Industrial Medicine Associates (“IMA”) has a contract to perform consultative examinations (“CE”s) for Social Security Disability (“SSD”) claimants. The IMA CE’s engages in numerous questionable activities, including its fraudulent releases, violating the law by failing to notify attorneys of CEs, fraudulently claiming that CE are needed when they are not, and making fraudulent findings. Searching my blog will reveal countless additional examples of IMA misconduct.
As stated in my blog entry from October 5, 2012, because of IMA’s dishonesty, I advise my clients to videotape CEs by IMA:
“There is no rule, regulation, statute, guideline, or case law that precludes an SSD claimant from recording his or her CE. There have been countless times where IMA doctors have been banned from performing CE’s, or their opinions have been rejected, after substantial evidence or cross examinations showed they falsified CE findings. If IMA doctors perform CEs in accordance with the regulations, then they should have nothing to hide, and should have no problem with the videotaping. Videotaping an IMA CE is consistent with the SSA recording experts and witnesses at hearings. IMA has a protracted history of acting improperly. Read some of my prior entries on this topic: 11/22/10, 6/6/12, 5/17/12, 10/5/11, 6/29/12, 6/16/12,3/8/10, 8/31/12, 8/11/08, 4/21/10, 6/4/12, 9/8/10, 8/16/12.
IMA has a contract with New York State to perform CEs, for which it gets paid a ton of taxpayer money. Medical Experts at hearings are videotaped, and IMA has no excuse or legal authority to justify its refusal to have its doctors videotaped while performing a CE ordered and paid for by New York State. Perhaps if IMA refuses to perform a large number of CEs when claimants try to videotape them, the State will terminate or refuse to renew its contract with IMA”
I previously pointed out that the Workers’ Compensation law specifies that a claimant has the “right to video tape or otherwise record” an examination. IMA does workers comp exams just as they do CEs. IMA told one of my clients yesterday that they could not record the CE, and pointed to a new sign that says, “To maintain client confidentiality, video and/or audio recording is absolutely prohibited anywhere in this facility.” In small print below, the sign adds, “This policy does not apply to Workers Compensations exams.”
The new sign admits that IMA is failing to maintain client confidentiality when it performs workers compensation exams. The governing agency should investigate IMA’s admission. Furthermore, IMA failed to explain how an SSD claimant’s recording their own exam can breach the claimant’s confidentiality. Moreover, IMA has refused to provide any explanation for its disparate treatment of disability claimants.
Most importantly, it seems to me that since IMA’s contract for providing CEs does not state that they can prohibit videotaping, their conduct constitutes a breach of contract. Even if IMA were to renegotiate its contract to allow it to refuse videorecording, it does not trump a claimant’s right to record their own exam. That is why IMA claims that its “policy” is prohibit videorecording, because there is no law that enables it to do so.
In April 2009, the New York State Inspector General and the Inspector General of the Office of the State Comptroller reviewed the contract that the Office of Temporary and Disability Assistance (“OTDA”) gave for performing CEs. The report addressed the allegations of Diagnostic Health Services that OTDA blatantly favored IMA in providing services. The IMA contract costs taxpayers about $20 million dollars for CEs in Bronx, Queens, Nassau and Suffolk. When will the State investigate IMA’s conduct?
Showing posts sorted by relevance for query IMA. Sort by date Show all posts
Showing posts sorted by relevance for query IMA. Sort by date Show all posts
Tuesday, March 24, 2015
Saturday, June 16, 2012
IMA Exams In New York
In New York, the Division of Disability Determinations of the New York State Office of Temporary and Disability Assistance (“OTDA”) decides if the medical evidence supports an application for Social Security Disability (“SSD”) benefits. If the OTDA believes that the claimant’s medical information is unavailable or insufficient, then the OTDA can pay for a consultative examination (“CE”). The Social Security rules and regulations clearly state that a claimant’s treating doctor is the preferred source for a CE, which Administrative Law Judges reluctantly admit.
Even though I submit medical tests, functionality opinions, and clinical records, when I file SSD applications, the OTDA almost without exception sends notices for my clients to go for a CE by IMA Disability Services. IMA Disability Services, which has also gone by the name Industrial Medicine Associates, is part of The IMA Group (collectively, ”IMA”).
Why are claimants always told to go to IMA when the rules and regulations clearly state that the treating physicians are the preferred sources for CEs? Why are claimants told they have to go to IMA CEs in virtually every case? I represent a 59 year old bricklayer whose SSD benefits were paid today two months after I filed his application, even though the OTDA sent two letters stating that it was “necessary” for him to be examined by an unnamed doctor from IMA. Obviously, the CE was not necessary.
The OTDA is supposed to issue three year contracts for performing CEs through a competitive bidding process. David Pulver, the President of IMA, gave a private cocktail party and fundraiser for Alan Hevesi while he was Comptroller. The Comptroller and Attorney General are supposed to review the CE contract process, and the fundraiser occurred when IMA’s contract was pending review at Hevesi’s office. Alan Hevesi plead guilty to unrelated corruption charges, and was sentenced to 1-4 years on April 15, 2011.
As of 2009, IMA held the contracts for performing CEs in 12 of the 13 regions in the State, and now apparently holds all 13, even though a State investigation revealed that IMA engaged in a practice of improperly altering and submitting documents to OTDA in connection with its bids for CE contracts, as well as other improprieties. How much does the OTDA pay IMA annually? Certainly, IMA has a great incentive to retain its monopoly.
The money that goes to IMA comes from our taxes. It would seem that anyone interested in preventing the wasting of tax revenues would want to ask a lot of questions about IMA CEs. Since the State found that there was no undue influence behind the OTDA issuing contracts to IMA, why, as noted above, are claimants reflexively sent for IMA CEs when they are in fact not necessary? Even if a CE is necessary, why does the OTDA insist that IMA perform the exam when many claimants’ doctors would conduct the CE without cost to the taxpayer? How much do we actually pay IMA in total each year for CEs? How much would we save if the OTDA only sent claimants for a CE when they were actually necessary, and then to treating doctors?
Monday, March 8, 2010
IMA Disability Services
Virtually every applicant for Social Security Disability (“SSD”) benefits on Long Island, and also in many areas around New York City, gets a letter stating that he or she “must” be examined by a “specialist” from IMA Disability Services (“IMA”). The letter always encloses a release so that the claimant can receive a copy of the IMA report. These letters are misleading in several respects.
First and foremost, the use of the word “must” is misleading because most claimants do not need to be seen by a doctor from IMA. The rules require the SSA to specify exactly what information is supposedly needed, and why the SSA claims the information is needed, which is rarely done. Moreover, the rules provide that the SSA cannot insist that a claimant attend a consultative examination (“CE”), such as the IMA exam, without first seeking the particular information from the treating physicians, or asking them to clarify any alleged inconsistency. Once again, that is virtually never done.
The word “must” is also misleading because many times, even after insisting that a claimant must attend an IMA exam, and after threatening to deny a claim if the applicant refuses to attend, SSD benefits are approved anyway. I represent a DHL delivery person whose SSD application was approved today two months after he was told that he must attend an exam by IMA.
The releases provided with the IMA demands are a joke. To date, despite countless submissions of the releases, IMA has never released one of its reports. IMA will say that it lacks the authority to release its report, which IMA will claim must be requested from the State agency. However, since the State agency does not release the IMA report before making its decision, an applicant is precluded from submitting a rebuttal.
