I have applied for a NYS disability pension about a year ago and have seen a Doctor for the State approximately 5 months ago and was found to be unable to perform the full duties of a Police Officer by him as well as my primary physician. I was told last month that my file has been sent to an "in-house" Doctor for review. I was wondering if this is a common action by the Board and how it might delay or alter a decision on my application.
Your case is being looked at by the NYSDRS review board, the board consists of MDs (that work on a part time bases) that will decide if you would receive a disability pension. Yes it is a common procedure, and unfortunately the time frame they are making you wait for your answer is wrong!Originally Posted by chandler
Is that different than the first Board that reviews it? A friend said that it was a way of looking for a "no" as both my Doctor and theirs concurred.
No different, same doctors. It took me two years to get a No answer you can appeal if you are not awarded but your talking another year of waiting.
Remember you are dealing with the worst system in the country and Comptroller DiNapoli has done nothing to change it. It's a system filled with government bureaucracy!
You never know what might happen, but any iw that i know that did get the award had it with in a year.
If I am denied and decide to appeal, how beneficial will it be that the Doctor that the State sent me to said I was unable to perform the full duties? Is it more difficult for them to decline based on his report currently?
Appeal process is based all on the state doctors report but now you are in front of a law judge that will have the last word on the decision. The state will also have their attorney present to fight the case. The appeal system is just as bad as the system you are dealing with now. If you do appeal, if interested I have a name of a attorney a lot of cops and firemen use in this area.(just pm me.)
If the state doctor said you are unable to preform your full duties then I would have to say you should be granted your NYSD. How many ime's did they send you to? What happens with the NYS and the same goes for WC with insurance companies the state will send you to more than one ime until they get the answer they are looking for. They find it and then the state will stick with that report. You are dealing with some very nasty people in the state system and could careless about you or what you are going through. (just look at the time frame you have been waiting)
This has happened to me the state sent me to three ime's the first two said unable to preform my duties the last ime is the report they were looking for and the state fought my case with his report and that took about two years. Read post #2 and 63
http://www.injuredworkersofnewyork.org/
Last edited by zinger; May 24th, 2011 at 09:55 PM.
Bureaucracy!! NYSWC A article that was sent to me from an injured iron worker during the 9/11 clean up. Ten years after this all happened and still getting screwed around.
It is no different with the NYSRS and 9/11 first responders! To this day most of these people are being jerked around.
Half a dozen doctors testified on his behalf. Experts on 9/11-related diseases confirmed his claims. A picture of him working on a smoldering pile of rubble at ground zero offered hard evidence.
Still, for Joe Picurro, it wasn’t enough. The New York State Workers’ Compensation Board ruled he still hadn’t proven his health problems were due to his 28 days as a volunteer during the 9/11 cleanup. He hadn’t even proven he’d actually worked at the site, they said, saying the photograph could have been doctored.
It took two years, five hearings, an appeal to the New York State Supreme Court and several pleading media appearances before he thought he finally won.
Picurro looks back with anger on the time and effort it took for what he calls his victory: a check for $67.71 a week. “They throw us a bone every once in awhile to appease us,” Picurro said a few months ago. “The cheapest one possible.”
But then more recently the checks stopped coming and he will have to go back to court.
More than five years after 9/11, many cleanup workers who rushed to help the city in its time of need say they have developed serious physical conditions due to that work: 756 cleanup volunteers and many more paid workers have submitted claims. Many claimants say, however, the Workers’ Compensation Board has been slow in helping them get back on their feet.
In seeking a fraction of their income before their illnesses, workers say they have entered a maze of bureaucracy. They say it’s difficult to get hearings scheduled, and once they do, proving their illnesses are related to their 9/11 work is more difficult than in normal compensation cases. Many cases have been pending for years and for some, the financial strain has grown too great to bear. “We’re numbers,” said Jeffrey Endean, a 9/11 volunteer and former commander for the Morris County Sheriff’s Office in New Jersey, “and next to those numbers are dollar signs that they don’t want to pay off.”
