New York State Disability Retirement System

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Remember that your WC claim has nothing to do with your SS. "What Happens to WC when I Get 65" WC benefits go on for life.

SSDI never converts to SSI. SSDI converts to regular retirement benefits when you reach full retirement age. There is a difference.
Your comp benefits can on on for life...fact specific to your claim. SSDI/SSI/Medicare are not related to your WC claim

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IW and the NYSRS one of the common practices by the State on a IW appeal case. They are asking for more time but if if was the IW asking you would never get it

Back in June we had my retirement hearing after the NYS Comptrollers Office denied my performance of duty disability after getting hurt more than three years back wrestling with an inmate. Well, at the hearing the lawyer for NYS didn't debate my medical, didn't debate that I got hurt etc. What NYS contended was that it was my fault, because I was trained I should have not gotten hurt. Well, both I and NYS had 45 days from the date of the hearing to submit a brief explaining our points. Well my attorney got mine in, now the state wants an extension. They had the same 45 days as I did, shouldn't the judge hold them to that? I can't afford to keep an attorney on the payroll. How long does it usually take once everything is in for a judge to determine these things? I have been in limbo since the docs including the IME declared maximum medical improvement, money is super tight and I am getting closer and closer to losing my shirt or declaring bankruptcy. I am just hoping for some good news.

IW..Yeah we hit the state pretty hard at the retirement hearing but now the state wants to submit more info, a supplemental brief. I hope the judge shuts them down because we both had 45 days before the hearing to provide info to be heard. The state had ten pieces of paper, I had a folder 6 inches thick. Just the dictation from my docs (all of them including the IME's findings which were on my side) was 120 pages, not counting incident reports from that night, other instances where this same inmate injured other officers, etc and then at the hearing they had the opportunity to present more and when I testified their cross examination was a joke and even my attorney was stunned at how little the state offered, they didn't dispute my injuries or any of the reports. The only question I was asked concerned if I had any training or if I had prior dealings with this inmate, after that the state rested. So I don't think its fair that they want a second bite of the apple. They had their chance, actually several to provide evidence and I hope the judge sees it that way too.

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IME Physicians



Virtually all Workers' Compensation claimants in New York will be forced to attend at least one exam conducted by the defense insurance carrier's "Independent Medical Physician," and most claimants will see several IME exams before permanency or settlement in their claim. Therefore, many claimants want to know their rights and responsibilities with regard to these exams. As a Workers' Compensation attorney in Rochester, here are my immediate thoughts:

First, the injured worker does not have to attend, but failure to attend typically results in suspension or termination of benefits or denial of recommended treatment. Therefore, failing to attend rarely the injured worker's best option.

Second, the law restricts the time and place at which an IME exam may be conducted. By Workers' Compensation Board Rule, such exams must be performed in a suitable location within a "reasonable" distance from the claimant's location, as well as during normal business hours. What is reasonable in one case may not be reasonable in another, so the facts of a particular claim govern the analysis. For instance, it is likely unreasonable to ask an accident victim suffering post traumatic stress disorder related to auto travel to drive 40 miles for an exam, especially if there are many doctors likely available to conduct such exams within a closer proximity. However, the same requirement may also be reasonable if the claimant already travels that far for each of his/her own physicians' exams.

Third, the law imposes notice requirements on the insurance carriers so that the injured worker cannot be blamed for a failure to attend an examination arranged without ten days notice. A claimant may elect to waive this requirement, however, and their are certainly good reasons for doing so (such as if crucial care is pending the outcome of the IME physician's exam).

Fourth, the Board Rules basically instruct judges not to rush to any judgement with regard to a claimant's failure to attend a first IME exam, so as long as the claimant makes a good faith effort to reschedule and then does actually attend a subsequent exam, usually there will be no negative ramifications (as long as there is not a gap in qualified medical opinions longer than 45 days with regard to the claimant's current degree of disability under the Workers' Compensation Guidelines).

