill... you'd have to imagine you would question "why..?" are so many visits necessary. "What is wrong with me?"



Chiropractic is one of the worst offenders in WC medical care... right up there with PT.
Chiro's treat, treat, treat some more... then treat treat and treat again. Chiro's will continue to treat until a patient just gives up and goes to a "doctor". I'm not saying there isn't a place for Chiropratice manipulation. But not all industrial injuries require simiple "manipulation"... if after a few weeks of Chiro visits there isn't measurable improvement... a "Doctor" of Ortho/Neuro should be referred, if not sooner.

Calif has capped PT/OT/Chiro at 24 visists for the life of the claim, but for special visits post op.
Not saying this is the best approach, particularly as there is no appeal process for PT/OT/Chiro... but it's a start, and IMHO, in the best interest of the IW as well as ER/IC.

interesting article. "So why are some doctors performing costly and risky fusion surgeries which often do nothing to relieve the patient's (iw) back pain and may leave him or her worse off than before the surgery? Money! They can't make millions in royalties by ordering conservative treatments like physical therapy.

http://richmond.injuryboard.com/medi...oogleid=287156

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Permanent Disability: Some really good information on what is a PPD.

Under New York State Workers’ Compensation Law, when a worker suffers a permanent disability, more must be known. This is because there are different types of permanent disability recognized under New York law.

Some permanent disabilities are Partial. This means that the worker is still expected to look for work. Indeed, if the worker with a Permanent Partial Disability (otherwise known as a "PPD") does not perform a “good faith, diligent” search for work, or obtain work even if this means accepting a lower-paying job, the worker may no longer be entitled to draw weekly Workers’ Compensation benefit checks under New York law. Medical benefits will still be available if the Permanently Partially Disabled worker fails to look for work, but wage replacement benefits may not be available if the insurance carrier raises issues, such as attachment to the labor market or "voluntary removal" from the labor market. For more on this difficult subject, please see our Work-Search page.

Some Permanent Disabilities are Total. This means the worker retains absolutely no capacity to continue working (not even on a part-time or “limited duty” basis). Because the worker with a Permanent Total Disability arising solely as a result of a work-related injury or occupational disease retains no physical capacity to perform useful work, such a Totally Disabled individual is relieved of his/her legal duty to perform the otherwise mandatory Work-Search. Thus, both medical benefits and wage replacement benefits will continue for life for the Permanently Totally Disabled worker, and any Totally Disabled worker need not look for work in order to continue drawing all benefits to which he/she has been previously found entitled.

So, the question arises, what happens if the injured worker suffers only a Partial Disability related to the worker’s previous job, but is nonetheless Totally Disabled because that worker no longer retains any capacity for work due to other, compounding factors or reasons? In such situations, the worker may still be eligible for a finding of “Total Industrial Disability,” which will then relieve the injured worker from having to perform the Work-Search, while at the same time the worker will still be entitled to draw both medical and wage replacement benefits. However, it is critical for those who read this page to understand that the Work-Search requirement will not be relieved until after a Judge (not the claimant’s doctor) has determined that the disabled worker no longer needs to look for work and all appeal rights have been exhausted.

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CONT. FROM LAST POST.
Of course, in order to obtain a finding of “Total Industrial Disability,” the injured worker will generally need the supporting opinions of experts such as doctors or vocational specialists. For instance, a disabled worker may be found “Totally Industrially Disabled” if that worker’s doctor writes a narrative report stating that the doctor has considered the claimant’s age, educational background, functional vocational skills remaining after the work-related disability is considered, together with all additional medical impairments suffered by the claimant (the physical and mental impairments not related to the claimant’s past work), and considering all these factors, and any others which may be relevant to the doctor’s conclusion, the doctor believes the worker should be considered “Totally Industrially Disabled.”