The Workers’ Compensation Board, established in 1914, was a compromise between workers and employers: New York workers gave up the right to sue employers for injuries in exchange for timely compensation and medical care if they were injured on the job.
For employees of companies hired to do 9/11 cleanup work, and for the unpaid volunteers who worked under government authorized rescue agencies, the board is the sole means of resolving no-fault claims. City employees, such as police officers, firefighters and sanitation workers, go through a separate compensation process.
For most cases that go in front of the board, an employer’s insurance company is responsible for challenging and ultimately paying off or settling a claim. Volunteer claims, however, are compensated out of a $50 million grant created shortly after 9/11 by Congress, which by special rule is also administered by the board.
For many of the workers, even getting started in the process can be difficult. They say it can take months just to get a hearing.
Louis Dauerer, president of the Injured Workers Bar Association, said the board has been “fixated on getting its number of hearings down” in recent years, adding that it’s difficult for all injured workers to get hearings these days, not just 9/11 workers. The number of workers’ compensation hearings in New York State has decreased from 407,983 in 2001, to 305,722 in 2005, according to the board’s annual reports.
Board spokesperson Jon Sullivan acknowledged that the board tries to reduce its number of hearings, but said that’s only because it wants to be efficient. “It doesn’t make sense to have a hearing if there’s nothing that moves the case forward,” he said.
Once hearings are scheduled, many 9/11 workers say they aren’t told what exactly they need to do to prepare, resulting in further delays in the case. Some say they don’t want to pay for a lawyer to help, citing New York’s already small maximum weekly compensation of $400 — a rate that hasn’t seen an increase since 1992.
Linda Carillo, who is 35 and lives in Far Rockaway, was a construction worker for 18 years before 9/11. Present as a volunteer in its immediate aftermath, she worked on a human assembly line that removed rubble from ground zero. She said she now suffers from serious respiratory problems and post-traumatic stress disorder. To date, her workers’ compensation case has been open for four years. She said she’s unable to work and has been forced into foreclosure on her house.
After waiting months for her first hearing she went to court, but her claim was denied because the board said she needed a letter showing she had respiratory problems. She’d had no idea she needed the letter, and it took her another year to reopen her case.
The Worker’s Compensation Board says 94 percent of its 9/11 related cases are “resolved.” The board does not say how many cases have been accepted or rejected, however, and worker case files are sealed.
Workers’ compensation lawyers say the term “resolved” is misleading.
The board is able to say a large percentage of cases are resolved because it routinely sends letters to claimants telling them their case needs “no further action.” According to Vic Fusco, of Fusco, Brandenstein and Rada in Manhattan, who represents a number of 9/11 workers, this puts the burden on the worker to file a new claim.
“All the issues that board can resolve are resolved,” said Sullivan, explaining the board’s process. “But we understand a resolved case today may need to be reworked tomorrow, because new issues come about.” He added that the length of time it takes to resolve a case can vary greatly, with complex 9/11 health cases often taking longer.
After Carillo refiled her claim with a chart from Manhattan’s Mount Sinai Medical Center showing a significantly decreased lung function, she faced an even more vexing problem. She was again denied, this time because there was no “causal relationship of the medical condition,” according to the letter sent to Carillo by the board.
It’s a problem for many 9/11 workers. Often, 9/11-related injuries are more difficult to prove than other workers’ compensation cases. Out of 756 volunteers that have submitted claims, 61 are currently receiving benefits, Sullivan said.
According to a recently released Mount Sinai study, 69 percent of 9/11 workers studied have developed new or worsened respiratory problems in the past five years. But the board doesn’t grant workers’ compensation for many of these types of claims. In 2005, it granted compensation for over 90,000 physical injuries, particularly to the back and legs, according to its annual report. In addition, it granted compensation for 5,000 occupational injuries caused by long-term physical stress, but half of those were chronic wrist injuries. Environmental or respiratory type injuries, however, were not listed.
