Guest guest Posted October 23, 2002 Report Share Posted October 23, 2002 http://www.newsday.com/news/health/ny-nywork202972070oct20.story Delays Add Insult To 9/11 Injuries Doctors: Hundreds of victims are fighting for workers' comp By Mason-Draffen and Margaret STAFF WRITERS October 20, 2002 Filomena Roman has been out of work for more than a year, waylaid by an ankle injury she said she suffered while being evacuated on 9/11 from her office building, just four blocks from the burning World Trade Center. But she's been busy in the meantime. For nine months, the Rego Park resident struggled to get her company's insurer to pay for therapy she was receiving for post-traumatic stress syndrome. Out of frustration, she turned to a lawyer for help. " I just needed somebody to fight for me, " said Roman, 40, " because I don't have the strength to deal with my foot and depression and deal with them [the insurance company]. " Like Roman, hundreds of workers who claim injuries from the World Trade Center attacks or aftermath have been having difficulty obtaining workers' compensation benefits, according to physicians and lawyers who work with them. Insurance companies have been vigorously disputing World Trade Center claims, these advocates say, leaving workers with no source of income to cover medications and treatment. In some cases, medical care has been delayed, they say; in others, health care providers have gone unpaid. " The insurance carriers are fighting workers' compensation claims emanating from the World Trade Center, " said Dr. Robin Herbert, co-director of the Mount Sinai-Irving J. Selikoff Center for Occupational and Environmental Medicine. " Honestly, I'm surprised by this. Given the circumstances of the attack, we had hoped they would have behaved differently. But, it seems to be business as usual. " Dozens of patients being treated at the center for lung problems and post-traumatic stress are having their cases challenged, she said. Extended delays and challenges by insurers have long been standard in workers' comp cases, say lawyers and doctors who deal with the system. A 1999 study of claims for carpal tunnel syndrome in New York State found that it took from 58 days to four years to settle them. " A person can literally go for six months or a year or more with an inability to obtain a hearing, " said lawyer Robin Sambur of Bay Shore based-Sherman, Federman, Sambur & Levine, which specializes in workers' comp. " And during that time an insurance company can just not pay. " But many physicians and lawyers thought Sept. 11 claims would be handled differently. " There was so much talk about the rescue workers being heroes, " said Dominick Tuminaro, a Manhattan labor attorney involved in some World Trade Center cases. " But, this is the flip side of the story. This is how we treat those heroic people. Insurance carriers contest their claims. It's a scandalous situation. " Insurers, while declining to discuss specific cases, in general defended their handling of the claims. " We have received several hundred workers' compensation claims related to September 11 and have had very few complaints, " Boston-based Liberty Mutual Group said in a statement. " We take all claims very seriously and are working hard to resolve all of them quickly and fairly. " Jon Sullivan, spokesman for the New York State Workers' Compensation Board, said that the board had resolved a record 322,000 cases last year, up from 281,000 cases in 2000. Ninety percent, he said, are not contested by insurance companies and move through the system in days to weeks. Nonetheless, in February, five months after the attacks, the state workers' comp board, which mediates disputes between injured workers and insurance companies, announced it would speed up authorizations for medical care in cases where insurers did not respond within 30 days. The change applies only to people who already have been found eligible for benefits. So far 600 of the 900 claims filed under the new policy have resulted in speedier authorizations, according to Sullivan. He said he couldn't say how many involved 9/11 injuries. " Governor Pataki has made it clear that the workers' compensation law is to be obeyed and that injured workers should have prompt access to nonemergency health care, " said workers' comp chairman R. Snashall in a statement announcing the new policy. The Trade Center attacks set off an unprecedented flood of workers' comp claims, including 2,195 death claims as of Thursday - compared with an average 400 to 500 death claims a year for the entire state. " We received five years' worth of death claims in one day, " Sullivan said. In addition, as of Thursday the board had received 4,638 injury claims from the attacks, or about 3 percent of the average 170,000 injury claims filed statewide every year. It's generally agreed that the insurers promptly resolved the death claims. " While the insurance carriers seem to have done the right things with regard to fatality cases, " said Dr. Levin, an occupational health specialist at the Mount Sinai center, " that sure hasn't been the general experience with the occupational cases that resulted from exposure. " One Mount Sinai patient, Hickey, a Sullivan County iron worker, had volunteered to help cut steel beams at the Trade Center site. Hickey said he was forced to wait almost six months for some badly needed surgery to clean out infected sinuses that caused chronic headaches and congestion. Despite filing for authorization in April, he said that at the first hearing in May, Liberty Mutual, his union's