New York State Disability Retirement System

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Low back pain ranks second only to upper respiratory infections as a cause of lost work productivity. It accounts for approximately 175.8 million days of restricted activity annually in the US.

The new laws in NYS medical guidelines. From what I am hearing from Dr. and iw this is what the treatmeant guidelines look like. Again the insurance companies are setting up their own rules in this game with the iw.

FREQUENCY OF REHABILITATION VISITS
Lower Back Pain

Nonsurgical


Specialist
Physical Therapist Up to 12 visits within 6 weeks

Physical Therapist Daily up to 6 weeks ‡

Occupational Therapist Daily up to 6 weeks ‡

Chiropractor Up to 3 visits within first week of onset

Clinical Psychologist Up to 2 visits within 6 weeks of onset

Clinical Psychologist Up to 12 visits within 6 weeks ‡

Ergonomist Up to 2 visits within 8 weeks

Vocational Counselor Up to 3 visits within 6 weeks ‡

you can now follow me on twitter @ zinger 455
I will post mostly web sites and links for the injured workers.

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Affidavit for continuing eligibility for comp benefits:

If you are collecting workers comp benefits from the NYS insurance fund (special funds) remember they do have the right to check up on you. Once a year by law they will come to your house and ask a few questions they call this annual file update. Very simple question like address, phone#, SS, doctors name and if you are working.
If you are not home the person will leave information to be filled out a questionnaire. It is very important that you take care of this ASAP and fax it over to the agency. If you are not sure always call your comp attorney’s office for advice.

What special funds does they hire private investigators to check up on you.
This agency works with SF all across this state.
The name of the company is the Bellerdine Investigative Agency


http://www.bellerdine.com/

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The IME is a big, big subject with the inured worker. I am posting a link that lists all ime's in this area and in different parts of the NYS. Do not be surprised if your doctor also double dips as a ime. I have had many iw that have dumped their doctors because of this.
In New York, the IME system is corrupt and chaotic. IMEs are routinely performed by retired doctors who have little or no interest in fair outcomes. It appears that many IME doctors slant their results toward the insurer, under the dubious notion that "he who pays gets his way."
Under the circumstances, IMEs should be dubbed "insurer medical exams" or perhaps just "Incoherent Mediocre Estimates."
Here's a list of all IMEs in NYS.
http://www.wcb.state.ny.us/content/m...tofAuthIME.jsp

Here's an interesting article... I posted this awhile back but with so many iw now reading this site i'll put it up again.
http://www.workerscompinsider.com/archives/001029.html

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Good and interesting article on relationship between stress and pain.

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Good and interesting article on relationship between stress and pain.

http://online.wsj.com/article/SB1237...s_us_nonsub_pj

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In the Buffalo News on Sunday was a article on the top pain doctor in this area.
Dr.Gosy has been my pain management doctor for the last ten years. A pain management doctor job is to manage pain. Better than half of the iw in this area see Dr. Gosy, and the ones I have talk too say without the doctor they would be suffering more than they already are. Injections for Back Pain Relief I have had about four injections over the last three years and Dr. Gosy is the best there is in giving them I never had a problem and his staff is
tops. The problems I did have was with the IC waiting for the approval for the injections! I just talked to a iw that has been waiting for his approval for an injection. Long story short the ic said they lost the paper work that is BS.


Pain management (also called pain medicine; algiatry) is a branch of medicine employing an interdisciplinary approach for easing the suffering and improving
the quality of life of those living with pain.[1] The typical pain management team includes medical practitioners, clinical psychologists, physiotherapists, occupational therapists, and nurse practitioners.[2] Pain sometimes resolves promptly once the underlying trauma or pathology has healed, and is treated by one practitioner, with drugs such as analgesics and (occasionally) anxiolytics. Effective management of long term pain, however, frequently requires the coordinated efforts of the management team.[3]

This is a good article about Injections for Back Pain Relie
http://www.spine-health.com/treatmen...ck-pain-relief

This is the article on Dr. Gosy.
http://www.buffalonews.com/incoming/article359323.ece

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http://www.chron.com/disp/story.mpl/...n/7493492.html

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Workers' compensation is a complicated area of law. Not only are there all sorts of legal tests and requirements you have to meet to get benefits for a work-related injury, the process is full of acronyms describing the types on injuries, benefits, and the legal process of applying for benefits. Here's a list of some of the acronyms you may come across. If you go to your first comp hearing or two or three many of these acronyms will be said in court. You can mark some down so you have an idea what is going on. I will list some of the more important ones on the next reply.

