New York State Disability Retirement System

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The Senecas and Insurance Company drop injured workers. Remember your employer could careless if your hurt, it is all about money and what they have have to pay out. In this case both the Senecas and ic company worked hand and hand to to dump these iw.


http://www.buffalonews.com/apps/pbcs...130209115/1010

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Yes! Your case can be reviewed I was reviewed twice in six months in 11 and they also can send you to and IME if they feel the need .

"SSA has set a goal of conducting 435,000 medical disability reviews in FY2013, based on the current level of funding. Beneficiaries with a high likelihood of medical improvement undergo a medical review; Beneficiaries with a lower likelihood of medical improvement are mailed a questionnaire, which may or may not trigger a medical review."

Q, on ssd appeal Can't tell you how long the SSA appeal process will be... depends on the court backlog...anywhere from a few months...to a year or longer.

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What is a Medicare Set Aside? You will be hearing more and more of this.

A Medicare set aside (hereinafter MSA) is a tool that allows an injury victim to preserve Medicare benefits by setting aside a portion of the settlement money in a segregated account to pay for future Medicare covered. The funds in the set aside can only be used for Medicare covered expenses related to your injury. Once the set aside account is exhausted, you get full Medicare coverage without Medicare ever looking to your remaining settlement dollars to provide for any Medicare covered health care. Medicare may approve the amount to be set aside in writing and agree to be responsible for all future expenses once the set aside funds are depleted. However, there is no requirement for Medicare to review and approve the set aside amount.

More about the Set Aside this is very good site and covers a lot of questions on the this subject. http://www.synergymsa.com/learn-more...njury-victims/

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Soom more information on set Aside account.

Establishing and Using your Medicare Set-Aside Account



· WCMSA funds must be placed in an interest-bearing account, separate from your personal savings or checking account.



· If you are not currently entitled to Medicare benefits, the WCMSA funds must not be used to pay for any medical expenses. WCMSA funds must be held until you become a Medicare beneficiary.


· WCMSA funds may only be used to pay for medical services related to your work injury that would normally be paid by Medicare. Examples of some items that Medicare does not pay for are: prescription drugs, acupuncture, routine dental care, eyeglasses or hearing aids and therefore, these items can not be paid from the WCMSA account. You may obtain a copy of the booklet "Medicare & You" from your Social Security office for a more extensive list of services not covered by Medicare. If you have a question regarding Medicare's coverage of a specific item or service to determine if you may pay for it from the WCMSA account, call 1-800-MEDICARE (1-800-633-4227).



Please note: If payments from the WCMSA account are used to pay for services other than Medicare allowable medical expenses related to medically necessary services or supplies, Medicare will not pay injury related claims until these funds are restored to the WCMSA account and then properly exhausted.

· WCMSA funds must be placed in an interest-bearing account, separate from your personal savings or checking account.



· If you are not currently entitled to Medicare benefits, the WCMSA funds must not be used to pay for any medical expenses. WCMSA funds must be held until you become a Medicare beneficiary.


· WCMSA funds may only be used to pay for medical services related to your work injury that would normally be paid by Medicare. Examples of some items that Medicare does not pay for are: prescription drugs, acupuncture, routine dental care, eyeglasses or hearing aids and therefore, these items can not be paid from the WCMSA account. You may obtain a copy of the booklet "Medicare & You" from your Social Security office for a more extensive list of services not covered by Medicare. If you have a question regarding Medicare's coverage of a specific item or service to determine if you may pay for it from the WCMSA account, call 1-800-MEDICARE (1-800-633-4227).



Please note: If payments from the WCMSA account are used to pay for services other than Medicare allowable medical expenses related to medically necessary services or supplies, Medicare will not pay injury related claims until these funds are restored to the WCMSA account and then properly exhausted.

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Another big issue is this one! "Finding Doctors Out of State Accepting Nys Work. Comp Insurance"
I also will be leaving this state in about six months moving to FL so my search is on for a doctor.

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Out of state providers have enough difficulty dealing with their own state comp mandates... as well as fee schedules.
They are not subject to NYS laws.

Talk to your claims adjuster, there may be Dr/providers on their lists... talk about a settlement that includes money for future medical. If you haven't already, apply for SSDI, you would be Medicare eligible in 24 mos...you could settle with a setaside arrangement, when that money is gone, Medicare would pick up benefits.

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IW: I am in FL with a NY WC case.
I sure can identify with your problem ! Some time ago I found a list that WC had put out for FL doctors that according to them accept NY WC. The list was bull. I called everybody on the list within about 150 miles....that is the ones that had local numbers. For some only NY State phone numbers were given. Figured that's a waste of time....

