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Comp Hearing NYS
#1
I live in New York,  just had a hearing 2 weeks ago and have couple questions. Back ground- injured in 2009 with multiple body parts injured, been collecting comp payments since then. I'm seeing a pain management Doctor for a low back and neck injury and seeing a orthopedic doctor for my shoulder and right arm. Pain management doc has me at 90% and ortho has me at 50%. I'm not at MMI, I just had shoulder surgery in March and I need another injection in my lower back. The insurance company has never sent a represenative to the other 6 hearings I have had but sent a lawyer to my last one. My lawyer and their lawyer were discussing my % of disability and theirs asked to drop it to 50% because one doctor had me at 50%. My lawyer spoke up and said my other doctor had me at 90% so they compromised at 70%. They also changed my payments from TTD to PPD and back dated it to my last hearing on 12/14. Lowering it from 90% to 70% didn't make a difference in the amount of my check.(still drawing max) Their lawyer also requested I seek gainable employment in the next 60 days.

Question 1-does this sound normal for them to lower my % of disability without reaching MMI or did my lawyer screw up? Or will this all change when I have a permancy rating applied ?(I asked my lawyer and she said this was just a way for the insurance company to sort their dirty laundry)
Question 2-what does changing the payments from TTD to PPD mean as far as my case? why did they back date it ?
Question 3-shouldn't I have to reach MMI before they make me seek gainable employement ?

thank you
 
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#2
you didn't give any reasons why you think you are not MMI but whole lot that says you are.

Why would they give you ratings if it would change and you weren't at Mmi?
MMI is a medical opinion not a workers choice.

PD is a separate benefit from TD. TD is not deducted from PD.

Negotiation is part of litigation and it's doubtful it,ll change.

There is evidence to support MMI on that date.

All the actions indicate there is evidence that you are at MMI.
You,ll need persuasive medical opinion to the contrary to get the court to change it.

the purpose of litigation is to resolve the claim not extend it.
Your atty is moving toward settlement and finalizing your claim.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#3
Well first I understand that MMI is not a workers choice and it's a medical opinion. My doctors haven't put me at MMI and I haven't had an IME appointment in over a year in which they said I wasn't at MMI. Also the insurance company lawyer even said I wasn't at MMI because it hadn't been a year since my shoulder surgery. I guess my question was misunderstood and I didn't give all the right information. I would assume MMI would be reached by my doctors or the IME's decision and not left up to the lawyers to decide?
And where you said negotiation is part of litigation and you doubt it would change. I'm just confused because if I have a serious back injury with a 90% rating and a carpal tunnel injury with a 5% rating they would split the difference at 42.5%? Seems like they would have to separate the 2 injuries somehow?

Thank you for the help
 
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#4
while the body parts are each affected differently, the final disability rating is a combination of all disabilities from the injury.
i agree with you there needs to be supporting medical opinion that your condition is at MMI.
I assume you've reviewed all the medical reports and know for a fact there is no medical MMI evidence. Its possible the lawyers have so much control over the doctors that they can have them issue an MMI opinion.
but It seems strange that there would already be a permanent disability rating given on a temporary condition. predicting a medical outcome is tricky enough in the best of cases. would seem a bit reckless on a serious 6 yr old injury, but it looks like they are anxious to get it finalized.
a year is not a mandatory recovery interval.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#5
Thank you for your replies 1171 and I have looked over all my medical records. There isn't any mention of MMI in any of the reports. I'm actually still having issues with my shoulder and just had an injection about 2 weeks ago. The doctor put in his report that he wants me to see him in 3-4 weeks after injection where at that point he may have me return to physical therapy if there is no change. My lawyer knew all this before we went in to the hearing because I had a discussion with her about it. Wouldn't I have to be sent for a functional capacity exam at some point before I receive a permanacy rating? It just seems my lawyer has 6-8 other people she represents at each hearing and I'm just a number. I may have to look into another lawyer. I just hope it's not to late to change the courts decisions if my lawyer was in the wrong.
Thank you
 
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#6
Comp fees are low so it's a volume business.
FCEs are not mandatory.
If You are not ready to settle, you need to be clear with your lawyer and let them know what you,re thinking of doing.
Court decisions are driven by evidence -- once the evidence is in it,s difficult to overcome.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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#7
Just an update, I received a letter from the comp board that there was a clerical mistake in the boards decision. The first letter stated my payments went from TTD to PPD but it was supposed to be TPD. So I still have to wait for MMI then a permanacy rating before they change to PPD.
 
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#8
Big difference between TD and PD. So the % don,t apply to your PD benefits but to TD.
Seems like your permanent impairment ratings are yet to be determined.
Reminder :
........Each state has their own comp system; POST YOUR STATE to get accurate information. Use the search feature to find information from similar questions.
THANKS FOR POSTING.
 
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