Wall Street Journal on Social Security Disability Doctor Problems

                            

The Wall Street Journal has an interesting article today on doctors working for the Social Security Administration (SSA) evaluating disability claims.   Apparently, these doctors are "revolting" because they feel that the Agency is improperly trying to influence their medical claim decisions in order to process the current backlog of disability claims faster.   The claims of these whiny doctors is all a bunch of hooey! 

The only thing "revolting" about many of these doctors are the poor medical decisions they have been making for years - which in turn are a major contributor to the current backlog of claims. This is nothing new and is not caused by any recent "upheaval".

As an Social Security Disability lawyer  who sees these doctors' decisions reversed on a regular basis by Administrative Law Judges (ALJ's),  I can tell you these doctors rarely make well reasoned, medically justified decisions.

More often, they simply "sign off" on claim denials because it is easier than justifying an award of benefits.  They simply pass the buck to the Administrative Law Judge, who may not see the claim for another six months or more, and then has to make the hard decision to grant or deny a claim. 

To the Social Security Administration's credit, their recent actions are corrective in nature and intended to relieve strain on the backlog of disability claims.  Social Security is simply trying to make sure that doctor's who work for them get it right the first time, thereby decreasing a claimant's wait for a correct decision on their disability claimScore one for SSA Commissioner Astrue!

The real deal is that most of these doctors are unhappy because Social Security is now paying them for  "performance"  on a per claim basis, as opposed to their prior leisurely $90 per hour pace.  These doctors, many of whom have been "retired" from the regular practice of medicine for decades, had a good thing going while it lasted.  When asked to produce, the "semi-retired" Social Security doctors are leaving the system - plain and simple.

And as Wall Street Journal economic policy reporter Damian Paletta correctly points out, bad medical decisions often times result in severe economic hardship for claimants.  The new initiative to improve the previously broken system should be applauded.  Is it perfect? Perhaps not yet. But it was broken long before. 

 

 

   

Big Day in New York Workers' Compensation Law! Court of Appeals Decides Aggregate Trust Fund Deposit Case of Raynor v. Landmark Chrysler in Ruling Against Insurance Carriers

It is the most important New York workers' comp legal decision since the the legislature passed the sweeping New York Workers' Compensation Reforms of March 2007. 

Today, in  Raynor v. Landmark Chrysler,  the New York State Court of Appeals affirmed a lower appellate court ruling upholding provisions requiring private workers' compensation insurance carriers to make mandatory Aggregate Trust Fund (ATF) deposits for claimants classified as permanently partially disabled (PPD) and injured both before and after March 13, 2007.

Based upon Raynor, if a claimant was injured on 7/1/2006 (before the reforms capping the duration of permanent partial disability (PPD) awards), but classified PPD after the reforms took place (3/13/2007), the insurance carrier must make a mandatory present value Aggregate Trust Fund deposit for the future value of the indemnity portion of the award. 

For example, let's assume a worker hurt on 7/1/2006 is classified PPD at a $400/week rate of compensation on 7/1/2008.  Prior to the reform laws (heavily pressed for by the business community), the private insurance carrier could have leisurely doled out the worker's $400/week over time, while holding the large bulk of its financial obligation to the worker in its own bank accounts.  Now, after the clarification of Raynor, that scenario has been turned on its head. 

Upon the worker being classified PPD, the private insurance carrier is obligated to deposit the present value sum of future indemnity payments into the Aggregate Trust Fund (ATF).  In many cases, such deposits will be in the hundreds of thousands of dollarsThis is a private workers' compensation insurance company's worst nightmare. 

The New York State Insurance Fund (NYSIF) and self-insured employers are exempt from the mandatory ATF deposits, and private insurance carriers argue this gives them a distinct competitive market advantage - which is hard to dispute.

Practically, just the threat of a potential PPD classification should cause insurance companies to pull out their settlement checkbooks and pens.  And this was the intention of the 2007 New York Workers' Compensation Reform legislation, at least in part.  

Prior to the reform legislation, there was too much litigation on cases that lasted sometimes for decades. The business community got their cap on PPD awards while claimants got what was hoped to be a quicker resolution of their claims. However, due to this long litigation brought by the private insurance carriers, there is currently a bottleneck of thousands of potential PPD claims at the New York Workers Compensation Board. Raynor should be the "Drano" the plumber ordered!

Now that the Raynor decision has put this issue to rest, private insurance carriers should immediately start to make settlement offers to claimants to avoid the hammer of the present value ATF deposit. 

The fairness of settlement offers will be based upon the ATF's present value discount tables and Board Bulletin 222-B. ( if you have questions about the fairness of your Section 32 workers compensation settlement offer, please contact  Troy Rosasco at  x123 for a Free Evaluation of your claim).

New York businesses should  finally start to see a financial benefit from the illusory promises of the 2007 reforms. And all will be right in New York Workers' Comp Land !??  Stay tuned...

 

 

9/11 Zadroga Victim Compensation Fund Open for New Claims as of 10/31/2011

Yesterday, September 11th Victim Compensation Fund Special Master Sheila Birnbaum reopened the Fund for new claims. Claimants can now file for "eligibility" determinations online.

To her credit, Ms. Birnbaum appears to be running a tight ship and is rolling out this complex compensation program in a timely and  understandable way.  This simplicity will be of great help to victims and their families.

In an effort to assist victims with the filing of claims, the Special Master also announced two upcoming legal clinics in Manhattan staffed by volunteer lawyers.   Such outreach, like her Town Hall meetings that preceded the reopening of the Fund, has quickly established Ms. Birnbaum as an equal to the much lionized former VCF Special Master, Kenneth Feinberg.  US Attorney General Eric Holder should be credited for an excellent choice. 

The 9/11 Victim Compensation Fund is currently taking "eligibility" applications, which are different than the actual "compensation claim" forms which will be released at the end of November 2011.  Potential claimants with questions can call the official Victim Compensation Fund Toll Free Number at 1-855-885-1555, or feel free to call me at 1-855-WTC-INFO (1-855-982-4636).