There are countless other reasons under the rules that make CEs inappropriate. Not surprisingly, since IMA makes enormous amounts of money from performing thousands of CEs, the overwhelming vast majority of the IMA reports contradict the claimant’s disability allegations. Therefore, the demands for IMA exams should be vigorously objected to in writing.
First and foremost, the use of the word “must” is misleading because most claimants do not need to be seen by a doctor from IMA. The rules require the SSA to specify exactly what information is supposedly needed, and why the SSA claims the information is needed, which is rarely done. Moreover, the rules provide that the SSA cannot insist that a claimant attend a consultative examination (“CE”), such as the IMA exam, without first seeking the particular information from the treating physicians, or asking them to clarify any alleged inconsistency. Once again, that is virtually never done.
The word “must” is also misleading because many times, even after insisting that a claimant must attend an IMA exam, and after threatening to deny a claim if the applicant refuses to attend, SSD benefits are approved anyway. I represent a DHL delivery person whose SSD application was approved today two months after he was told that he must attend an exam by IMA.
The releases provided with the IMA demands are a joke. To date, despite countless submissions of the releases, IMA has never released one of its reports. IMA will say that it lacks the authority to release its report, which IMA will claim must be requested from the State agency. However, since the State agency does not release the IMA report before making its decision, an applicant is precluded from submitting a rebuttal.
There are countless other reasons under the rules that make CEs inappropriate. Not surprisingly, since IMA makes enormous amounts of money from performing thousands of CEs, the overwhelming vast majority of the IMA reports contradict the claimant’s disability allegations. Therefore, the demands for IMA exams should be vigorously objected to in writing.
Friday, October 5, 2012
Videotaping IMA Consultative Examinations
An Administrative Law Judge issued a favorable decision today that approved the Social Security Disability (“SSD”) application of my client, a former firefighter, without requiring a hearing.
The State agency had denied the claimant’s SSD application on the fraudulent grounds that the claimant had failed to be examined by its doctors from Industrial Medicine Associates (“IMA”). That assertion was untrue. The claimant was ready, willing, and able, to be examined by IMA, and appeared at IMA’s office at the designated date and time for his consultative examination (“CE”). However, IMA refused to proceed with the CE because the claimant brought a camera to videotape the CE. In other words, it was IMA, not the claimant, who refused to proceed with the CE.
There is no rule, regulation, statute, guideline, or case law that precludes an SSD claimant from recording his or her CE. There have been countless times where IMA doctors have been banned from performing CE’s, or their opinions have been rejected, after substantial evidence or cross examinations showed they falsified CE findings. If IMA doctors perform CEs in accordance with the regulations, then they should have nothing to hide, and should have no problem with the videotaping. Videotaping an IMA CE is consistent with the SSA recording experts and witnesses at hearings. IMA has a protracted history of acting improperly. Read some of my prior entries on this topic: 11/22/10, 6/6/12, 5/17/12, 10/5/11, 6/29/12, 6/16/12, 3/8/10, 8/31/12, 8/11/08, 4/21/10, 6/4/12, 9/8/10, 8/16/12.
IMA has a contract with New York State to perform CEs, for which it gets paid a ton of taxpayer money. Medical Experts at hearings are videotaped, and IMA has no excuse or legal authority to justify its refusal to have its doctors videotaped while performing a CE ordered and paid for by New York State. Perhaps if IMA refuses to perform a large number of CEs when claimants try to videotape them, the State will terminate or refuse to renew its contract with IMA.
The State agency had denied the claimant’s SSD application on the fraudulent grounds that the claimant had failed to be examined by its doctors from Industrial Medicine Associates (“IMA”). That assertion was untrue. The claimant was ready, willing, and able, to be examined by IMA, and appeared at IMA’s office at the designated date and time for his consultative examination (“CE”). However, IMA refused to proceed with the CE because the claimant brought a camera to videotape the CE. In other words, it was IMA, not the claimant, who refused to proceed with the CE.
There is no rule, regulation, statute, guideline, or case law that precludes an SSD claimant from recording his or her CE. There have been countless times where IMA doctors have been banned from performing CE’s, or their opinions have been rejected, after substantial evidence or cross examinations showed they falsified CE findings. If IMA doctors perform CEs in accordance with the regulations, then they should have nothing to hide, and should have no problem with the videotaping. Videotaping an IMA CE is consistent with the SSA recording experts and witnesses at hearings. IMA has a protracted history of acting improperly. Read some of my prior entries on this topic: 11/22/10, 6/6/12, 5/17/12, 10/5/11, 6/29/12, 6/16/12, 3/8/10, 8/31/12, 8/11/08, 4/21/10, 6/4/12, 9/8/10, 8/16/12.
IMA has a contract with New York State to perform CEs, for which it gets paid a ton of taxpayer money. Medical Experts at hearings are videotaped, and IMA has no excuse or legal authority to justify its refusal to have its doctors videotaped while performing a CE ordered and paid for by New York State. Perhaps if IMA refuses to perform a large number of CEs when claimants try to videotape them, the State will terminate or refuse to renew its contract with IMA.
Saturday, January 31, 2015
Sadistic IMA Conduct
The Free Dictionary defines harassment as the systematic actions of a group, including threats and demands, whose purpose may be merely to gain sadistic pleasure from making someone fearful or anxious. That definition applies to the manner in which IMA Disability Services (“IMA”) treats Social Security Disability (“SSD”) claimants.
For many years, my clients have advised me that the consultative examinations (“CEs”) performed by IMA contain findings that could not have been made. Consequently, because of IMA’s dishonest conduct, I have advised claimants to videotape their CE. There is no rule prohibiting an SSD claimant from videotaping their CE, and there is a rule permitting workers compensation (“WC”) claimants to videotape examinations.
I represent an SSD claimant who appeared at IMA for a CE. IMA told him that WC claimants can videotape exams, but not SSD claimants. When my client showed IMA that the letter scheduling the CE did not prohibit videotaping the CE, IMA said that their policy is to prohibit the taping, and therefore, IMA refused to perform the CE.
IMA refused to explain why the same person could tape the exam if he were seeking disability benefits from WC, but not SSD. There is absolutely no rational[NO e] or legitimate reason to treat the same person differently just because the source of IMA’s funding is different. Therefore, logic dictates that the purpose of IMA’s systematic inconsistent and arbitrary actions is to gain sadistic pleasure from making SSD claimants fearful or anxious.
For many years, my clients have advised me that the consultative examinations (“CEs”) performed by IMA contain findings that could not have been made. Consequently, because of IMA’s dishonest conduct, I have advised claimants to videotape their CE. There is no rule prohibiting an SSD claimant from videotaping their CE, and there is a rule permitting workers compensation (“WC”) claimants to videotape examinations.
I represent an SSD claimant who appeared at IMA for a CE. IMA told him that WC claimants can videotape exams, but not SSD claimants. When my client showed IMA that the letter scheduling the CE did not prohibit videotaping the CE, IMA said that their policy is to prohibit the taping, and therefore, IMA refused to perform the CE.
IMA refused to explain why the same person could tape the exam if he were seeking disability benefits from WC, but not SSD. There is absolutely no rational[NO e] or legitimate reason to treat the same person differently just because the source of IMA’s funding is different. Therefore, logic dictates that the purpose of IMA’s systematic inconsistent and arbitrary actions is to gain sadistic pleasure from making SSD claimants fearful or anxious.
