New York Disability Lawyer & Attorney : Turley, Redmond & Rosasco : Brooklyn, Queens, Long Island, Nassau, Suffolk, Bronx, Staten Island

You need life saving cancer treatment, but your HMO will not pay. What are your rights? Can you enforce them in time? I recently went to a great seminar on this topic at the Nassau County Bar Association given by my good friend, Susan Slavin. Susan was one of the pioneers of breast cancer litigation in the early 1990's, and continues today as a leading ERISA and disability rights attorney.

So what do you do when you get an HMO denial? In most states, including New York, you have a right to an External Appeal by an Independent Panel not affiliated with the health plan.. These appeals usually deal with the issues of "medical necessity", "experimental/investigational treatment" and/or "clinical trials". In New York, you have to complete the Health Plan's first level of internal appeal prior to requesting an external appeal. Then you have only 45 days to request the external appeal - and this is a strict deadline. There is also a procedure for Expedited Appeals in emergency cases. In cases involving other issues such as out-of-network expertise, you may have to file a separate ERISA appeal.

The Good News - statistics as of March 11, 2005 show that patients win almost 50% of external appeals. Even better, the appeal process is set up so that most patients don't need a lawyer. An excellent resource is the New York Attorney General's Health Care Hotline: 1-800-400-8882. So when your "HMO Says No", make sure you investigate your appeal rights. You might just win!

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Are you able to work after a diagnosis and treatment for cancer? Is this a better measure of treatment success for working age people? Most cancer survivors are able to stay on the job, according to a new study found in the current issue of the journal Cancer and reported by Reuters.

The nation's largest long term disability insurance company, UnumProvident, recently reported that cancer is the leading cause of long term disability claims in the United States. According to the new study, survivors of early detectable cancers ( breast, prostate, skin, thyroid and uterus) had the lowest risk of having to quit work. Survivors of other cancers, such as brain cancer, lymphoma and leukemia, had the highest rates of work disability.

The challenge for cancer specialists is to identify and help their patients with employment problems. Doctors need to " reassure employers that most cancer survivors are going to live a long time and will be just as productive as anyone else". One of my favorite organizations is New York based CancerCare. They helped my good friend Tim successfully battle Hodgkin's Disease as a young man. After beating Hodgkin's, he went on to graduate with me from St. John's Law School and became an Assistant District Attorney in Nassau County. Cancer didn't keep him down - it just made him tougher. Just ask the criminals he sent to jail!

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As I write this late in the afternoon on Good Friday, the Christian Holy Day commemorating the crucifixion of Jesus, Terry Schiavo is slowly dying. The irony is stunning. I'll leave it to better theological scholars to draw the parallels.

Did such a personal tragedy have to turn into a political football for the President and Congress? I think not. The only branch of government that can look itself in the face at the end of this debacle is our judiciary. Whether you agreed with their rulings or not, they applied the law to the best of their ability, without bowing to pressure from various interest groups with an eye toward the next election.

As disability attorneys, we must try to protect our clients from this unfortunate situation. Encourage your clients, friends and family to execute a Living Will and Health Care Proxy. If Terry Schiavo had such a document, this would have remained the private family matter it should have been all along.

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Sububan Sweatshops is an important new book by Jennifer Gordon documenting the appalling working conditions of immigrants in our modern day suburbia. We had the pleasure of attending a book signing and celebration held last week at Hofstra University. Hofstra is down the street from The Workplace Project, a ground breaking organization founded by Ms. Gordon to provide legal representation to undocumented workers from Latin America. Our firm has had the privilege to represent many in their workers compensation claims and provide additional financial support for the organization.

Ms. Gordon, a MacArthur Fellow and now an Associate Professor of Law at Fordham University, has written a book that deserves a spot on your shelf next to Barbara Ehrenreich's Nickel and Dimed: On (Not) Getting By in America. If you want to understand how dependent we all have become on the immigrants who drive (or get run over by) our underground suburban economy, read this book.