ADL: activities of daily living - your everyday activities

ALJ: Administrative Law Judge - judicial officer who decides workers' comp cases

AOE/COE: Arising out of employment and occurring in the course of employment - injury must be work-related to be covered

AWL: actual wage loss - the precise amount of wages you didn't earn because of an injury

AWW: average weekly wages - the average amount of wages you earned in the 52 weeks (one year) before your injury

CFS: chronic fatigue syndrome - severe feeling of tiredness that's not improved by sleep or bed rest

COLA: Cost of living adjustment - change in the amount of workers' comp benefits to adjust for changes in the cost of living

CRPS: complex regional pain syndrome - chronic or on-going sever pain, usually in an arm, hand, leg, or foot

CTS: carpal tunnel syndrome - injury to a nerve in the wrist

DoA: date of accident

DOI: date of injury

DVT: deep vein thrombosis - blood clots in deep veins, typically in the legs

DWC: division of workers' compensation

E/C: employer/carrier - "carrier" is the insurance company providing workers' comp insurance to the employer

FEC: future earning capacity - wages you'll likely be able to earn after you return to work with or without effects of the injury

FL: functional limitation - a medical or health condition that hampers your ability to perform certain tasks

HCO: health care organization

IME: independent medical examination - examination conducted on you by a doctor chosen by your employer or the employer's insurance carrier

LDP: last day paid

LDW: last day worked

LEC: loss of earning capacity - how much wages you can no longer earn as a result of your injury

LT: lost time - how much work time you missed because of your injury

NCCI: National Council on Compensation Insurance - database of workers' compensation insurance information

ND: nonwork disability - injury or condition that's not caused by or related to your work but hampers your ability to work

NEL: noneconomic loss - damages other than money or wages, such as "pain and suffering"

OCC: occupation - your job

OD: occupational disease - illness or disease caused by work-related conditions

ODNCR: occupational disease, notice, and causal relationship - what you need to show to make a workers' compensation claim for an occupational disease (as opposed to a claim based on an injury)

PCR: prevention, compensation, and rehabilitation - the three goals of workers' compensation laws

PD: permanent disability - disability or impairment that remains forever and impacts your ability to work

PPD: permanent partial disability - lifelong disability that prevents you from working at full capacity

P&S: permanent and stationary - the point where your medical condition has leveled out at the point where you'll likely get no better or worse

PTD: permanent total disability - a lifelong disability that prevents you from working completely

RFC: residual functional capacity - what your able to do after an injury and after you've reached permanent and stationary status

RTW: return to work - usually a medical determination that you're physically able to go back to work

SOL: statute of limitations - the time limit you have to file a legal claim or lawsuit, including a claim for workers' comp benefits

SSDI: Social Security Disability Insurance - federally-provided benefits for certain disabled workers and their families

TD: temporary disability - disability or injury that won't prevent you from returning to work forever

TPD: temporary partial disability - a disability or injury that doesn't completely prevent you from working while recovering

TTD: temporary total disability - disability or injury that completely prevents you from working while recovering from a work-related injury

UI: unemployment insurance - temporary payments made to unemployed workers while they look for a new job

VR: program to help disabled or injured workers find a new job

WC: workers' compensation

WD: work disability - injury or medical condition that's caused by or related to your job and hampers your ability to work

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cont. from post 428

Very important acronym's. You might want to write them down on a 3x5 index card and take them to court so you know what is going on.

PCR: prevention, compensation, and rehabilitation - the three goals of workers' compensation laws

What is temporary total disability (TTD)?

TTD is your disability, under medical authorization, which leaves you unable to work. Benefits are paid for TTD after your accident to replace lost wages while you're recovering from your injury, and it's expected you'll return to work. Benefits may be paid every week or two, and the amount is a percentage of your average weekly pay.

How long do total temporary disability (TDD) payments last?

TTD benefits are paid while you have medical authorization to be off work, or your employer doesn't have any work for you to do that falls within your work restrictions.

what is permanent partial disability (PPD)?