Friday, August 22, 2014
IMA Disability Services
Typing “IMA Disability Services” (“IMA”) in the search box on my blog page will reveal that I probably have written about IMA more than any other topic.
I was notified that the Social Security Disability (“SSD”) application of one of my client’s, a 54 year old custodian with back and knee problems, was approved today. On June 13, 2014, July 8, 2014, July 28, 2014, and July 29, 2014, the State agency sent my client letters stating that he had to be examined by IMA. Moreover, IMA telephoned my office and stated that they can schedule an exam and, they don’t have to send my office a letter.
Social Security has paid IMA millions of dollars to examine disability claimants. IMA is charged with knowing the rules and regulations for scheduling and performing exams as part of its contractual obligation for the exclusive right to perform the exams for Social Security. IMA is obligated to send written notification to claimants when scheduling exams.
Perhaps more importantly, when applying, I notify Social Security that neither they nor the State Agency are authorized to communicate with the claimant directly, and I cite the applicable sections of the POMS, where the attorney must be contacted after advising that the claimant does not want to be contacted by the State agency directly. As far as I am concerned, if I do not receive written notification that the State agency wants a claimant to attend an exam, then it was never scheduled. Notwithstanding the above, despite the fact that IMA sent four letters demanding that the claimant attend its exam, and despite the fact that IMA insisted that it was imperative for the claimant be examined, his SSD application was approved today, three months after it was filed.
I was notified that the Social Security Disability (“SSD”) application of one of my client’s, a 54 year old custodian with back and knee problems, was approved today. On June 13, 2014, July 8, 2014, July 28, 2014, and July 29, 2014, the State agency sent my client letters stating that he had to be examined by IMA. Moreover, IMA telephoned my office and stated that they can schedule an exam and, they don’t have to send my office a letter.
Social Security has paid IMA millions of dollars to examine disability claimants. IMA is charged with knowing the rules and regulations for scheduling and performing exams as part of its contractual obligation for the exclusive right to perform the exams for Social Security. IMA is obligated to send written notification to claimants when scheduling exams.
Perhaps more importantly, when applying, I notify Social Security that neither they nor the State Agency are authorized to communicate with the claimant directly, and I cite the applicable sections of the POMS, where the attorney must be contacted after advising that the claimant does not want to be contacted by the State agency directly. As far as I am concerned, if I do not receive written notification that the State agency wants a claimant to attend an exam, then it was never scheduled. Notwithstanding the above, despite the fact that IMA sent four letters demanding that the claimant attend its exam, and despite the fact that IMA insisted that it was imperative for the claimant be examined, his SSD application was approved today, three months after it was filed.
Friday, August 31, 2012
IMA Disability Services
After you apply for Social Security Disability (“SSD”) benefits in New York, you will be sent a letter from the Office of Temporary and Disability Assistance (“OTDA”), or will receive a call from IMA Disability Services, telling you that you “must” be examined by an IMA doctor. Sometimes, IMA will even say that your application will be denied if you do not go to the exam. For some reason, the IMA appointments are automatically scheduled without any investigation as to whether or not they are really needed.
I represent a 50 year old nurse whose SSD application was approved today, even though she had previously received a letter from OTDA telling her that it was “necessary” for IMA to examine her, and that she “must” attend the appointment. Why are claimants told to to go the IMA when the rules and regulations clearly state that the treating physicians are the preferred sources for exams? Why are claimants told they have to go to IMA exams in virtually every case when it is not true? The answer may have nothing to do with a claimant’s medical evidence.
The OTDA pays IMA a great deal of money for examining claimants, which money comes from our taxes. The fact that the OTDA automatically pays for IMA exams that are not necessary means that tax revenues are being wasted. Even if an exam were actually necessary, the why doesn’t the OTDA ask the claimants’ doctors to do the exam, especially since many would do so without requiring payment from the OTDA; that is, without cost to the taxpayer? How much do taxpayers pay IMA annually for unnecessary exams?
I represent a 50 year old nurse whose SSD application was approved today, even though she had previously received a letter from OTDA telling her that it was “necessary” for IMA to examine her, and that she “must” attend the appointment. Why are claimants told to to go the IMA when the rules and regulations clearly state that the treating physicians are the preferred sources for exams? Why are claimants told they have to go to IMA exams in virtually every case when it is not true? The answer may have nothing to do with a claimant’s medical evidence.
The OTDA pays IMA a great deal of money for examining claimants, which money comes from our taxes. The fact that the OTDA automatically pays for IMA exams that are not necessary means that tax revenues are being wasted. Even if an exam were actually necessary, the why doesn’t the OTDA ask the claimants’ doctors to do the exam, especially since many would do so without requiring payment from the OTDA; that is, without cost to the taxpayer? How much do taxpayers pay IMA annually for unnecessary exams?
Wednesday, April 21, 2010
Deceptive SSA Notices
The Office of Temporary & Disability Assistance (the “State agency”) is responsible for making the initial decision on Social Security Disability (“SSD”) claims in New York. The State agency sends letters to SSD applicants stating that he or she “must keep the appointment” to be examined by a “specialist” from IMA Disability Services (“IMA”). The letters are frequently followed by phone calls from IMA threatening that the application will be denied if the claimant fails to appear for the appointment.
As a legal matter, it is untrue that a claimant “must keep the appointment.” The truth is that most claimants do not need to be seen by a doctor from IMA. The rules provide that a claimant cannot be compelled to attend a consultative examination (“CE”), such as the IMA exam, without first seeking the particular information from the treating physicians, or asking them to clarify any alleged inconsistency in the medical evidence. However, the State agency sends the letters for the IMA CE without complying with the rules.
As a factual matter, it is also untrue that a claimant “must” attend the IMA CE. Many times, even after insisting that a claimant must attend an IMA exam, and after threatening to deny a claim if the applicant refuses to attend, SSD benefits are approved anyway. I represent a 59 year old former nurse whose SSD application was approved today six weeks after she was told that she must attend an exam by IMA.
There are countless other reasons why most demands for a claimant to attend a CE violate the rules. Not surprisingly, since IMA makes enormous amounts of money from performing thousands of CEs, they try to make claimants believe that they have no right to refuse to attend a CE. Therefore, letters insisting that a claimant attend a CE should be objected to in writing, preferably citing the regulatory basis for the objections.
As a legal matter, it is untrue that a claimant “must keep the appointment.” The truth is that most claimants do not need to be seen by a doctor from IMA. The rules provide that a claimant cannot be compelled to attend a consultative examination (“CE”), such as the IMA exam, without first seeking the particular information from the treating physicians, or asking them to clarify any alleged inconsistency in the medical evidence. However, the State agency sends the letters for the IMA CE without complying with the rules.
As a factual matter, it is also untrue that a claimant “must” attend the IMA CE. Many times, even after insisting that a claimant must attend an IMA exam, and after threatening to deny a claim if the applicant refuses to attend, SSD benefits are approved anyway. I represent a 59 year old former nurse whose SSD application was approved today six weeks after she was told that she must attend an exam by IMA.
There are countless other reasons why most demands for a claimant to attend a CE violate the rules. Not surprisingly, since IMA makes enormous amounts of money from performing thousands of CEs, they try to make claimants believe that they have no right to refuse to attend a CE. Therefore, letters insisting that a claimant attend a CE should be objected to in writing, preferably citing the regulatory basis for the objections.