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Give him credit! With his Social Security privatization plan sinking faster than a turncoat with cement shoes in the East River(can't you tell I'm from New York), the President floats out his 79 year old mother to the rescue. A brilliant, yet all too common tactic for sons. When the public deserts you and Congress wishes you never brought the whole Social Security issue up, who better to pump up support than a woman who lives month to month on her Social Security check! Yes, she will say she is doing this for her many grandchildren. Balderdash! - they will have trust funds. This is all about a mother's unwavering support for a son, which is actually pretty nice to see in this self-centered age.

On a more serious note, it now looks like Congress would rather deal with the Social Security solvency issue without inserting "private accounts" into the equation. One long time friend of Social Security Disability recipients has been Republican Clay Shaw of Florida. As he recently stated in a fine article by David Broder of the Washington Post, "private accounts" will have to be "add ons", not a partial replacement of the current Social Security benefit, to get bipartisan support. Shaw is one of the few Social Security experts in Congress. The President (and his mother) would be wise to listen the experts in his own party.

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Helpful information for injured and disabled workers - that’s what this blog is all about. In non-lawyerly language, we will try to provide information that will be useful to the disabled, healthcare professionals, support groups, union officials, disability advocates, fellow attorneys and of course, our clients.

The blog is published by the full service disability law firm of Turley, Redmond & Rosasco, LLP. The firm represents clients in Workers Compensation, Social Security Disability, Long Term Disability (Private and ERISA) and Construction Accident cases throughout the New York metropolitan area. We have ten attorneys and a staff of over thirty who are dedicated to helping injured and disabled workers. If you live outside New York or our geographic area, we are members of national legal organizations, including the National Organization of Social Security Claimant Representatives (NOSSCR) and the Workers Injury and Law Advocacy Group (WILG),and would be glad to put you in contact with another well-qualified attorney who can help you.

Disabled workers are often times in desperate straits - physically, emotionally and financially. They need an attorney to help explain the disability maze and fight for all the benefits they deserve. This blog will supply you with the information you need to help make important life decisions about your legal cases.

We will not shy away from taking a stand for disabled workers who are fighting insurance companies or the government. We will expose injustices perpetrated on the disabled by some uncaring and disinterested employers. At the same time, we respect all opinions and welcome comments by those who might disagree with us, even our adversaries! Most importantly, we hope this blog makes the world of disability, workers’ compensation and accident claims more transparent. The more our clients know about their claims, the better we can represent their legal interests. Welcome and enjoy!

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For those who needed more convincing that New York State Attorney General Elliot Spitzer is a friend of disabled workers, here is another example of his willingness to prosecute the powerful who prey on the vulnerable workers. Last November, Spitzer played an important role in forcing the Unum Provident Corporation to change their unfair case handling practices in long term disability claims.

Spitzer is now combating one of the largest causes of workers compensation premium increases for small business - EMPLOYER PREMIUM FRAUD! An upstate bridge painting company defrauded the New York State Insurance Fund out of over $145,000 in premiums by misclassifying their employees - one of the oldest employer tricks in the books. This all comes on the heals of Spitzer exposing bid rigging and price fixing by Marsh & McLennan in the workers compensation insurance market. The public must be made aware that one of the main drivers of increased workers compensation costs is the the unethical behavior of some employers and insurance carriers in a very profitable segment of the market.

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Yesterday, we received a call about our workers compensation client who was struggling with Complex Regional Pain Syndrome (also known as Reflex Sympathetic Dystrophy) and depression. He shot himself over the weekend. Our sympathy goes out to his loved ones.

We represented this client for over five years in both New York workers compensation and social security disability claims. We successfully fought to get him special authorization for surgery at Yale University Medical Center and psychiatric treatment. We won his social security case.

Tragedies like this one are a real kick in the gut to the lawyers and paralegals in our firm who inevitably got to know this individual well. We now have the unenviable task of filing a suicide death claim on behalf of the widow, a claim which is allowed in New York under circumstances like this.