Unfortunately, many unrepresented claimants DO NOT GET GOOD legal advice, and as a result, DO NOT sufficiently understand the legal standards pertaining to Permanent Disability status. Very often a worker may suffer a severe disability related primarily to pain, and often that pain strikes whenever the injured person attempts to do anything significant or perform any more-than-minimal exertion. Often, such terribly-disabled workers cannot conceive of working while under this condition, and yet the law may only find a Permanent Partial Disability in that worker’s claim. At once the worker is legally required to look for work (or potentially suffer the loss of benefits), and yet the worker cannot possibly conceive of performing in the competitive labor marketplace.

below are the legal criteria which doctors and judges must consider when the degree of a particular worker’s disability is adjudicated within back injury claims. Note that there are specific criteria for “Mild” disability, as well as for “Moderate,” “Marked,” and “Total” disabilities. Anything less than a “Total” disability will be considered a Partial Disability and the Work-Search requirement then applies.

CRITERIA THAT MAY BE
USED FOR EVALUATION OF
DEGREE OF PARTIAL
DISABILITY
The following criteria of degree of impairment
should be reflected in every medical report and
should assist the Law Judge in his/her final
decision on the degree of disability.

http://criscuololaw.com/pdf/Back%20C...20Moderate.pdf

http://criscuololaw.com/pdf/Back%20C...nd%20Total.pdf

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Question that I have been asked by i-w applying for SSD, not sure if New York skips reconsideration level.
In NYS,if the initial disability application is denied, next step will be and appeal hearing.
If you live in Alabama, Alaska, California (northern and western Los Angeles), Colorado, Louisiana, Michigan, Missouri, New Hampshire, New York (Albany and Brooklyn), or Pennsylvania, you are located in a “prototype” state. This means that your claim will skip the Reconsideration step and your appeal proceeds directly to a hearing with an administrative law judge.
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For the i-w living outside of this area you have a reconsideration level.
Level Two – Reconsideration. If the initial disability application is denied, you have 60 days to ask for a reconsideration or first appeal. Your medical and vocational information will need to be reviewed and updated. At this level, a different individual within the Social Security Administration reviews the application. The SSA will send you a letter explaining how it made its decision. The average wait period at level Two is three to five months. Approximately 87 percent of first appeals are denied. If there is denial at the Reconsideration level, then a hearing would be scheduled with a SSA ALJ.

Approximately 62 percent of second appeals are awarded to the applicant. The SSA estimates the average time spent at this level was 426 days in 2010. If a disability hearing ends in another denial, the decision can be appealed again.

Again there is no reconsideration level in New York State.

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What is happening with injured workers in NYS under the new comp laws.

Injured worker: With the new law in place,my doctor filed a MG-2 variance to continue my care with the ic.
"in conjunction with the adjuster from the ic on my workers comp file."
treatment is authorized as follows.
care 2 times a month for three months, then 1 time a month for 3 months to end in 6 months or by the end of July 2011.
The ic Cc's this to my attorney, and NYS workers comp board.
so after 6 months what happens???
__________________________________

Your Dr evaluates, reviews the PT notes and if necessary submits another request for treatment.
The adoption of the new treatment guides is an attempt to control the escalating costs of medical care in a claim.
There is info on the NY medical treatment guides in a new thread I started here in the NY board that will help identify the 20 most often claimed/diagnosed injuries, and the associated treatment guidelines.
When treating to the new guides, just because you complete your next 6 months of approved treatment, or the guides only go to that extent doesn't mean treatment stops, or no more would be authorized.
Just like a Rx your Dr gives you, there are limits to the number of refills provided. While when using your own health care ins, or paying out of pocket you wouldn't be subject to prior approval for refills, in WC, the ER/IC wants to know what/why/how much/ and when it is expected to end.

With the Obamacare changes in the health care provided in the U.S., and attempt to control the costs we and the IC's are faced with, Dr are going to have to do with same in explaining why/how much treatment is being Rx'd, in your non industrial medical care.
We all should be questioning our Dr's why a MRI is being ordered when a X ray may do the job.