· PPD is your lasting disability, resulting from your injury at work. For example, a complete or partial loss of use of a limb due to your accident.

PTD: permanent total disability - a lifelong disability that prevents you from working completely .

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My First Hearing
Some of the most asked questions from injured workers, going to my first hearing along with ime’s. The following is a question from an i-w about going to a comp hearing. I left a lot out because of the injures etc. Basically the point is the hellish system and what to do about following up with a hearing.

IW…. I had spinal surgery 4 months ago. And was in PT for 8 weeks. Dr.'s ordered more PT because I’m not better yet. (6-8 weeks long gone). IC said no. Because ime put conflicting info on record and verbally said something else. So with the new laws I have to go to court. What will happen? There's a lot more to the story. This whole thing has me stressed out. And I'm told I need more surgery to fix first. Just want off this ride and back to normal.


First thing is talk to a Lawyer. It costs nothing off the bat. In WC you don’t pay a typical retainer fee like you would in other circumstances. At this point you really need a Lawyer. Its nice to think you don’t need one or cant affords one. But with all the rules of WC and the basic fact that the Insurance Co. doesn’t really want to pay you unless they have to. You need one. Any money you would eventually pay the Lawyer will be well worth it both financially and for piece of mind. And don’t be afraid to talk to a few lawyers find the one you are comfortable with.

You will be much better off going into any sort of hearing when you are represented.
Retaining a specialized workers compensation attorney and the fact that there are no up fees, ESPECIALLY WITH A SPINAL INJURY!

From the NYSWC handbook. This may be is occurring to you:

Insurers will often accept a claim and promptly begin paying benefits. However, an insurer can
dispute a claim, for various reasons. It may not agree you were injured, it may not believe the injury
occurred while it provided insurance, or any number of other situations. Board claims examiners
and conciliators first attempt to resolve issues. If they can’t, the Board will hold hearings in front of a
workers’ compensation law judge. The judge takes testimony, reviews your medical records and
wages. Then, the judge decides the issue, and sets the amount of any award.
Either side may appeal that decision. This must be done in writing within 30 days of the decision.
Three Board commissioners review appealed cases. They may agree, change part of a decision, or
reject it. They may also return the case for more hearings. Insurers don’t have to pay lost wage benefits
while the three commissioners are reviewing the case. An insurer can accept part of a
case and appeal another. In that instance, it must pay the accepted part of the award while the case is
reviewed. The insurer must pay your wages and medical bills if your award is upheld by those
commissioners, even if it appeals further.
Either side may appeal that decision, to the full Board of workers’ compensation commissioners. If
the full Board takes the case, it will agree, change or overturn the decision.
Appeals from Board decisions may be taken within 30 days to the Appellate Division, Third Department,
and Supreme Court of the State of New York. That decision may be appealed in the Court of Appeals.
Disability Benefits During a Dispute
If you aren’t receiving benefits because your claim was disputed, you may get disability benefits in
the meantime. You can file a DB-450 form, available from www.wcb.state.ny.us/content/main/forms/
db450.pdf or by calling 1-800-353-3092. You pay back any disability payments from your lost wage
benefits.
Resolving Disputed Claims
you always have the right to an attorney or
licensed representative. That person may not ask
for or take a fee from you. The Board determines
the fee for legal services.
That fee is deducted from the lost wages award.

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In receiving a lot of emails from out of state iw this is the basic claims process in most states.