One good reason for refusing to attend with a particular IME examiner is if that examiner has caused the claimant injury in past exams. The reality is that some insurance carrier's examiners are rather rough on injured workers, and it is this writer's professional opinion that certain IME physicians actually become carrier doctors because they can't cut it in private practice (because their clients all leave them). However, other carrier physicians aren't monsters and can be trusted to act responsibly and even provide reasonable opinions.

A knowledgeable comp attorney may be the best source for an opinion regarding a particular IME physician, but there is also information available to the public on http://nydoctorprofile.com/. This is a page established as part New York's Patient Bill of Rights. By law, each physician (whether working in actual patient care or whether restricting their practice to IME exams) must register with the state, and information such as the physician's medical training, specialties, and medical malpractice history must be provided so that the public can make informed decisions regarding each doctor.

Still, the bottom line is that insurance carriers usually order IME exams for only one reason: to avoid paying as much money as possible. Therefore, claimants can typically expect carriers to hunt for doctors who are known to give conservative estimations of disability or who may have published research or taken specific positions in the past with regard to causal relation regarding certain types of claims (for instance, there are only two physicians in upstate New York known by this writer to take the position that carpal tunnel syndrome cannot be caused by typing, and both of these doctors regularly show up as IME physicians testifying for the defense). For this reason, it is important to understand that many IME physicians will provide opinions that are frustrating and even hurtful in many ways to injured workers. For this reason, whenever a carrier serves notice of a pending IME exam, any unrepresented claimant should likely seek legal counsel as soon as possible, and any represented claimant should touch bases with his/her counsel.

Finally, the Workers' Compensation Law imposes strict requirements with regard to an IME physician's reports. There are so many technicalities that an IME physician's report must meet, and these technicalities are violated so frequently, that very often an unfavorable exam report can simply be precluded from an injured worker's compensation claim by a motion and precise arguments from a skilled claimant's attorney. These technicalities regard service, timeliness, content, certifications, compliance with Board orders for production...and even whether or not the required cover sheets are completed properly. Thus, there may be many angles from which to seek preclusion or minimize the impact of an unfavorable report, and skilled claimant's attorney will best understand the rules. Most such attorneys do provide free consultations, so there is no good reason for a claimant to just accept an unfavorable report without taking action.

This article is written by a Workers' Compensation Attorney in Rochester, New York.

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cont. from last post.

Sadly, many claimants complain that the IME physician didn’t listen to them, didn’t write down the true facts in the IME’s medical report, didn’t perform a full exam, didn’t ask seemingly appropriate questions, or spent a grand total of only a few minutes before coming to a “ridiculous” medical determination. In fact, IME physician opinions are probably the Number Two reason why claimants should seek experienced representation immediately for their Workers’ Compensation claims (the tactics often used by the insurance carrier’s attorney against unwitting claimants is the Number One reason). Thus, the best response to the IME experience is simply to retain an experienced attorney to attack the credibility of the IME opinion. If the IME opinion is diminished, it is much more likely that a judge will accept the opinion of the claimant’s treating physician(s).

Remember, the IME physician’s report may control the outcome of your claim. The judge may have some questions for the insurance carrier’s doctor, and will also allow you to ask that doctor any "relevant" questions you wish during open court proceedings if you are unrepresented. However, without experience, most claimants don’t know how to properly cross-examine the carrier’s physician (who has been cross-examined many times by trained professionals) for greatest effect. If you do obtain an attorney, on the other hand, your attorney will be granted permission by the court to depose the insurance carrier’s doctor and ask all the tough questions necessary to undercut or shatter the credibility of the doctor’s stated medical opinion. In that way, it is more likely that your own doctor’s opinion will control the judicial determinations to be made in your claim (and these, in turn, determine what medical attention and monetary benefits you will receive).

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You can still apply for SS during the shut down.

We're now experiencing our first government shutdown in 17 years. SSD benefits will still be paid but the processing of new disability applications and approvals may be delayed or on hold.