I also called the carrier, they claimed to have no information available....

When I needed back surgery I was unable to find a surgeon. It seemed nobody would accept NY WC, not even IF pre approval for surgery was given by carrier...
I finally contacted the MAYO CLINIC in Jacksonville located on the E. Coast...I live on the W. Coast. THEY WERE willing to accept my case, SUBJECT TO PRE APPROVAL...however the Carrier never issued the PROMISED pre approval. Did find out that they have a whole department devoted to WC....
So, eventually ( after about 6 months) I had no choice and went to the Emergency of my local hospital, where at first they too were unwilling to take me on for surgery because it was not a 'Life threatening' situation....ha, my family doctor already had given me his home phone as he was afraid that I could go paralyzed at any moment.... finally when I totally 'cracked up' the emergency doc apparently took pitty on me and contacted the very same local orthopedic surgeon who I had approached previously and who did not take NY WC. This time, don't know why,(did not care as to reason, just knew I needed surgery) he took the case. BTW ....was treated like dirt in his office post surgery, as if I carried the pest...

Anyhow my family doctor, who also does not take WC agreed to take my case, however THAT'S a lot of 'fun' too...he means well, but....as he acknowledges 'he does not know anything about WC' (so I have a real 'advocate' in my pocket....uh) Getting any kind of report out of him is like pulling teeth (he is only use to filling out standard forms for Medicare on a computerized check list basis...(actually I think that in comparison it would be a pleasure to have some teeth pulled).
Despite of all this I am totally dependend on this primary doctor and my biggest fear is that maybe some day, for some reason he may not be around.

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How Can You Be Denied Worker's Comp if Approved for SSD.
If one applied for and received SSD due to a WC injury what would be the case law (OR logic) determining a WC determination finding for other than a PTD? I know they have different guidelines but how would an IC go against the finding of an independent medical's (SSD) federal program?

Your work injury may be the trigger for applying for SSDI, but not necessarily are you 100% disabled due to the injury.

WC state laws provide for rating PD, you are TTD/Temp Total Disabled while you treat/recover due to your injury and cannot perform your basic job function. SSA uses a much higher threashold to determine you are 100% disabled, and unable to perform ANY type of job, even sedentary. SSA uses all of your physical/mental impairments... WC uses only the work injury.

WC... you may be 99% PD once you reach MMI, which may mean you are capable of sedentary work, many people in wheelchairs with severe back injury are still capable of sedentary work, medical billing, claims adjusters, phone sales.

Two thing happen, most of the time your employer most of them do not offer light duty, or a lower paying job. When I was going through this my employer told me no light duty. (I was approved by SSD)But if you were politically connected there was light duty.

If your in the NYS system they could careless if you received SSD if you filed for a DP.

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Not everyone needs a legal representative to guide them through the Social Security Disability Benefits approval process but around 80% of applicants have one by the time they reach the appeal stage.

"You may hear people say, 'Well, Joe down the street gets disability, and there’s nothing wrong with him.' Well, they probably don’t know that much about Joe’s medical situation. Instead, I suggest you find someone you know and trust, who either has gone through the system themselves or has had a close friend or relative go through it. Ask them how easy they think the system is."



http://www.pressherald.com/maine-voi...html?p=2&tc=pg

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When you are going through the system WC or waiting to hear from the NYSRS for a disability pension or the SSA.
I have had many,many, iw contact me on the stress it causes on them and their families waiting for answers. It is a waiting game with these people NYSRS I would say is the worst system to deal with second goes to WC cases and your employers ime's. You have to play the game with them what they want you to do is give up and go away, something you do not want to do. With the help of the internet the iw has become very informed and educated on the system and how it works. Go back not to long ago the iw
had know idea what to do about anything most iw gave up on their injuries (claims} because of the pure stress it took on themselves and their families.


IW: Long story short, it's been 1 1/2 years since I had my surgery and out of work for a WC case, complications last year occurred and I'm now out of a job because of them. I have had my ups and downs throughout all of this, but lately, I'd say for about the last 2-3 months, I just can't get out of this funk. I know the symptoms of depression and think I'm there. My question is who do I go to, with my private insurance I have to have a referral, but since I know this is from what has gone on because of my WC case do I go through one of my doctors treating me. I go to ortho's for injuries and see a PM dr also. Who would be the best to approach on this issue?? I don't think I can handle much more before I completely loose it, I've held it together so far, but it's getting harder. Many issues, pain, finances, lost my job and possibly total disabled because of this whole situation.