Saturday, January 16, 2016
IMA Folly
I represent a 60 year old former institutional cook whose Social Security Disability (“SSD”) application was approved today, but not before IMA Disability Associates (“IMA”) sent over a half dozen letters insisting that he must attend a consultative examination (“CE”). My client did not.
On October 22, 2015 and October 23, 2016, the State agency sent letters stating that the claimant “must” attend a CE because it was “necessary” for him to be examined by IMA. Both letters were received on October 26, 2015. That day, I faxed the State agency a detailed seven page letter explaining the reasons why scheduling a CE with IMA was improper. My letter specified that the claimant was not refusing to attend a CE, but asked the State agency to address the questions raised in my letter raised first.
On November 5, 2015, the State agency refused to address the issues raised in my October 26, 2015, and said that this was the claimant’s last chance to attend a CE. The State agency then send another notice on November 10, 2015, reiterating that the claimant “must” attend a CE because it was “necessary” for him to be examined by IMA. On November 12, 2015, I replied that the claimant would attend the CE as soon as the State agency responded to the matters raised in my October 26, 2015 letter.
The State agency continued to refuse to cooperate, and instead, on November 16, 2015, sent yet another CE notice stating that the claimant “must” attend a CE on November 16, 2015, because it was “necessary” for him to be examined by IMA. On November 18, 2015, I faxed the State agency we received their letter on November 17, 2015, the day after the CE was scheduled. Moreover, I advised the State agency that I sent them a detailed report from the claimant’s pain management specialist, together with a lumbar spine MRI, which obviated any supposed need for the CE. I added that if they believed otherwise, then respond to each of the matters raised in my October 26, 2015 letter.
The State agency never attempted to address any of the issues raised in my October 26, 2015 letter, and it did finally approve SSD benefits, but the claimant never went to IMA for a CE. The question is, why does the State agency keep telling claimants that claimants “must” attend IMA CEs when that is not true.
On October 22, 2015 and October 23, 2016, the State agency sent letters stating that the claimant “must” attend a CE because it was “necessary” for him to be examined by IMA. Both letters were received on October 26, 2015. That day, I faxed the State agency a detailed seven page letter explaining the reasons why scheduling a CE with IMA was improper. My letter specified that the claimant was not refusing to attend a CE, but asked the State agency to address the questions raised in my letter raised first.
On November 5, 2015, the State agency refused to address the issues raised in my October 26, 2015, and said that this was the claimant’s last chance to attend a CE. The State agency then send another notice on November 10, 2015, reiterating that the claimant “must” attend a CE because it was “necessary” for him to be examined by IMA. On November 12, 2015, I replied that the claimant would attend the CE as soon as the State agency responded to the matters raised in my October 26, 2015 letter.
The State agency continued to refuse to cooperate, and instead, on November 16, 2015, sent yet another CE notice stating that the claimant “must” attend a CE on November 16, 2015, because it was “necessary” for him to be examined by IMA. On November 18, 2015, I faxed the State agency we received their letter on November 17, 2015, the day after the CE was scheduled. Moreover, I advised the State agency that I sent them a detailed report from the claimant’s pain management specialist, together with a lumbar spine MRI, which obviated any supposed need for the CE. I added that if they believed otherwise, then respond to each of the matters raised in my October 26, 2015 letter.
The State agency never attempted to address any of the issues raised in my October 26, 2015 letter, and it did finally approve SSD benefits, but the claimant never went to IMA for a CE. The question is, why does the State agency keep telling claimants that claimants “must” attend IMA CEs when that is not true.
Wednesday, October 2, 2024
"Let's Get Loud" Series - DDS's Laziness
by Susan Golden
Claimant 4 – Consultative Exams ordered by the State agency
Ms. G applied for SSD benefits on June 26, 2024. Ms. G was an elementary school teacher for 33 years. She suffers from severe migraines, vertigo, severe back problems and anorexia, to name a few of her impairments. On August 5, 2024, we submitted supporting medical reports from Ms. G’s treating doctors, which included an EMG and a pharmacy printout.
On August 22, 2024, my assistant, Samantha Diamond, received a phone call from Mr. Begelman, the analyst at the State agency assigned to Ms. G’s case. He was calling to advise us that he was scheduling Ms. G. for a Consultative Exam (“CE”) with the IMA, the company that SS contracts with to perform CE’s. According to the regulations, CE’s are supposed to be scheduled only after making best efforts to obtain the necessary information from the treating sources, which are the preferred source. When Ms. Diamond asked Mr. Begelmann= if he had reviewed Ms. G’s file and seen what we submitted, he admitted that he hadn’t even looked at the file yet. So without even knowing what was or was not needed, and without doing the bare minimum required by the regulations, Mr. Begelman scheduled Ms. G for a CE with IMA.
Notably, most of the time the “specialists” at IMA are from the wrong medical board, if they are certified at all, let alone trained in the specialty that is relevant to the claimant’s impairments. Additionally, IMA doctors claim they do not have any records or information from the State agency about claimants, which begs the question, how do they know what exam to perform? IMA also has signs all over their offices which state that Social Security claimants are not allowed to record their exams, yet in small print on the same sign it states that Workers’ Comp claimants are allowed. That disparate treatment is ridiculous, and if our claimant tries to record an exam, the IMA employees cry that their HIPAA rights are being violated. HIPAA only applies to a person’s medical information - it provides no rights, and has no relevance, to IMA staff. Since IMA admits to allowing Workers Comp claimants to record exams in the very same offices where the SS claimants are being examined, by the very same staff, and the very same doctors, then IMA must be confessing to countless HIPPA violations.
Tuesday, July 14, 2015
Report IMA & DDS Fraud To Inspector General
When a Social Security hearing office receives a disability appeal, it sends the claimant form HA-L2, which is a Request for Hearing Acknowledgment Letter. At the bottom of the first page of Form HA-L2 in bold face type is the (800) 269-0271 telephone number for the Inspector General’s Fraud Hotline, in case you “Suspect Social Security Fraud.” Presumably, that warning is designed to intimidate claimants.
In all my years representing Social Security Disability (“SSD”) claimants, I can think of only one instance of a claimant attempting to perpetrate a fraud. On the other hand, on a seemingly weekly basis, I find the Disability Determination Services (“DDS”) and its contractor, IMA, committing fraud. Claimants and their advocates should call the Inspector General’s Fraud Hotline when DDS or IMA fraud is suspected.
One of my client’s eFolder became accessible today. A review of the eFolder revealed several instances of fraud by the DDS and IMA.
The second fraudulent assertion that Kumar made was that the CE was needed because there was insufficient evidence to evaluate the claim. The file contains over a hundred pages of treatment records, functionality opinions, and diagnostic testing. To compound matters, I sent a detailed seven page single spaced letter to the DDS, asking them to identify any additional medical evidence that they claimed was needed to evaluate the claim. As always, instead of specifying a single piece of medical evidence they purportedly needed, the DDS simply sent a second CE notice, despite my having sent them that detailed letter, which among other things stated:
"In order for me to have the chance to obtain the information that you claim you need, you need to clarify precisely what information you are seeking. Simply resending a notice with a new CE date fails to fulfill your responsibility to develop the record, and shows that you lack any valid reason for the CE."