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Another horror story from an IW dealing with the NYSRS. These people could careless about you or your family! Went through it just like this person has only back in in 08 same thing. If you plan on going through the system for a disability retirement, plan on two year wait including the appeal hearing.

The Retirement Hearing Judge Has Ruled but New York State Won't Tell Me the Decision

IW: I had my retirement hearing back in June of this year because NY State as said that my injury that has left me permanently disabled at the hands of an inmate was my own fault. Not that I provoked it but that because I had training I should have known how to handle the situation differently. Of course since this inmate also injured four other Officers in four other incidents and is back in our jail because he assaulted someone with a bat and has been to prison three times in three years so what do we know right. Anyway, we had the hearing and I was told the judge's decision would be in two weeks ago. Nothing, nothing from anyone. So I inquired and so did my attorney. What I got was an email stating that the judge's decision was in and NY State would tell me in 1-3 months. My attorney has called the Comptrollers office twice a day every day since with no answer. They refuse to tell him the judge's decision and they refuse to give him an answer. They also refuse to give me an answer. My attorney said that he is working hard on getting my answer quickly and he thinks there is a good chance that I won, as he said, if I had lost they would probably have told me that as quick as possible. We think that this is out of spite, this has been a very personal battle since day one and we think that they are letting it continue to be that way. Has anyone else had this type of outcome, where the only one's who know the state's position is the state and they refuse to tell anyone else? I would just like to know, it's been a long time coming and it seems every time we are supposed to get an answer, well the line gets drawn somewhere else. Between this and my employer keeping the settlement money that I was awarded, which it turns out that my employer never appealed to the state of NY and just held the money. My attorney has filed an appeal because its been more than 30 days but we don't know how that will turn out or when. The last couple of months have been very tough on me and the family and with winter coming I am not sure how we are going to make it.

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A lot of question about special funds this is a very good link about the system and how it works.

The Special Funds Conservation Committee's administrative budget is funded through assessments against New York's carriers and self-insurers. Insurance carriers and self-insured customers expect and receive fair, equitable and efficient claim handling service with their C-251/C-251.1 Submission for Reimbursement requests.
- Special Funds Conservation Committee acts as the insurance carrier for claims that are established under 25-a of the Workers' Compensation Law. Thus, claimants are also customers and are entitled to prompt and fair payment of benefits as well as expeditious resolution of their claims.

http://www.specialfunds.org/aboutus.htm
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"Preliminary figures suggest a benefit increase of roughly 1.5 percent, which would be among the smallest since automatic increases were adopted in 1975, according to an analysis by The Associated Press."
http://news.yahoo.com/social-securit...122713809.html

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Very import read about the IME (Independent Medical Expert) Do not refuse to go to your IME exam.

Concern to Workers’ Compensation claimants, the insurance company's IME physician may dispute causal relation even where the claimant's doctor is 100% sure that the claimant’s work caused the injury or illness necessitating treatment and wage replacement benefits. Even when the insurance company's doctor does agree that work caused the claimant's injury or illness, often that doctor will still insist the disabling condition is less severe than has been found by the claimant's own physician. This is how the insurance companies attempt to save money through litigation.

Unfortunately, because the insurance company has its Due Process rights, the claimant may not simply refuse to be seen by the IME physician. When given notice to appear for an IME exam, claimants must submit to such an exam or else face possible termination of their Workers' Compensation benefits until they do. Again, the insurance carrier has litigation rights and cannot properly be held liable unless given every opportunity to dispute a particular claim. Of course, this is a fact the insurance company lawyers know very well.

Sadly, many claimants complain that the IME physician didn’t listen to them, didn’t write down the true facts in the IME’s medical report, didn’t perform a full exam, didn’t ask seemingly appropriate questions, or spent a grand total of only a few minutes before coming to a “ridiculous” medical determination. In fact, IME physician opinions are probably the Number Two reason why claimants should seek experienced representation immediately for their Workers’ Compensation claims (the tactics often used by the insurance carrier’s attorney against unwitting claimants is the Number One reason). Thus, the best response to the IME experience is simply to retain an experienced attorney to attack the credibility of the IME opinion. If the IME opinion is diminished, it is much more likely that a judge will accept the opinion of the claimant’s treating physician(s).