“9/11-related illnesses are considered illness and not injury,” said Dr. Jacqueline Moline, director of the World Trade Center Medical Monitoring Center, which treats Picurro and Carillo. “If a man falls and twists his ankle, he would be compensated because they know the time and the date it happens.”
The only way to prove 9/11 cases is to find qualified doctors willing to testify on a worker’s behalf. The board requires doctors to have a “reasonable degree of medical certainty” that 9/11 caused a worker’s injury.
However, many workers go to respiratory specialists who can diagnose their illness, but cannot point to its cause. One reason is that until August 2006, the city Department of Health did not release any guidelines for diagnosing 9/11-related illnesses, leaving many doctors unaware of their symptoms.
Joe Picurro, 39, a native of Toms River, N.J., was an ironworker during the 9/11 cleanup, removing twisted metal in an effort to find bodies buried in the rubble. Now he’s been diagnosed with a number of serious respiratory diseases and leukemia, which has an uncertain link to W.T.C. dust and may take many years to establish. When he was initially hospitalized in the Toms River Community Medical Center, doctors told him he had the flu as he vomited up small pieces of his esophagus, according to his wife Laura Picurro.
His doctors were incredulous when she told them she believed 9/11 dust had caused her husband’s illness. “They said they had never heard of such a thing,” she said. They gave him an antibiotic. Only after a number of costly visits to different doctors did they finally learn he had scarring and particles of pulverized glass in his lungs. Picurro was unemployed at the time he volunteered. Because he lacked health insurance, the rounds of visits and hospital stays put the couple heavily in debt.
Often, doctors unfamiliar with 9/11 illnesses will attribute workers’ respiratory problems to a preexisting condition. Claimants who are smokers, like Picurro, particularly face this problem, although that would not have explained the pulverized glass in his lungs.
“Not many doctors are aware of the nuances because they don’t see the sheer numbers of people,” said Moline, who said she herself has been able to testify persuasively in a number of workers’ compensation cases because of her broad experience.
Albany tried recently to address some concerns about the board. In August, former Gov. George Pataki extended the deadline to apply for 9/11 related worker’s compensation, which had passed in 2003, until August 2007. The bill also included several measures intended to speed up the workers’ compensation process and to provide speedier access to medical care if a claim is being challenged.
Still, many frustrated workers and volunteers are now looking beyond the workers’ comp process to get the money they feel they deserve.
There are 8,000 people who have filed a lawsuit claiming negligence by the Environmental Protection Agency and the New York Port Authority, among others, for alleged misleading statements about the air quality at ground zero. The fate of the suit is still unclear.
There is also the possibility of reopening the “9/11 Victim Compensation Fund,” which Congress originally created just weeks after 9/11.
The original fund provided more than $38 billion to 9/11 victims and their families, and was paid for largely by the federal government. But the fund’s Special Master Kenneth Feinberg, who awarded money to workers who developed symptoms early on, decided that Congress had not intended the fund to compensate workers with injuries that would develop over a longer period of time, because there was no way of knowing the amount each claimant’s illness would eventually cost.
But now, some New York and New Jersey lawmakers, including Senator Hillary Clinton, want the fund reopened for those very workers. In September, they introduced a bill to allow workers to apply to the fund whose symptoms became apparent after the initial December 2003 deadline.
The original fund was unusual in several ways. There was no limit on how much could be spent, and compensation was decided outside the normal legislative or legal processes.
Francis McGovern, a professor at Duke Law School and an alternative dispute resolution expert, thinks that Congress as a whole won’t want to reopen the fund. “If you do this once, you could say it’s 100 percent unique,” he said. “But if you do it twice, you’re saying anything else like this gets federal funding to pay for it. I think the inclination of Congress, except Hillary Clinton, would be to let the tort system take care of these folks.” McGovern said a system similar to the asbestos trust recently proposed in Congress, which would have more financial constraints, would be more feasible.
Clinton and her New York colleagues in the House and Senate want $1.9 billion in new spending for continued 9/11-related medical monitoring, treatment and research for workers and residents affected by the attack.