Kumar’s third fraudulent misrepresentation was that stating “No RFC /MRFC assessments are associated with this claim.” Contrary to Kumar’s unambiguous statement, the eFolder contained, not one, but two, Residual Functional Capacity (“RFC”) assessments. In fact, the RFC from the claimant’s orthopedist appears in the eFolder twice. There was also an RFC from the claimant’s cardiologist. It was impossible for Kumar to have missed all three reports when reviewing the claimant’s file. Nonetheless, Kumar stated in no uncertain terms that no RFC assessment was in the eFolder.
The fourth instance of fraud also concerns the CE. Kumar wrote that the claimant missed both CE appointments. As discussed below, that statement is demonstrably false. However, giving Kumar the benefit of the doubt, it is possible that Kumar was provided with the false information by IMA.
In the eFolder is form DDD-4184, entitled CE Appointment Notice History. The form DDD-4184 states that the claimant did not keep the appointment for the CE. It is unclear who prepared form DDD-4184, but it is clear that whoever did so, committed fraud. The claimant has photographs of him entering the IMA offices. The claimant also has videotape of him inside the IMA offices, being told to leave by IMA. It is a blatant and undeniable lie that the claimant did not keep the appointment.
As stated in prior posts, I would advise claimants to videotape their CE. There is nothing in the Social Security statute, regulations, POMS, HALLEX, or case law that precludes videotaping a CE. Furthermore, I secured a copy of the contract that IMA has with the DDS, and there is nothing in it that prohibits videotaping a CE.
In all my years representing Social Security Disability (“SSD”) claimants, I can think of only one instance of a claimant attempting to perpetrate a fraud. On the other hand, on a seemingly weekly basis, I find the Disability Determination Services (“DDS”) and its contractor, IMA, committing fraud. Claimants and their advocates should call the Inspector General’s Fraud Hotline when DDS or IMA fraud is suspected.
One of my client’s eFolder became accessible today. A review of the eFolder revealed several instances of fraud by the DDS and IMA.
First, a DDS examiner named V. Kumar wrote that the claimant’s doctors refused to perform a consultative examination (“CE”) for the state approved vendor fee. That was a lie. Neither Kumar nor anybody else from the DDS ever contacted any of the claimant’s doctors to ask them if they would perform a CE, let alone ask them if they would perform a CE for any particular fee. What makes Kumar’s fraudulent misrepresentation especially appalling is that I had sent a letter about the CE, which stated:
"the treating physicians are ready, willing, and able to perform a CE, but you have not asked them to perform a CE. I have spoken with the claimant who has agreed to pay any difference between what you are willing to pay and the amount the treating doctor would charge. Therefore, do not falsely claim that a treating source refused to do the CE because of the fee involved."
If you have a case that is pending at a hearing office, I would suggest reviewing the eCAT report to see what the DDS examiner wrote.
If you have a case that is pending at a hearing office, I would suggest reviewing the eCAT report to see what the DDS examiner wrote.
The second fraudulent assertion that Kumar made was that the CE was needed because there was insufficient evidence to evaluate the claim. The file contains over a hundred pages of treatment records, functionality opinions, and diagnostic testing. To compound matters, I sent a detailed seven page single spaced letter to the DDS, asking them to identify any additional medical evidence that they claimed was needed to evaluate the claim. As always, instead of specifying a single piece of medical evidence they purportedly needed, the DDS simply sent a second CE notice, despite my having sent them that detailed letter, which among other things stated:
"In order for me to have the chance to obtain the information that you claim you need, you need to clarify precisely what information you are seeking. Simply resending a notice with a new CE date fails to fulfill your responsibility to develop the record, and shows that you lack any valid reason for the CE."
Kumar’s third fraudulent misrepresentation was that stating “No RFC /MRFC assessments are associated with this claim.” Contrary to Kumar’s unambiguous statement, the eFolder contained, not one, but two, Residual Functional Capacity (“RFC”) assessments. In fact, the RFC from the claimant’s orthopedist appears in the eFolder twice. There was also an RFC from the claimant’s cardiologist. It was impossible for Kumar to have missed all three reports when reviewing the claimant’s file. Nonetheless, Kumar stated in no uncertain terms that no RFC assessment was in the eFolder.
The fourth instance of fraud also concerns the CE. Kumar wrote that the claimant missed both CE appointments. As discussed below, that statement is demonstrably false. However, giving Kumar the benefit of the doubt, it is possible that Kumar was provided with the false information by IMA.
In the eFolder is form DDD-4184, entitled CE Appointment Notice History. The form DDD-4184 states that the claimant did not keep the appointment for the CE. It is unclear who prepared form DDD-4184, but it is clear that whoever did so, committed fraud. The claimant has photographs of him entering the IMA offices. The claimant also has videotape of him inside the IMA offices, being told to leave by IMA. It is a blatant and undeniable lie that the claimant did not keep the appointment.
As stated in prior posts, I would advise claimants to videotape their CE. There is nothing in the Social Security statute, regulations, POMS, HALLEX, or case law that precludes videotaping a CE. Furthermore, I secured a copy of the contract that IMA has with the DDS, and there is nothing in it that prohibits videotaping a CE.
Monday, August 19, 2019
Videotaping IMA
When applying for Social Security Disability (“SSD”) in New York, Industrial Medicine Associates (“IMA”) has been performing the consultative examinations (“CEs”) for the State agency for many years now. One of the reasons to videotape IMA CEs is to preserve first hand evidence. As an SSD attorney, I advise all of my clients to videotape their CEs for this very reason.
I represent a 23 year old former clerical assistant with rheumatoid arthritis and a knee injury. An administrative law judge (“ALJ”) approved her SSD application today, which would have been denied if the IMA CE had not been videotaped.
The State agency initially denied the claim by disregarding everything the treating specialist concluded, and by having its doctor, Verdella Cincore, claim that the IMA CE report showed the claimant was not disabled.
According to the New York State Department of Health, Cincore is an ob/gyn, who lacks any board certification. The American Board of Medical Specialties also confirmed that there is no physician named Cincore in the United States who is board certified in any field of medicine. Dozens of websites, including Good Samaritan Hospital, Healthgrades, Doximity, Zoddoc, NPI, HIPAASpace, Medcarelist, all state that Cincore holds herself out as an ob/gyn. According to medicinenet.com, “OB is short for obstetrics or for an obstetrician, a physician who delivers babies. GYN is short for gynecology or for a gynecologist, a physician who specializes in treating diseases of the female reproductive organ.” It should be obvious that an ob/gyn is not the appropriate specialist to evaluate the claimant’s impairments, which have absolutely nothing to do with delivering babies or the female reproductive organ.
The IMA doctor diagnosed the claimant with complex regional pain syndrome, rheumatoid arthritis, and hypothyroidism, which he wrote resulted in “Moderate to marked restrictions with walking, climbing, kneeling, squatting, bending, and prolonged standing.” However, the videotape of the CE revealed the IMA doctor unambiguously stating that the claimant should get disability benefits, and that it would be unreasonable if she did not get SSD benefits. In the absence of that videotape, the ALJ would have stated that the IMA doctor concluded the claimant could perform sedentary work, and would have denied the SSD application.
I represent a 23 year old former clerical assistant with rheumatoid arthritis and a knee injury. An administrative law judge (“ALJ”) approved her SSD application today, which would have been denied if the IMA CE had not been videotaped.
The State agency initially denied the claim by disregarding everything the treating specialist concluded, and by having its doctor, Verdella Cincore, claim that the IMA CE report showed the claimant was not disabled.