IW: just didn't know where to start, I have physical therapy tomorrow afternoon, which gives me a free morning to make some phone calls. I guess my train of thought was leaning towards my PM dr since he prescribes all my meds. I have had a hard time in the past with my other drs wanting to prescribe me anything. But i'll start with my PCP and see what he says. Thanks again, and yes this should be comp, but I'm still in the middle of the war to cover my knee injury as comp, so I'm sure they'd fight it and I'm just tired of all the BS to get help.

Unfortunately you've just reminded me that I have to pay my cobra or I won't have any coverage after the 1st, 500 is killing me a month, but it is the only way for my leg to be taken care of. I am at my whits end, all bills are 2 months behind and it seems I'm just slipping deeper into this whole, well gonna try to make last months rent and the insurance payment, wanted to cover the car insurance, but that wont be happening, oh well, such is life. Just having a sucky day, sorry for all the complaining. Just want my life back, but the reality of it all is that I know this is it, it may get a little better, but I have no great expectations for quick improvement. It's an uphill battle and I honestly am trying to keep climbing, even on days like today

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The Social Security Administration’s Office of the Inspector General succeeded, in a single two-year period, in securing 282 criminal convictions and recovering $16.6 million in stolen funds from people who fraudulently collected benefits when a friend or relative died."


http://www.nationalreview.com/articl...n-kay-melchior

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Government fast tracks military Social Security Disability applications




Information on the expedited processing of military applications for Social Security Disability is online at the Wounded Warrior website.

http://www.digitaljournal.com/pr/1313130

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How Can You Be Denied Worker's Comp if Approved for SSD.
If one applied for and received SSD due to a WC injury what would be the case law (OR logic) determining a WC determination finding for other than a PTD? I know they have different guidelines but how would an IC go against the finding of an independent medical's (SSD) federal program?

Your work injury may be the trigger for applying for SSDI, but not necessarily are you 100% disabled due to the injury.

WC state laws provide for rating PD, you are TTD/Temp Total Disabled while you treat/recover due to your injury and cannot perform your basic job function. SSA uses a much higher threashold to determine you are 100% disabled, and unable to perform ANY type of job, even sedentary. SSA uses all of your physical/mental impairments... WC uses only the work injury.

WC... you may be 99% PD once you reach MMI, which may mean you are capable of sedentary work, many people in wheelchairs with severe back injury are still capable of sedentary work, medical billing, claims adjusters, phone sales.

Two thing happen, most of the time your employer most of them do not offer light duty, or a lower paying job. When I was going through this my employer told me no light duty. (I was approved by SSD)But if you were politically connected there was light duty.

If your in the NYS system they could careless if you received SSD if you filed for a DP.

A WC judge CAN NOT tell you when you can apply for SSD I have heard this a few times with iw. go right ahead and file right away. www.ssa.gov

IW won his workers comp claim a year ago, but the judge said he had to wait 30 months before filing for disability, Can a judge make you wait to file for social security disability?

No...a workers comp judge has no authority over SSA/SSDI.
However, SSDI is not a substitute for WC or other disability benefits he may be due.
SSA/SSDI takes quite a long time to get approved, and there is a much higher threashold to qualify.

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Web put off-limits to Social Security. They have used the web until this.

http://www.washingtontimes.com/news/...udge/?page=all

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Questions on how NYS WC ranks in terms of other states.

There is not much out there on this CA is the worst state for WC and injured works, I thought NY was second but from what I have been informed this state is below average but not second.

You would have to have acknowledged and agreed upon set of standards/goals with which to measure the systems as well as an acceptable process for computing/measuring how each state system performs.

40 years ago there was a national commission established to try and set such standards for work comp. 9 years ago there was a report done as to how various states have implemented reforms and conform to those standards.
while New York was below average it is not "the worst".

more here
http://workerscompresources.com/?page_id=28

Since the report more states have restricted and rolled back work comp rights and benefits as republicans have gained control of legislatures.

IW review.I would have to say, from my experience, which are not all good by any means, Illinois has to be one of the best for the worker. I personally skip most post on CA because it is really depressing what the workers have to deal with.

Some of the worst CA,Hawaii followed by Texas.

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A few things on attorneys there are many very good comp attorneys around and some very bad ones you will know once you start your case. Same when you are appealing your SSD case. Do your homework keep track of all your records and take notes in court when at a hearing. You do not need a SS attorney to file your case most people don't because they think they have to pay up front for a SSA to represent them. They take a percent of the awarded if you do receive your SS and nothing if you don't.

Not everyone needs a legal representative to guide them through the Social Security Disability Benefits approval process but around 80% of applicants have one by the time they reach the appeal stage.


http://www.economicpopulist.org/cont...ity-disability

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http://choosework.net/blog/jsp/blog.jsp?post_id=235