Remember, the IME physician’s report may control the outcome of your claim. The judge may have some questions for the insurance carrier’s doctor, and will also allow you to ask that doctor any "relevant" questions you wish during open court proceedings if you are unrepresented. However, without experience, most claimants don’t know how to properly cross-examine the carrier’s physician (who has been cross-examined many times by trained professionals) for greatest effect. If you do obtain an attorney, on the other hand, your attorney will be granted permission by the court to depose the insurance carrier’s doctor and ask all the tough questions necessary to undercut or shatter the credibility of the doctor’s stated medical opinion. In that way, it is more likely that your own doctor’s opinion will control the judicial determinations to be made in your claim (and these, in turn, determine what medical attention and monetary benefits you will receive).

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Back injuries are number one injury filed in NYS.

Arcade man awarded $10 million for disabling workplace accident.

An Arcade man who suffered back injuries in a 2007 workplace accident at a North Tonawanda recycling plant was awarded more than $10 million last week.

A State Supreme Court jury awarded $10.1 million to Kirby J. Colling, 28, who sued Frontier Fibers after the Feb. 12, 2007, accident at its Mechanic Street plant.

Colling, who was 21 when he was hurt, was delivering documents to be shredded at Frontier for his employer, Hanes Supply, a Buffalo contractor and industrial supplier, according to the suit.

At the recycling plant, a Frontier forklift driver rounded a corner and pushed a heavy pallet of shredded materials into Colling, pinning him against a shredder machine, said Anne B. Rimmler of the Paul William Beltz law firm, who represented Colling.

Justice Donna M. Siwek presided at the trial.

The award included more than $2 million for past and future medical expenses, nearly $4 million for the loss of past and future earnings, more than $3.2 million for past and future pain and suffering, and more than $848,000 for loss of past and future household services, Rimmler said.

The forklift operator, a recent hire, had not been properly trained and certified to operate the forklift, she said.

Colling suffered a fracture and other injuries to his lower back and was required to undergo two surgical procedures, including artificial disc replacement. He also faces additional medical procedures throughout his life, his attorney said.

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Expedited Hearing ~ New York ~ Confused

Expedited hearings are "for cases in which the issues have not been resolved within one year after such issues have been raised before the board, or if multiple claims arise from the same accident or occurrence,
Hearings in the special expedited hearing process:

shall be conducted by a Workers' Compensation Law Judge;
shall be scheduled in such a manner so that, where appropriate, any and all outstanding issues may be addressed at one hearing; and
shall be scheduled within 30 days after the order of transfer.


http://www.wcb.ny.gov/content/main/wclaws/300_34.jsp

An expedited hearing is in your favor, it's a way to resolve issues in a timely manner.

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This is in regards to my last post 550.. Expedited hearing: Remember the IC works for your employer in this case intimidation by the IC and the employer the iw doctor but failed. I have been through this many of times during my cases with my employer and their IC, and the NYS retirement system . In a few court hearings a rep from my employer would show up for the hearings and would stand outside of the hearing room and the ic attorney would keeping leaving and filling that person in. Very important to have a good comp attorney for your comp case.An expedited hearing is in your favor, it's a way to resolve issues in a timely manner.

IW, my benefits, medical treatment and anything else were "suspended" while the doctors I see and the IME doctor were to be deposed. This originally was supposed to be completed by the 29th of May. My doctor had to reschedule and the board said all information had to be in by July 3rd at that point. I have a doctor who says I am 67% disabled because my injury in on my left side and I am right handed, my other doctor (who the insurance companies are actually afraid of) says he feels right now I'm still 100% and started talking about doing the steps to figure out the degree of permanency. The insurance companies don't like when this doctor testifies because they cannot intimidate him, he doesn't change his diagnosis based on what the insurance company wants. He does what is best for his patient. I just received a letter today that says there is now an "expedited hearing" scheduled for this month, I think it's actually the day before my doctor is supposed to be deposed.

