NYS OTDA Fraud Update

A year ago, I posted about unacceptable conduct committed by the New York State Office of Temporary Disability Assistance (the “OTDA”). Unfortunately, there has been no change in the OTDA’s conduct. 

I represent a 54 year old with diabetes, and neck, back, and hand problems, who earned over $100,000 annually working as a steamfitter for 28 years, which required lifting up to 100 pounds. Common sense tells you that anyone who worked that long at that job, earning that amount of money, stopped only because he was no longer able to continue. 

Once again, a review of the Social Security Administration (“SSA”) claim file reveals that the OTDA acted in bad faith, and actually committed fraud, in order to deny the Social Security Disability (“SSD”) application. 

In 2014, the OTDA told the claimant that he was required to go to a consultative exam (“CE”). The OTDA denied the claimant’s SSD application on the grounds that the claimant did not attend the CE, but when scheduling a CE, the OTDA is required by law to ask a treating doctor to perform it. An OTDA disability examiner named A. Washington claimed that there was no treating doctor to perform the CE, and that the claimant had no medical opinion about his being disabled. However, each of those statements was patently false. 

The SSA’s file revealed numerous documents listing the doctors who had been treating the claimant. Moreover, the SSA file contained, not one, but two, reports from treating physicians detailing the reasons why the claimant lacked the physical capacity to work. A. Washington simply lied; i.e., committed fraud, which is knowingly doing or saying something that was false, in order to evade the legal obligation to ask a treating doctor, as the preferred source, to perform the CE. 

The SSA reversed the OTDA denial on appeal, at a rapid hearing where the medical and vocational experts immediately testified in the claimant’s favor. 

Any type of incident where the OTDA misrepresents the truth should be reported to the SSA Inspector General.