According to the New York State Department of Health, Cincore is an ob/gyn, who lacks any board certification. The American Board of Medical Specialties also confirmed that there is no physician named Cincore in the United States who is board certified in any field of medicine. Dozens of websites, including Good Samaritan Hospital, Healthgrades, Doximity, Zoddoc, NPI, HIPAASpace, Medcarelist, all state that Cincore holds herself out as an ob/gyn. According to medicinenet.com, “OB is short for obstetrics or for an obstetrician, a physician who delivers babies. GYN is short for gynecology or for a gynecologist, a physician who specializes in treating diseases of the female reproductive organ.” It should be obvious that an ob/gyn is not the appropriate specialist to evaluate the claimant’s impairments, which have absolutely nothing to do with delivering babies or the female reproductive organ.
The IMA doctor diagnosed the claimant with complex regional pain syndrome, rheumatoid arthritis, and hypothyroidism, which he wrote resulted in “Moderate to marked restrictions with walking, climbing, kneeling, squatting, bending, and prolonged standing.” However, the videotape of the CE revealed the IMA doctor unambiguously stating that the claimant should get disability benefits, and that it would be unreasonable if she did not get SSD benefits. In the absence of that videotape, the ALJ would have stated that the IMA doctor concluded the claimant could perform sedentary work, and would have denied the SSD application.
Saturday, January 16, 2016
SSA Self Policing
“Letting a fox guard the henhouse” illustrates the foolishness of placing a person in charge of something when they have a conflict of interest. When you assign somebody a duty that places that person into a position where he can exploit the situation for his own benefit, then you are letting the proverbial fox guard the henhouse. That is the situation created by allowing the Social Security Administration (“SSA”) to decide the propriety of Freedom of Information Act (“FOIA”) requests.
We represent a claimant for Social Security Disability ("SSD") benefits. Despite the fact we had submitted supporting evidence from his treating doctors, the SSA scheduled a Consultative Exam ("CE") for him. The client went to the CE, even though he was in a lot of pain, but when he arrived IMA said the CE doctor was out that day. No one from the SSA, State agency, or IMA ever tried to reach the claimant to tell him the CE doctor would not in that day.
To prove that the DDS/IMA were committing fraud, we filed a FOIA request. Our request included: 1. The number of other patients the CE doctor was scheduled to see that same day, May 8, 2015, at the IMA offices in Hempstead, NY. 2. A copy of all the other patients' medical reports (with the names and Social Security numbers redacted) from May 8, 2015, who were examined by the same doctor that was scheduled to examine our client on that date. 3. The time records for all exams performed by the Hempstead IMA doctors on May 8, 2015.
In response to our FOIA request, Mary Ann Zimmerman, Acting Privacy Officer, claimed that she did not have our client’s Social Security number, even though it was right at the top of the FOIA request. Yes, Zimmerman claimed that she could not see the Social Security number, which was the very subject of the FOIA request. Then, to make matters even worse, Zimmerman claimed that she did not have proof that we are the claimant's Appointed Representative, even though the SSA had already acknowledged receiving the proof.
Zimmerman then claimed that she needed the written consent of the claimant whose records were requested. However, we never asked for any personally identifiable information. In fact, we specifically asked for "a copy of all the other patients' medical reports (with the names and Social Security numbers redacted) who were examined on May 8, 2015. In other words, Zimmerman’s response was nonsensical at best as there cannot be a need for the written consent of people when no personally identifiable information was requested. Since we explicitly stated that no personally identifiable information was requested, it is not possible for the FOIA request to constitute an invasion of anyone's personal privacy or violation of the Privacy Act.
Not surprisingly, the SSA’s Glenn Sklar upheld the decision to deny the FOIA request by citing boilerplate language about the FOIA. Sklar’s only individualized claim was that releasing generic information about the number of exams and their duration performed by IMA doctors would somehow lead to the disclosure of personally identifiable information. Sklar knows that rationalization is a lie because it is impossible to identify a claimant who went for an IMA exam by providing the number of IMA exams and their duration. That is the type of opprobrious misconduct that occurs when you allow the SSA to police itself.
We represent a claimant for Social Security Disability ("SSD") benefits. Despite the fact we had submitted supporting evidence from his treating doctors, the SSA scheduled a Consultative Exam ("CE") for him. The client went to the CE, even though he was in a lot of pain, but when he arrived IMA said the CE doctor was out that day. No one from the SSA, State agency, or IMA ever tried to reach the claimant to tell him the CE doctor would not in that day.
To prove that the DDS/IMA were committing fraud, we filed a FOIA request. Our request included: 1. The number of other patients the CE doctor was scheduled to see that same day, May 8, 2015, at the IMA offices in Hempstead, NY. 2. A copy of all the other patients' medical reports (with the names and Social Security numbers redacted) from May 8, 2015, who were examined by the same doctor that was scheduled to examine our client on that date. 3. The time records for all exams performed by the Hempstead IMA doctors on May 8, 2015.
In response to our FOIA request, Mary Ann Zimmerman, Acting Privacy Officer, claimed that she did not have our client’s Social Security number, even though it was right at the top of the FOIA request. Yes, Zimmerman claimed that she could not see the Social Security number, which was the very subject of the FOIA request. Then, to make matters even worse, Zimmerman claimed that she did not have proof that we are the claimant's Appointed Representative, even though the SSA had already acknowledged receiving the proof.
Zimmerman then claimed that she needed the written consent of the claimant whose records were requested. However, we never asked for any personally identifiable information. In fact, we specifically asked for "a copy of all the other patients' medical reports (with the names and Social Security numbers redacted) who were examined on May 8, 2015. In other words, Zimmerman’s response was nonsensical at best as there cannot be a need for the written consent of people when no personally identifiable information was requested. Since we explicitly stated that no personally identifiable information was requested, it is not possible for the FOIA request to constitute an invasion of anyone's personal privacy or violation of the Privacy Act.
Not surprisingly, the SSA’s Glenn Sklar upheld the decision to deny the FOIA request by citing boilerplate language about the FOIA. Sklar’s only individualized claim was that releasing generic information about the number of exams and their duration performed by IMA doctors would somehow lead to the disclosure of personally identifiable information. Sklar knows that rationalization is a lie because it is impossible to identify a claimant who went for an IMA exam by providing the number of IMA exams and their duration. That is the type of opprobrious misconduct that occurs when you allow the SSA to police itself.
Saturday, July 23, 2022
IMA & DDS
The questionable relationship between IMA and the State agency continues, without any meaningful oversight. It seems nobody is concerned about the thousands of unnecessary exams.
We were retained by a 55 year old pharmacy tech from West Babylon with progressive orthopedic impairments following a motor vehicle accident, after her Social Security Disability (“SSD”) application was denied. As usual, the claimant was sent a letter stating that it was “necessary for” her to be examined by an unnamed doctor from IMA Disability Services.
In light of the persistent COVID-19 pandemic, we advised the State agency that it was more important now than ever to comply with the regulation concerning a consultative examination (“CE”). After all, according to Social Security’s website, they continue to conduct many hearings by telephone due to COVID-19. We advised the State agency to make a decision because the claimant was not willing to postpone a CE with IMA. Additionally, we advised the State agency that whatever information it believed was needed from IMA, could be requested from the claimant’s medical sources, who are the preferred source pursuant to the regulations.
