NYCERS: Why are more WTC Claims being denied than approved?

A number of news publications in New York have released articles begging the same question: Why isn’t more being done for workers who were involved in 9/11 rescue, recovery, and clean-up operations?

The links below aren’t the first of the articles. It goes without saying that one article written about this is one too many. They all come to the same conclusion, stating that NYCERS isn’t doing enough to look at, or even consider, 9/11 Disability cases. Statistically, more of these claims are being denied than approved-that is if claims are looked at in any reasonable amount of time. Workers affected in the Battery Park neighborhood were given the right in November to sue the Battery Park City Authority for not working faster with their claims. No one should have to sue their city to be able to receive benefits for working under such tragic conditions. One FDNY EMT’s claim was denied twice, written about in an article linked below. An article written by The Chief Leader described a “lack of coordination” between NYCERS and the Victims Compensation Fund.

These are six articles from 3 different publications, all ending with the same answer: There is no rhyme or reason why more isn’t being done for those who have sustained 9/11-related illnesses.

Labor Department denies ex-OSHA inspector workers’ compensation as other agencies accept his 9/11 illness

NYCERS, WTC Disability Advocates Meet About Improving Responsiveness

Stop stalling on WTC sick: U.S. Labor Department and NYCERS are failing 9/11 victims

City is denying 9/11 first responders disability pensions

WTC Health Program Doctor Concerned About Benefit Denials

9/11 Cleanup Workers Can Sue Over Health Claims, Court Rules

Continued battle for 9/11 First Responders benefits

Recently, the civil service publication The Chief Leader published several articles discussing the state of 9/11-related disability claims being processed at NYCERS. Statistically, WTC Disability claims are on the chopping block. More are being denied than approved, and the ones that are usually denied take years to be evaluated. Other issues at hand are transparency during the process of filing and overall treatment of claims and claimants by the Medical Board.

Our partner, Sean Riordan, Esq. and several other WTC Disability advocates met with the leading members of NYCERS to address the sluggish turnover rate, the unfortunately high denial rate, and ways to fix the two. Though issues of the handling of claims and claimants is still present, the meeting was regarded as positive:

“On Dec. 7, Melanie Whinnery, the system’s Executive Director, and Ilyse Sisolak, its General Counsel, met with John Feal, founder of the FealGood Foundation, Sean Riordan, legal counsel for the FealGood Foundation, Ben Chevat, the executive director of 9/11 Health Watch, and attorneys Matthew McCauley and Michael Barasch, who specialize in WTC disability claims.

Also in attendance was Dr. Michael Crane, the medical director at the WTC Health Program Clinical Center of Excellence at Mount Sinai. The meeting lasted 90 minutes.

Both sides were upbeat about the value of the meeting and the prospects for finding common ground going forward. The 9/11-disability advocates presented NYCERS with a four-page memo obtained by this newspaper that highlights dozens of areas where the process could be more transparent and less adversarial, according to the advocates.”, as quoted from the article linked below.

NYCERS, WTC Disability Advocates Meet About Improving Responsiveness

November 2017 NYS WCB Proposal Summary

Back in September, thousands of injured workers, legislators, and other advocates stood with us in a far-reaching fight to stop the disastrous changes proposed by the NYS Worker’s Compensation Board. The public comment period ended in October and as a result of the uprising, the NYS WCB rescinded the initial proposal. November 22nd, the second proposal was released. A summary of it, written by our partner Richard Donohue, Esq., is below. The period for public comment for this ends 12/22/2017. You can email regulations@wcb.ny.gov before then to voice your opinions or concerns on the changes.


 

NOVEMBER 2017 PROPOSED SCHEDULE LOSS OF USE GUIDELINE CHANGES

 As indicated previously, the Board, under the direction of the New York State Legislature, has issued regulation changes and proposed amendments to the “Impairment Guidelines for Schedule Loss of Use”.  Their initial proposal dated 9/1/17 caused an extreme and fervent backlash from the labor community as well as from claimants and their attorneys during the public comment period which expired 10/23/17.  As a result, the Board issued a second set of proposed regulations and guidelines dated 11/22/17 regarding Schedule Loss of Use.

The November 2017 proposal rescinded the September proposal and also carried forward most of the existing schedule loss permanency guidelines, with several significant exceptions.  Although we are not in agreement with all the changes proposed in the November 2017 guidelines, we believe that this guideline proposal is a significant improvement over the initial September 2017 guideline proposal which would have devastated injured claimants and eliminated most awards for permanent loss of use to extremities.

Significantly, the November 2017 proposal eliminates the assignment of 10% to 15% schedule loss of use for rotator cuff tears, a proposal in which we are not in agreement and believe will result in lower awards for permanent shoulder injuries.  Additionally, the current existing guidelines arguably permit the addition of percentage losses for both forward flexion and abduction, whereas the November 2017 proposal states that only the greater of the two losses should be used in calculating the percentage loss of use.  We believe this will also result in lower awards for permanent shoulder injuries.

With regard to injuries to the elbow, some of the considerations given for mild to moderate loss of flexion are reduced insofar as the existing guidelines give a range from 7.5% to 10% whereas the new guidelines indicate only 7.5% for mild loss of flexion.  Whereas the range for moderate loss of flexion was 33.33% to 40%, the new guidelines indicate that only 33% loss of use would be given for moderate loss of flexion in the elbow joint.  We believe this will also result in lower monetary awards for permanent injuries to the elbow.  Similar reductions were incorporated into the guidelines for the hand.

Importantly, the new guidelines also delete a 7.5% schedule loss of use attributable for meniscus tears in the knee, whereas before they were approximately in the average range of 15% to 20% under the existing guidelines.

Changes were also made in the new guidelines proposal with regard to total joint replacements of both the knee and the hip which reflect advances in surgical techniques that have resulted in better outcomes for these type of surgeries.  Although we agree with the general proposal that the baseline for any schedule loss of use relative to total hip and knee injuries should begin at 35%, we believe the way the current proposal is written incorporates many range of motion finding deficits, thus making it unlikely that the final award will exceed the 35% figure, except in the event of a disastrous medical result.  Range of motion deficits should be added to the 35% baseline figure, not included in it.

Certainly, while the November 2017 proposal represents a significant advance over the prior September 2017 proposal which, again, was disastrous for injured workers, we believe that there remain areas in which benefits for injured workers can be improved by eliminating some or all of the aforementioned guideline changes.