insurer, said it didn't know about his condition. In addition, he said the insurance company's lawyer didn't believe Hickey worked in the Trade Center cleanup. " I went crazy and started yelling at them, " said Hickey, 39, whose father, brother and uncle, also ironworkers, helped to build the Twin Towers. After three more hearings, he said the workers' comp judge ordered the insurance company to authorize the surgery, which he had on Oct. 1. Liberty Mutual declined to comment on the specifics of his case, citing privacy concerns. " It's not fair, " Hickey said. " All the cops and firemen are being taken care of. What about the iron workers? Without us they couldn't do anything. " Many of those claiming injury have breathing and throat problems. But Levin said the insurance companies are fighting the stress-related cases even more vigorously than the respiratory cases. In Roman's case, she said she had some difficulty getting her insurer to cover treatment for her injured ankle. But getting coverage for her stress was worse. Roman said she began therapy for post-traumatic stress syndrome last October, she said, after a Red Cross worker advised her to seek help for her sobbing and depression. She had been working as a job developer for the Center for Employment Opportunity, a nonprofit agency that finds jobs for ex-offenders. But after the attacks, Roman said she had frequent heart palpitations, headaches and a fear of leaving the house. She found a local therapist who accepted workers' compensation cases because Roman said the State Insurance Fund, her company's insurer, said she could present her insurance card for medical help. But the clinic's bills went unpaid, she said. She said both she and the clinic submitted requested documents between October and February. Yet at each board hearing over the disputed bills the State Insurance Fund said it didn't have any of the documents, she said. She said her son even bought her a fax machine to make it easier to send documents. But the insurer continued to insist that it didn't receive them. In May the fund agreed to have Roman examined by its psychiatrist, who she said confirmed that she suffered from post-traumatic stress. In July, the fund agreed to accept the ailment as part of her case, clearing the way for the clinic to receive payments. " You would have thought that post-traumatic stress syndrome would have been a given with a 9/11 case, " said Ronna Horwitz-Bard, the lawyer Roman hired in February. Horwitz-Bard works in the Hempstead office of Islandia-based Turley, Redmond and sco. An insurance fund spokeswoman declined to comment on the specifics of Roman's case. But she emphasized when a claimant's documents are in order, the fund processes the claims promptly. The controversies over claims are not limited to New York State. Workers' compensation is a state-based system, and some of the volunteers and responders who flooded into New York from around the nation have filed claims in their home states. Connie Joyce of Texas arrived at Ground Zero last October to work 12-hour days, supervising cleanup of soot-filled office buildings nearby. As a project manager for the nation's largest disaster restoration company, she had built a career on running to scenes of destruction. But this was different. In January, Joyce was admitted to NYU Downtown Hospital with acute respiratory distress. By the end of the month, she flew back to Texas, attached to an oxygen tank. A biopsy found glass-like particles in her lungs. Sick and unable to return to her job at Belfor USA, she filed for workers' compensation in Texas to cover her medication and living expenses. But even though four doctors said that her breathing problems had been caused by her exposure at Ground Zero, her claim was rejected. " Right now, I feel victimized, " said Joyce, 50, from her home in Iowa Park, Texas. " I was on the job when I got sick just like the firemen, policemen and everyone else. I don't pretend to know how they feel, but I was injured and almost died. I always knew there was a danger on every job, but I never imagined anything like this happening to me. " In Texas, Dr. Lowell Harvey, a pulmonary specialist, diagnosed Joyce as suffering from hypersensitivity pneumonitis. This condition, commonly known as farmer's lung, is caused by an allergic reaction to inhaled mold, microorganisms or chemicals. In March, her claim was rejected by the insurer, American Home Assurance, because she failed to identify " the substance, the dosage, the time exposed and evidence that she reacts to that substance. " They also argued she has " an ordinary disease of life, " not caused by Ground Zero exposure. Frances Lout, an attorney for the insurers, declined to comment on the case. In May, Dr. Reape of NYU Downtown Hospital warned Joyce's employers in a letter: " I have cautioned her that she should not return to work at Ground Zero as another exposure may result in her death. " Since then, Connie Joyce said her condition has slightly improved. But she still has frightening episodes where her lungs feel like they are failing. She said she takes Prednisone, a potent steroid medication, to help her breathing; two other drugs to counter the steroid's side effects; two medicated inhalers and a drug for depression. She said she has almost exhausted her savings and is worried about what she will do if she is denied compensation. " I may never get to go back to work, " she said, " my savings is gone, and I feel so alone. " Copyright © 2002, Newsday, Inc. 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