The claimant did not attend a CE with IMA. We received a Notice of Award today for the claimant, who provided all her medical records and reports from her doctors. The State agency’s motivation for disregarding the CE regulations remains unclear. However, it is clear that the State agency’s letters asserting the IMA CEs are “necessary” is untrue. The claimant’s application should never have been denied in the first place.
Friday, October 24, 2014
Video Taping Consultative Examination
For virtually every Social Security Disability (“SSD”) claim, the State Agency sends letters to claimants telling them that they have to attend a consultative examination (“CE”). In New York, the State Agency contracted with Industrial Medicine Associates (“IMA”) to perform the CEs.
There is no Social Security ruling, regulation, statute, guideline, POMS, HALLEX, or case law that precludes an SSD claimant from video recording his or her CE. To the contrary, video taping an IMA CE is consistent with the SSA tape recording experts and witnesses at hearings. Notably, section 137 of the Workers’ Compensation law specifies that a claimant has the “right to video tape or otherwise record” an examination.
One of my clients appeared at IMA for his CE. However, the IMA office manager refused to allow the CE to proceed because the claimant wanted to video tape it. The IMA office manager stated that they had the “discretion” to refuse to be video taped. When the claimant asserted his right to videotape the CE, the office manager told him to leave.
Because the claimant video taped the IMA office manager saying that they had the “discretion” to refuse to be video taped, and telling him to leave, it is undeniable that IMA, not my client, refused to proceed with the CE. That videotape will prove that any assertion by the State agency that the claimant “failed to cooperate” is a lie, as he was ready, willing, and able to examined.
There is no Social Security ruling, regulation, statute, guideline, POMS, HALLEX, or case law that precludes an SSD claimant from video recording his or her CE. To the contrary, video taping an IMA CE is consistent with the SSA tape recording experts and witnesses at hearings. Notably, section 137 of the Workers’ Compensation law specifies that a claimant has the “right to video tape or otherwise record” an examination.
One of my clients appeared at IMA for his CE. However, the IMA office manager refused to allow the CE to proceed because the claimant wanted to video tape it. The IMA office manager stated that they had the “discretion” to refuse to be video taped. When the claimant asserted his right to videotape the CE, the office manager told him to leave.
Because the claimant video taped the IMA office manager saying that they had the “discretion” to refuse to be video taped, and telling him to leave, it is undeniable that IMA, not my client, refused to proceed with the CE. That videotape will prove that any assertion by the State agency that the claimant “failed to cooperate” is a lie, as he was ready, willing, and able to examined.
Wednesday, September 8, 2010
IMA Disability Services
The Office of Temporary & Disability Assistance (the “State agency”) is responsible for making the initial decision on Social Security Disability (“SSD”) claims in New York. The State agency sends letters to SSD applicants stating that he or she “must” be examined by a “Specialist” from “IMA Disability Services” (“IMA”). The letter is frequently followed by phone calls warning that the application will be denied if the claimant fails to appear for the appointment. These letters are misleading.
The use of the word “must” is misleading because most claimants do not need to be seen by a doctor from IMA. I represent a former cosmetology account manager whose SSD application was approved a few weeks after being told that she “must” attend an exam by an unnamed “specialist” IMA, which exam she refused to attend. Among other things, the SSA cannot require a claimant to attend a consultative examination (“CE”), such as the IMA exam, without first asking the treating physician to perform it.
There are countless other reasons why most demands for a claimant to attend a CE violate the rules. Not surprisingly, since IMA makes enormous amounts of money from performing thousands of CEs, they try to make claimants believe that they have no right to refuse to attend a CE. Therefore, a claimant should send written objections to the State agency specifying the factual and legal reasons why the CE would violate the rules and regulations.
The use of the word “must” is misleading because most claimants do not need to be seen by a doctor from IMA. I represent a former cosmetology account manager whose SSD application was approved a few weeks after being told that she “must” attend an exam by an unnamed “specialist” IMA, which exam she refused to attend. Among other things, the SSA cannot require a claimant to attend a consultative examination (“CE”), such as the IMA exam, without first asking the treating physician to perform it.
There are countless other reasons why most demands for a claimant to attend a CE violate the rules. Not surprisingly, since IMA makes enormous amounts of money from performing thousands of CEs, they try to make claimants believe that they have no right to refuse to attend a CE. Therefore, a claimant should send written objections to the State agency specifying the factual and legal reasons why the CE would violate the rules and regulations.
Monday, March 5, 2018
IMA Disability Services
Don’t believe everything you hear; especially when it comes from IMA Disability Services (“IMA”).
I represent a 58 year old construction foreman, whose job was very heavy work. He had rheumatoid arthritis and carpal tunnel syndrome, which prevented him from continuing to work. As usual, the State agency directed the claimant to attend a consultative examination (“CE”).
I advised my client to videotape the CE. Two weeks ago, he went to the IMA office in Bohemia with his wife, who was videotaping the entire CE process with her cell phone. He was taken for an x-ray before the physical examination. Before the x-ray was taken, an IMA representative told the claimant that he was not allowed to record the CE. When the claimant insisted that he had the right to videotape his own exam, he was told that the CE would not proceed and to leave.
As the claimant was leaving IMA, he was told that he would be back the next week. The claimant never returned to IMA, and he received his Social Security Disability (“SSD”) check in the mail today.
I represent a 58 year old construction foreman, whose job was very heavy work. He had rheumatoid arthritis and carpal tunnel syndrome, which prevented him from continuing to work. As usual, the State agency directed the claimant to attend a consultative examination (“CE”).
I advised my client to videotape the CE. Two weeks ago, he went to the IMA office in Bohemia with his wife, who was videotaping the entire CE process with her cell phone. He was taken for an x-ray before the physical examination. Before the x-ray was taken, an IMA representative told the claimant that he was not allowed to record the CE. When the claimant insisted that he had the right to videotape his own exam, he was told that the CE would not proceed and to leave.
As the claimant was leaving IMA, he was told that he would be back the next week. The claimant never returned to IMA, and he received his Social Security Disability (“SSD”) check in the mail today.
Monday, June 4, 2012
Why Bother With An Exam By IMA?
When filing for Social Security Disability ("SSD") benefits, the Social Security Administration ("SSA") usually asks claimants to be examined by one of its doctors in what is referred to as a consultative examination ("CE"). In New York, you will probably be sent to a doctor from Industrial Medicine Associates (“IMA”) for the CE.
The SSA requires a CE in the vast majority of cases even though the regulations actually permit CEs in very limited circumstances. If a CE is actually needed, then it is supposed to be performed by a treating doctor. The SSA leads claimants to believe that their SSD application will be denied if they refuse to attend the CE.
A CE is a single exam, with a vague opinion regarding a claimant’s functionality. The courts have ruled that a CE opinion is usually entitled to little or no weight. Therefore, why do we as tax payers pay millions of dollars for CEs?
A 54 year old former electrician retained me after the SSA denied his SSD application. The opinion from the IMA CE included that the claimant must avoid even mild exertion, which indicates that he could not even do sedentary work. Moreover, the IMA CE concluded that the claimant had “moderate” limitations walking, standing, and sitting. Light work requires frequent standing and walking. A moderate limitation would be inconsistent with light work, which requires 6 hours of being on one’s feet out of 8. A moderate limitation could also be inconsistent with sedentary work, which only requires 2 hours of being on one’s feet out of 8. Similarly, a moderate limitation of lifting and carrying would be inconsistent with light work, which requires lifting 20 lbs. A moderate limitation may be consistent with sedentary work, which only requires lifting 10 pounds.