Waiting on Congress and the courts, many workers have given up on their cases, preferring instead to rest and focus on their health problems, according to case workers and advocates.
Diana Salvador, a psychologist and former director of the 9/11 Family Wellness program, believes the stresses created by trying to go through the process only makes workers’ health worse. “There’s a sense of powerlessness,” she said. “Between the trauma and talking to the board and getting health insurance, it can become more than a full-time job.”
i applied to the nysrs back in october, i just recently saw a state doctor, this state doctor wrote an unfavorable report on my behalf, this is the only negative report i have received and the content is so outlandish ,my lawyer ,who has been doing this work for almost 30 years told me this was the worst report he has ever seen, my question is, will i definatly get denied with this report and are my chances slim on appeal?,, it seems the majority of people lose on appeal? Thanks
i applied to the nysrs back in october, i just recently saw a state doctor, this state doctor wrote an unfavorable report on my behalf, this is the only negative report i have received and the content is so outlandish ,my lawyer ,who has been doing this work for almost 30 years told me this was the worst report he has ever seen, my question is, will i definatly get denied with this report and are my chances slim on appeal?,, it seems the majority of people lose on appeal? Thanks
Chandler and NYCOP,
Gather all your information, doctors reports as soon as possible and most importantly have your doctor examine you soon after the states doctor did, that way you could have some sort of proof that your condition is similar to what your doctor has said all during your treatment, and your doctors reports versus one doctor should be a slam dunk in your favor. A few web sites to look over. gather the evidence!
http://www.osc.state.ny.us/retire/me...earing_faq.htm
double post sorry
Last edited by zinger; June 2nd, 2011 at 08:07 PM.
NYCCOP and Chandler, This was sent to me today by another iw today. this i-w went through 2 app. I went through 2 apps, and our politicians continue to ignore a very bad system.
I hate to say it zinger, but you are at their mercy! it is actually worthless! The retirement system can do what they want. Their reports/evidence rules are so rediculous, they actually amount to no rules at all. I have been through 2 retirement applications with them, and fought them up to the supreme court and still lost. They have the right to base their decision on any medical opinion of their choosing. In my particular case, I had 14 reports. 1 of them was jaust as you described yours. They were both written by the same Dr who they sent me to for IME, one time on each application. The first time they sent me to him, was 1 month after they recieved the IME report from the 1st Dr they sent me to. He concured with all 11 medical reports in my application, which were all in my favor. They didn't like his report, OR 12 concurring reports were NOT good enough for them, so they sent me to this quack in Goshen NY. His was the ONLY report that claimed I had no medical condition. That was the report they based their decision on. On my second application, which is the one I fought to the supreme court and lost, the sent me to this guy AGAIN. I attempted to fight this IME as a "conflict of interest" and demanded another DR to do it, since the notice said "if you have been seen by this Dr or treated by him before, it may be a conflict of interest so notify us immediately". They basically told me tuffcrap you go to him or we automatically deny the application. Again they used his IME report and his only, and denied my application. I lost in the supreme ct because my only legal arguement was that there were 12 other medical reports that directly and tremendously dispute hisand the decided my application based on ONLY his. But I lost anyway, because the law says they can base their decision on any single report or any combination of reports, so going only by his was perfectly legal, no matter how flagrantly unfair or stupid it is. What follows is a repost of what happened in my case, from another forum related to this one. I am about to make a new application, citing new medical evidence, since I have found in going through all my papaerwork, that some medical evidence was never included in either of my other 2 applications, plus I now have more proceedures and Dr reports documenting the worsening condition despite having been at home since 1996 not working.