Suicide among workers compensation claimants is rarely talked about. Over 30,000 Americans a year committ suicide. Over the last ten years, our firm has successfully litigated four suicide cases which were the result of claimant's original work related injuries. These cases all seem to follow an eerily familiar course: 1) person has severe injury on the job, 2) lives in agonizing pain, 3) loses job, 4) can't live on workers compensation alone, 5) loses home, 6) gets depressed and 7) committs suicide. We, as advocates for injured and disabled workers, must continue to convince courts and insurance carriers that psychological injuries can be just as devastating as physical ones.

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As recently reported in Matthew Lerner’s excellent New York Civil Law blog, the New York Court of Appeals recently decided that a worker who fails to use safety devices provided to him by his employer cannot prevail in a Labor Law §240(1) claim (otherwise known as the Scaffold Law). Cahill v. Triboroough Bridge and Tunnel Authority. The "Scaffold Law" allows the injured worker to sue a general contractor or property owner, in addition to collecting workers compensation from the employer. Jury awards in scaffold cases can be very high.

Using the term "recalcitrant worker" to describe the employee in this case, the Court found that the key question is whether the employee's own conduct was the proximate cause of his injury.
I would not describe this as a pro-worker decision. However, the general public policy that a worker must avail himself of safety devices provided to him prior to instituting a Labor Law §240 claim does have inherent logic. As lawyers for construction workers, we continue to see the Courts narrowing the protections found in Labor Law §240. The bottom line - if you are a construction worker on a scaffold, use your safety equipment or you may lose your right to sue.

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I wouldn’t bet on it. Despite dwindling support in his own party and the public in general, the President has shown in the past that he is a stubborn and resilent fighter for his policies. Rather than folding up shop and licking his wounds, he has announced a new multi-state push to convince the American public that his way is the better way to fix Social Security. His biggest nemesis, AARP, will surely be nipping at his heels after every stop and trying to undercut his proposal for "private" (or shall we say "personal") accounts. For entertaining bashing on both sides of the Social Security Reform issue, visit There Is No Crisis and Social Security Choice.

Even if the President’s privatization plan fails, there will most likely be some sort of Social Security reform in the next year. Advocates for disabled workers must see to it that the Social Security Disability program isn’t left on the cutting room floor when all the smoke clears. We will have to lobby all our friends in Congress to make sure that they protect the most vulnerable among us – the disabled. As with most things, the devil is in the details. There are more than a few pitchfork carrying souls lurking in the halls of Congress who would love to gut the disability program. With all the discussion about private accounts, let’s also keep an eye on the disability insurance program.

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When I was studying at Cornell’s School of Industrial & Labor Relations, one of the most riveting events we studied was the Triangle Shirtwaist Factory Fire. In short, on March 25, 1911, a raging fire broke out on the top floors of the Triangle Shirtwaist Company building in lower Manhattan. Many of the workers, mostly immigrant women and girls, could not escape because the company had locked the exits. Because of the locked exits, many of the workers had to jump from the ninth floor to their death. In total, 146 workers died. Up until the 9/11 tragedy, the Triangle Fire was the seminal event in occupational safety history, and led to the establishment of workers’ compensation laws and better working conditions throughout the nation.

On March 24, 2005, the Third Annual Triangle Memorial Fire Dinner will be held at the Fire Museum of the City of New York at 6:00 pm. My good friend Jim McCarthy and fellow workers’ compensation attorneys spearheaded this fantastic event, and the proceeds fund scholarships for children of injured workers. All those interested in attending can contact Jim at (718) 830-3200. For those who can’t make the dinner but are interested in the history of this gripping industrial tragedy, I strongly recommend the recently published Triangle: The Fire That Changed America by David Von Drehle. It is a real page turner involving struggling immigrants, building inspectors on the take, crafty lawyers, titans, of industry, and the politicians demanding reform (only after a tragedy occurs my how things don’t change!). Hope you can join us on March 24th.

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