Understanding the Claims Process

Immediately
The worker obtains the necessary medical treatment and notifies his/her supervisor about the accident and how it occurred.
The employee notifies the employer of the accident in writing, as soon as possible, but within 30 days.
The employee files a claim with the Board on Form Employee Claim (C-3) by mailing the form to the appropriate Board District Office. This must be done within two years of the accident, or within two years after the employee knew or should have known, that the injury was related to employment.
Within 48 hours of the accident
The doctor completes a preliminary medical report on Form Doctor's Initial Report (C-4) and mails it to the appropriate District Office. Copies must also be sent to the employer or its insurance carrier, the injured worker, and his/her representative, if any.
Within 10 days of notification of the accident
The employer reports the injury to the Board and the insurance company on Form Employer's Report of Work-Related Injury/Illness (C-2).
Within 14 days of receipt of Form Employer's Report of Work-Related Injury/Illness (C-2)
The insurer provides the injured worker with a written statement of his/her rights under the law. This must be done within 14 days after receipt of the Employer's Report of Work-Related Injury/Illness (C-2) from the employer or with the first check, whichever is earlier. In addition, if the insurer requires claimants to use a network it has contracted with to obtain diagnostic tests, it must notify the claimant of the name and contact information for the network at the same time it sends the written statement of his/her rights or immediately if that time has passed.
Within 18 days of recepit of Form Employer's Report of Work-Related Injury/Illness (C-2)
The insurer begins the payment of benefits if lost time exceeds seven days. If the claim is being disputed, the insurer must inform the Workers' Compensation Board (and the claimant and his/her representative, if any). If payment is not being made for specific reasons stated on the notice (e.g. that there is no lost time or that the duration of the disability is less than the 7-day waiting period), the insurer must also notify all the parties.
The insurer files Form Notice to Chair of Carrier's Action on Claim for Benefits (C-669) or Notice That Right to Compensation is Controverted (C-7) with the Board indicating either that payment has begun or the reasons why payments are not being made. If the employee does not notify the employer timely, this notice may be filed within 10 days of learning of the accident.
Every 2 weeks
The insurer continues to make payments of benefits to the injured employee (if the case is not being disputed). The carrier must notify the Board on Form Notice That Payment of Compensation Has Been Stopped or Modified (C-8.6) when compensation is stopped or modified.
Every 45 days
The doctor submits progress reports on Form Doctor's Progress Report (C-4.2) to the Board.
After 12 weeks
The insurer considers the necessity of rehabilitation treatment for the injured employee.
Failure to file a claim or give the employer notice may result in the loss of rights to compensation.

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Social Security Medical Exam: Is different than the WC ime exam some i-w are getting mixed up on this. YES, the same IME can do both a SSD, and a WC exam but for two different agencies. It's a good possibility that you might see the same "quack" as you are going through the systems at different levels. It has happened to myself about three years ago. Also it you live in NYS and have filed for a disability retirement with the NYSRS again at some time down the road you could see the same ime.

***SSA is a separate program... has nothing to do with your comp claim or your NYSR disability clam.

Some good information on a SSD exam.

You don't get copies of the SSA medical evaluation.
There is no need for examination beyond what the Dr feels when you are seen. This is not to determine a treatment plan like you might see a IME for. Nor is this to approve/deny your SSD application. This Dr. makes no decisions in your application, only your physical/mental condition. If the Dr. said you should see a surgeon...that is entirely up to you, has nothing to do with your SSA application, or WC claim/injury. It doesn't matter what the DA requests from SSA... they won't provide the medical records...and the DA/ER/IC is not entitled to that info...one, they didn't pay for the evaluation, and two, has nothing to do with your work injury or condition.



**Typically, when an ssd or ssi disablity claimant is sent to a social security medical exam (known as a CE, or consultative examination), it is for the purpose of gathering recent medical evidence. This is because the social security administration, in its processing of disability claims, is required to determine whether or not a disability claimant is currently disabled.

In cases where a claimant has not been seen by their own doctor for longer than a six to eight weeks, certainly, it will be difficult to make such a determination without current evidence. For this reason, consultative exams are routinely scheduled by disability examiners. (See also Role of Medical Experts in SSD Appeal Hearings).



Regardless, though, of the reasons why exams are scheduled, disability claimants should keep this in mind: going to a social security medical exam (or to psychological testing, or to have an x ray done) can never hurt their claim. In fact, the only detrimental aspect regarding a consultative exam is not going to one that is scheduled. Claimants who do not show up for scheduled testing or examinations can have their claims summarily denied for "failure to cooperate".

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Sorry about the numbers not lining up the last numbers are the years.

Permanent Partial Disability Benefits are Generally Limited to a Certain Number of Weeks Based Upon the Degree of Disability as that is Determined by the Board (not the treating physician):

Degree of Disability: Weeks of Benefits Available: Years:

> 95% 525 10.1

> 90% to 95% 500 9.62

> 85% to 90% 475 9.13

> 80% to 85% 450 8.65

> 75% to 80% 425 8.17

> 70% to 75% 400 7.69

> 60% to 70% 375 7.21

> 50% to 60% 350 6.73

> 40% to 50% 300 5.77

> 30% to 40% 275 5.29

> 15% to 30% 250 4.81

15% or less 225 4.33



The Death Benefit Will Be Computed Based Upon a Maximum Weekly Wage of:

$750 for Deaths After July 1, 2007

$800 for Deaths After July 1, 2008

$900 for Deaths After July 1, 2009

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Do not do it alone!