I M E Dr's are also known as "Doc's in the Pockets" and it is NOT for baseless reasons! In fighting my case, I had no less than 14 medical reports from 13 Dr's. Of those Dr's and reports, 1 was my primary Dr, 1 was the Specialist he sent me to, @ were Specialists that the specialist sent me to. The rest were all IME Dr's. Of the 14 reports by 12 of the Dr's, all reports agreed to the extent of my injuries & my current and future capabilities. Of those, 8 were IME's forced by my employer/ic, and also the NYState retirement system since I was fighting for my NY disability pension simultaneously. All of those 12 reports, 11 were in my favor. The 12th one was written by one of the IC IMEs. He found against me the first time he saw me, but then was told to see me again. On the second visit he actually examined me AND listened to my answers to his questions, after which he changed his opinion to match the othe 11 reports. The 13th & 14 IME's were again done buy the same DR over 2 years apart. This was a DR that the retirement board sent me to after their 1st IME ruled in my favor. During questioning at a hearing, he was asked the nature of his practice, the number of patients he sees a day, and the breakdown of his patient base. When he gave the break down, everyone in the rooms mouth dropped open, except for the hearing judge who also turned out to be very close to completely deaf. The facts he spewed out were appaling to say the least. The math on his answers during testimony meant in 5 days a week, with only 1 or 2 being his "regular" patients that he treats,during his given office hours, he saw each patient no more than 15 minutes max. It also, based on the math, meant he never stopped to take a piss or wash his hands between patients, and also never ate a single meal for the entire day after leaving his home at 7am and not leaving his office until after 8 pm every day. That fact that he didn't wash his hands did not go un-noticed by me at the time I was in his office on both occasions either. I have never been in any Dr's office where they came into the room directly from their last patient, carrying folders and not put them down and wash their hands or put on exam gloves before touching their next patient and washing their hands again before leaving the exam room to go to the next patient! This alleged DR never did a complete physical/hands on exam on either visit, would ask questions while at the same time reading through a 3 inch thick file he was sent, and would cut me off in mid sentence with another question. I spent 1 hr in his waiting room and a total of 10 minutes in his exam room which included getting undressed while he wasn't in there, his "IME", and then getting dressed afterwards, again without him in the room. When it happened the first time I was alone & my wife could not believe I wasn't making it up. When they sent me to him again prior to an appeal hearing, it was almost 2 years later, with more concurring reports in the file he was sent than the last time, and I brought my wife with me as a witness this time, that I was not making up anything I told her about the first time there. She was shocked and appaled at what she sawe, what she went thru with me, how long we waited, how long he was with me and his so called IME. Needless to say, I was very glad on both occassions the the filthy creep masquerading as a Dr did not touch me! Some reasearch on the internet as well as through some other NY work injury online groups, showed that this man just about always found in favor of the IC or the State. He had a reputation so bad as an employer owned Dr that pretty much if an ime were brought into his office on a gurney with no arms and no legs, this jerk would send a report saying they were fit to return to work in either full or part capacity. While I am very sure that this turd with a medical degree is not typical of all or most IME Dr's, I have been thru enough IME's over the years and also personally know others that have as well, to know that a great deal of IME Dr's are not fair or impartial. It appears that the ones that are, have a very small percentage of IME type patients and never more than about 50 percent. The one I mentioned specifically here has(or had) his office/practice in Goshen NY. While I cannot speak directly as to the rules of medical evidence involved in a WC case, I know for a fact that in NY State Retirement System cases, the deciding judge can pick any single Dr report of his choosing to make his ruling, he can base it on an average so to speak of all of them, or he can LEGALLY choose the only report in the file that goes completely against 13 other reports and base his decision on that one. It is rediculous and unfair to say the least, and it actually should be criminal, not a right written into the law.
this guy lost both of his appeals, did you? so what im getting out of this post as well our private message is im DOOMED, due to one doctors report? now matter how outlandish it is? i would say the same thing about the doctor i saw with the research ive done on him! his M.O is always against the injured worker! specifically he seems to always give an opinion to have a "safe correctable surgical procedure"
In your experience and research, are there people that win against the doctors appeal? Are your chances better at appeal?
What's the max number of Doctor's that NYS Retirement can send you to and how have people been fairing on appeals lately that did not have a so called "safe correctable procedure" and how many levels of appeal are there?
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