Under the SSA medical-vocational rules, the claimant had to be found disabled even if able to do sedentary or light work. Thus, the claimant had to be able to do medium work, which requires lifting up to 50 pounds, not to be found disabled. Although the CE opinion described above showed the claimant could not do sedentary work, let alone light work, the State agency had denied the application.
When I was retained, I secured a report from the claimant’s orthopedist, which specified the claimant lacked the ability to lift, carry, walk, stand, and sit needed to do sedentary work. I submitted that report when I appealed the State agency decision to the SSA. The SSA approved the application today without a hearing based on the treating orthopedist’s opinion.
The question arises why wasn’t the application approved based upon the IMA CE? The great majority of CE opinions contend that claimants are not disabled, which are accepted as the basis for denying applications. Why then, in the rare situation where a CE shows a claimant is disabled does the State agency still deny the application? What is the purpose of an IMA CE when regardless of its opinion it will be used to deny an application? What is the purpose of an IMA CE when the SSA rejects it as a one time exam that the regulations require be given little weight?
The Wall Street Journal wrote an article that tried to blame the SSA’s financial problems on attorneys representing disabled people. Perhaps that paper’s resources would be more productively spent directing its attention to the CE boondoggle. Whereas attorneys are making sure that the rules and regulations are being applied, CEs are being ordered by the tens of thousands in violation of the rules and regulations.
The SSA requires a CE in the vast majority of cases even though the regulations actually permit CEs in very limited circumstances. If a CE is actually needed, then it is supposed to be performed by a treating doctor. The SSA leads claimants to believe that their SSD application will be denied if they refuse to attend the CE.
A CE is a single exam, with a vague opinion regarding a claimant’s functionality. The courts have ruled that a CE opinion is usually entitled to little or no weight. Therefore, why do we as tax payers pay millions of dollars for CEs?
A 54 year old former electrician retained me after the SSA denied his SSD application. The opinion from the IMA CE included that the claimant must avoid even mild exertion, which indicates that he could not even do sedentary work. Moreover, the IMA CE concluded that the claimant had “moderate” limitations walking, standing, and sitting. Light work requires frequent standing and walking. A moderate limitation would be inconsistent with light work, which requires 6 hours of being on one’s feet out of 8. A moderate limitation could also be inconsistent with sedentary work, which only requires 2 hours of being on one’s feet out of 8. Similarly, a moderate limitation of lifting and carrying would be inconsistent with light work, which requires lifting 20 lbs. A moderate limitation may be consistent with sedentary work, which only requires lifting 10 pounds.
Under the SSA medical-vocational rules, the claimant had to be found disabled even if able to do sedentary or light work. Thus, the claimant had to be able to do medium work, which requires lifting up to 50 pounds, not to be found disabled. Although the CE opinion described above showed the claimant could not do sedentary work, let alone light work, the State agency had denied the application.
When I was retained, I secured a report from the claimant’s orthopedist, which specified the claimant lacked the ability to lift, carry, walk, stand, and sit needed to do sedentary work. I submitted that report when I appealed the State agency decision to the SSA. The SSA approved the application today without a hearing based on the treating orthopedist’s opinion.
The question arises why wasn’t the application approved based upon the IMA CE? The great majority of CE opinions contend that claimants are not disabled, which are accepted as the basis for denying applications. Why then, in the rare situation where a CE shows a claimant is disabled does the State agency still deny the application? What is the purpose of an IMA CE when regardless of its opinion it will be used to deny an application? What is the purpose of an IMA CE when the SSA rejects it as a one time exam that the regulations require be given little weight?
The Wall Street Journal wrote an article that tried to blame the SSA’s financial problems on attorneys representing disabled people. Perhaps that paper’s resources would be more productively spent directing its attention to the CE boondoggle. Whereas attorneys are making sure that the rules and regulations are being applied, CEs are being ordered by the tens of thousands in violation of the rules and regulations.
Tuesday, March 17, 2015
IMA Evading Law Again
I represent a 51 year old home improvement contractor with back and shoulder problems, whose Social Security Disability (“SSD”) benefits were approved today despite IMA Disability Services (“IMA”)’s attempt to circumvent my legal representation. No hearing was required.
IMA performs consultative examinations (“CEs”) for the Social Security Administration (“SSA”) in New York. When the SSA asks IMA to do a CE, information regarding the claimant’s attorney is provided to IMA. Nonetheless, with surprisingly regularity, IMA fails to copy my office when sending letters to claimants that state they must attend the CE.
I submitted medical reports and records from the claimant’s orthopedists, neurosurgeons, physical therapist, pain management specialist, that the SSA found sufficient to approved SSD benefits. The perfunctory CEs, frequently performed by inappropriate, rarely are consistent with the supporting reports of the treating doctors. Had the claimant attended the CE, his SSD application almost certainly would have been denied.
IMA performs consultative examinations (“CEs”) for the Social Security Administration (“SSA”) in New York. When the SSA asks IMA to do a CE, information regarding the claimant’s attorney is provided to IMA. Nonetheless, with surprisingly regularity, IMA fails to copy my office when sending letters to claimants that state they must attend the CE.
I submitted medical reports and records from the claimant’s orthopedists, neurosurgeons, physical therapist, pain management specialist, that the SSA found sufficient to approved SSD benefits. The perfunctory CEs, frequently performed by inappropriate, rarely are consistent with the supporting reports of the treating doctors. Had the claimant attended the CE, his SSD application almost certainly would have been denied.
Tuesday, July 24, 2018
Recording A CE
Regardless of what the medical records reveal, the State agency tells a Social Security Disability (“SSD”) claimant to go for consultative examinations ("CE”). CEs almost invariably contain fraudulent findings. For example, the CE report will say that the claimant had no trouble getting on and off the exam table, when the claimant only sat in a chair. This has been happening for many years.
To guard against fraudulent findings, I advise my clients to video record the CE, which are performed by IMA. Because there is no law, rule, or regulation that prohibits a SSD claimant from recording the CE, IMA claims that it is against their policy. However, in IMA offices, they have signs stating that claimants can record their exams, so their “policy” is specious at best.
I represent a 52 year old former teacher for the deaf whose SSD application was approved by an ALJ today. The State agency had denied the claim on the grounds that the claimant refused to attend the CE. The claimant testified that when the IMA doctor saw the claimant’s spouse recording the exam, the doctor threw a fit, left the exam room, and refused to return. The claimant further testified that she never refused to answer any question or submit to an exam by IMA. If the reports of IMA doctors actually reflected what transpired during their exams, then there would be no reason for IMA’s “policy.”
To guard against fraudulent findings, I advise my clients to video record the CE, which are performed by IMA. Because there is no law, rule, or regulation that prohibits a SSD claimant from recording the CE, IMA claims that it is against their policy. However, in IMA offices, they have signs stating that claimants can record their exams, so their “policy” is specious at best.
I represent a 52 year old former teacher for the deaf whose SSD application was approved by an ALJ today. The State agency had denied the claim on the grounds that the claimant refused to attend the CE. The claimant testified that when the IMA doctor saw the claimant’s spouse recording the exam, the doctor threw a fit, left the exam room, and refused to return. The claimant further testified that she never refused to answer any question or submit to an exam by IMA. If the reports of IMA doctors actually reflected what transpired during their exams, then there would be no reason for IMA’s “policy.”
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