Finding And Choosing An Attorney

Although there is no law which says you need to hire a lawyer, in practical terms and regardless of how you feel about attorneys, it is difficult to handle a workers' compensation case on your own. With trained adjustors working for the insurance companies who have lawyers at their everyday disposal, hiring a qualified attorney is essential. Unless your case is extremely simple, a good lawyer is important to protect your rights. Trying to handle your own case may save you a penny but cost you a pound in the long run. Hiring a lawyer is critical in any of the following situations: · The employer denies you were injured on the job · The carrier has denied benefits · You cannot get medical treatment · You are not getting paid · The adjuster promises benefits or care which never arrives · An attorney for the employer or insurance company contacts you and wants to take a deposition · You want to sue a third person- You begin to represent yourself and you encounter someone on the other side who is particularly difficult and is trying to take advantage of your lack of legal expertise These are but a few of the situations which arise and should make you consider hiring an attorney. Remember, the more problems you encounter, the more you probably need representation. To find a qualified attorney, go to your city and search and review the attorneys listed. Many have links to their firms where you can peruse the information or you can call or write to the attorneys and request they provide you with written or oral information about their credentials. Call or write and make an appointment. We only list attorneys who practice in the area of workers' compensation and who have experience in this field. Remember, the hiring of a lawyer is an important decision that should not be based solely upon advertisements. Before you decide, ask the lawyer to send you free written information or view their Website about their qualifications and experience. Choosing a lawyer is a personal matter. A lawyer generally has 19 years of formal education and must have passed a difficult exam to be able to practice law. This training combined with his legal experience constitutes his education. His education and experience are primary considerations along with the proven ability in the field of workers' compensation. Board certification shows that the practitioner has a high degree of experience and ability. Because there is a continuing relationship between the lawyer and the injured worker as a client, the personal nature of the relationship must also be considered. Most workers' compensation attorneys work on a contingency basis. That is, if they do not get you money, they do not charge you. In addition, in many situations, the employer/carrier may have to pay any fee or costs.

Back Injuries:
Even if a back injury is not initially severe, torn discs or injured vertebrae can result in medical complications that make it difficult to work or engage in normal physical activity.

Realizing insurance companies will try and downplay a back injury or argue complications are due to a pre-existing condition, Using medical records and expert medical opinion, your attorney will address self-serving claims by insurance doctors that attempt to justify a reduced or denied claim regarding our client's back injury.


* Herniated disc
* Crushed vertebrae
* Lower back injury
* Torn ligaments
* Fractured spine

Back Injuries - Complications and Quality of Life Issues

Back injuries typically involve either injury to the muscle and tendons or injury to the spinal column. Complications can arise when an injury fails to heal properly or when damage involves the permanent loss of mobility. In both cases, qualify of life is impacted as injury victims may be unable to do the things they normally do or work.

.

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How close does NYSWC work SSD? How close does NYSRS disability work with SSD? I asked a friend of mine on another site about this.

"I was told the NYS disability retirement system could careless if you were awarded SSD due to a work related injuries. The state retirement system has their own set SS laws when it comes to a awarding a disability retirement and makes it very hard on the iw.
WC and SSD how close do they work together on award?"


nothing... SSA/SSDI is a seperate program..you are not awarded benefits based on the work injury alone...even though that may be the trigger for application.

You are TD/Total Disabled due to your work injury alone for WC purposes...and unable to perform your usual and customary job function... eventually that status changes to PPD/Permenant Partial Disabiltiy, and those indemnity benefits begin. Or, you can be PTD/Permenant Total Disabled, and other comp benefits may be available.

For SSDI, you must be "disabled" under SSA definition, which takes into consideration your ability to perform any kind of gainful employment. Also, SSA takes into consideation all of your physical/mental conditions that cause your inability to perform work.
***There is a much bigger threashold for SSA vs WC disability.


See SSA for info http://www.ssa.gov/disability/step4and5.htm#Q5_1