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Six Changes Social Security Is Making to Its Disability Program.


SSD The agency is rewriting the job descriptions of its judicial corps, allowing officials more latitude to crack down on judges who are awarding disability benefits outside the norm.

Many judges have operated as if they were independent of the agency and awarded or denied benefits based on their own judgments. A few weeks ago, the SSA notified the judges of the changes.

The job descriptions will no longer include the words "complete individual independence," and will also clarify that the judges are "subject to the supervision and management" of other agency officials,

http://blogs.wsj.com/washwire/2013/1...ility-program/

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Please read this article: I have been reading a lot about this before it hit the News..
Cops, Firefighters, CO's in a huge fraud case, but caught.


The Associated Press

on January 9, 2014 - 2:10 AM



NEW YORK (AP) — When dozens of former police officers and firefighters sought disability benefits, advisers provided a playbook for faking mental illness — how to describe daily routines of languishing dysfunction, flunk simple concentration tests convincingly, dress down for benefits interviews, even how to link their supposed symptoms to 9/11, prosecutors say.

The decades-long scam netted more than $20 million in Social Security disability payments for more than 100 people and tens of thousands of dollars in kickbacks for the benefits experts who helped them, the Manhattan district attorney's office said this week in unveiling a case that points up the complicated role consultants play in a system that helps sustain more than 10 million people nationwide.
"A lot of times, a person really does need a lawyer or someone to guide them through the system. But once you have that, they have a financial interest in the case succeeding," says Dr. David Reiss, a San Diego, Calif., psychiatrist who has evaluated first responders and other applicants for disability, workers' compensation and other benefits. At times, he thinks consultants' conduct begs a question: "Where's the line between helping someone to express what's going on emotionally, and where is it planting seeds?"

http://www.buffalonews.com/article/2...9/AP/301099853

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INFORMATION ABOUT NEW YORK STATE’S WORKERS’ COMPENSATION MEDICAL TREATMENT GUIDELINES -


WHAT ARE THE MEDICAL TREATMENT GUIDELINES?

As of December 1, 2010 all workers' compensation claims in New York State involving the back, neck, knees, and/or shoulders irrespective of accident date are subject to a series of new Medical Treatment Guidelines. The stated purpose of the Medical Treatment Guidelines is to reduce litigation by pre-authorizing certain procedures that previously took up to 30 days to approve and often required protracted litigation as to medical necessity. In addition, the Workers’ Compensation Board sought to create with the Medical Treatment Guidelines a schedule of treatments for the back, neck, shoulders, and knees that are geared towards increasing and maintaining functionality with documented positive patient response.


Also some have asked about WHAT IS THE VARIANCE PROCEDURE?

If proposed treatment comports with the Medical Treatment Guidelines your doctor in many cases will not need to apply for pre-authorization though he or she can file an MG-1 Form (found online here: [url]http://www.wcb.state.ny.us to ask the insurance company or the Workers' Compensation Board to quickly agree that proposed treatment fits within the Medical Treatment Guidelines. If, however, proposed treatment does not fall within the guidelines he or she MUST file an MG-2 form (found online here requesting a variance BEFORE he or she renders the treatment. A doctor’s request for a variance is literally a request by the doctor to render treatment that varies from the Medical Treatment Guidelines. The insurance company may approve or deny the variance request. If the insurance company denies the variance you or your lawyers must request a hearing with a Law Judge to adjudicate whether or not the variance should be granted by the Workers' Compensation Board.

[NY The Vampire State]

I dont know man... Im self employed and if I bust my back, its my own problem and Im SOL. I didnt read all 37 pages of this, but some people out there dont have any safety net to fall on after an injury. Its a reality of life you may have to come to grips with. We all got aches and pains.