SHOULD YOU HIRE THE ATTORNEY THAT YOUR LONG TERM DISABILITY CARRIER RECOMMENDS?

NO!

Why not?

Where do you think those attorneys, disability advocates and non-attorney representatives get all of their cases from? Do you think they will act in your best interests or the interests of their bread and butter—the long-term disability carrier. These representatives have an inherent conflict of interest and have no business representing you.

When your long-term disability carrier contacts you and says “we have an attorney or a disability advocate for you who will help you with your Social Security disability claim,” RUN FOR THE HILLS !!! You are not required to use the attorney or disability advocate that the long-term disability carrier recommends.

Contact us. We will help you through the process and represent YOU !!!

SSDI: The truth behind media and political mischaracterizations

August 25, 2014
The Social Security Disability Insurance (SSDI) program is an integral part of the Social Security system that provides vital economic security to workers and their families. SSDI provides modest but essential coverage that American workers earn, and protects against the economic devastation that often accompanies life-changing disability. Unfortunately, recent media coverage (including recent opinion pieces in The Hill) has painted a highly inaccurate picture of this program, in an effort to encourage damaging changes that would hurt people with disabilities.

Eligibility criteria for the SSDI program are extremely strict and only people with the most significant disabilities qualify for benefits. An applicant must prove with medical evidence the inability to engage in “substantial gainful activity” (defined as earning less than $1,070 monthly in 2014), due to a physical or mental impairment expected to result in death or last for at least one year. Most applicants are denied; only about 40% are approved, a fact which belies claims that there is a “systematic bias” toward approving applicants who are not actually disabled.

People with disabilities turn to the program as a last resort, often having attempted to continue working after it is no longer healthy to do so and having spent down their savings before applying. There is no evidence that people are leaving the labor force to receive SSDI. While it is true that SSDI applications increased during the recent economic downturn, approval rates also declined. In fact, the current approval rate is the lowest it has been in 40 years.

Growth in the SSDI program has long been predicted by the Social Security Chief Actuary and is due almost entirely to two demographic factors: the aging of the baby boomers and women entering the workforce. According to the SSA, program growth has peaked and is projected to level off.

The SSDI program is complex so it is not surprising that many applicants choose to retain a representative, given the importance of the outcome. Having an experienced professional provide assistance is valuable for people with disabilities. Representatives help ensure that applicants provide SSA with all relevant medical evidence and help the agency make the right decision as early in the process as possible. SSA’s policies and procedures to regulate representatives do a good job of dealing with the very small number of representatives who violate the rules.

Notably, Congress has not uncovered any evidence of fraud in the SSDI program beyond the cases SSA itself uncovered, after several years of investigation. Nor has Congress found any evidence that people who should not be eligible are wrongly approved. Senator Coburn has been quoted on the topic and appears to mischaracterize what his 2012 investigation actually found. That investigation reviewed only 300 appeals decisions from just 3 counties, and his staff questioned the quality of about 25% of the written decisions but did not claim the decisions were wrong. In fact, the investigation did not find that a single individual was approved who should have been denied.

The Social Security Administration does a good job of identifying potential fraud in the program, despite its woefully inadequate recent funding levels and resources. SSA’s administrative budget is only about 1.4 percent of benefits paid out each year. However, Congress has provided nearly $1 billion less than requested over the past three years. SSA’s program integrity work has suffered too, receiving $421 million less than authorized over the last two years. The result? SSA has lost more than 11,000 employees since 2011 – a heavy blow to the agency’s ability to serve the American people.

If Congress is serious about protecting the integrity of this program, it should start by providing SSA with adequate funding to do so. It should enact H.R. 4090, the Social Security Fraud and Prevention Act of 2013, introduced by Representative Xavier Becerra (D-CA) earlier this year. It would provide SSA with dedicated mandatory funding for program integrity activities, strengthen fraud detection activities, and increase penalties for people convicted of exploiting the program.

The SSDI program does not need significant changes. It has provided economic security to workers who become disabled, and their families, for more than 50 years. But Congress does need to enact legislative changes to secure the future of Social Security and prevent cuts for SSDI beneficiaries in 2016. A rebalancing of the Old Age Survivors Insurance and Disability Insurance trust funds through reallocation of the payroll tax going into each of the funds, approved by Congress multiple times in the past, would account for demographic shifts and solve short-term funding gaps. This program is a key piece of our national social insurance infrastructure and it needs to be kept strong for current and future generations.

Reprinted from NOSSCR

Medicare Enrollment Is Now Open

The annual Medicare Open Enrollment Period has begun. From October 15 to December 7, 2013, Medicare beneficiaries have to opportunity to change their Medicare managed care plan and prescription drug coverage for 2014. In other words, you can enroll in or change your Medicare Advantage plan during this period. You can also change Part D plans.

What does this mean for you? You should review your current drug prescriptions to make sure that your Part D plan provides the best coverage for the medicines that you are currently taking. If there is a significant gap in your current benefits, you should compare the drug formulary for your current plan with other plans to see if it makes sense to change plans. You should also compare co-pays and other costs.

You should also make sure that you have received all of your “no cost” preventative health screenings that are available to Medicare beneficiaries for this year.

Remember that Medicare is not part of the ACA. You are not enrolling through the Health Insurance Marketplace. You are not replacing your Medicare insurance with Marketplace Insurance. You will continue to have the Medicare benefits that are available to you.

Update on Jimmo v. Sebelius

As many of you may know, a class action lawsuit involving Medicare payments for nursing home and in-home care was settled earlier this year. In that lawsuit, Jimmo v. Sebelius, the application of Medicare’s “Improvement Standard” which was being used to cut off Medicare benefits for patients receiving nursing home or in-home care was challenged. Under the terms of the settlement, the government agreed to that patients could no longer be cut off from Medicare benefits for the reason that the patient was no longer making any progress toward recovery, if the patient continued to need such care to prevent or slow further deterioration.

The Centers for Medicare and Medicaid Services has now issued a fact sheet regarding the settlement (www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/Jimmo-FactSheet.pdf). Should a facility or provider attempt to cut off services based upon the Improvement Standard, this factsheet can be used to show that such services should be covered.

Identity Theft and the Elderly

Identity theft is a real and growing concern for everyone, but more and more identity thieves are targeting the elderly in their illegal endeavors. Using fraudulent telemarketing schemes and email phishing expeditions, these criminals obtain Social Security and credit card numbers from vulnerable seniors, and then redirect government benefits to their own accounts and make purchases using the stolen credit card numbers. In the most recent issue of Bifocal, a Journal of the ABA Commission on Law and Aging, author Sarah Anderson offers the following tips on how seniors can protect themselves from tax and government benefits identity theft:

  1. Open your mail and respond to any correspondence from the IRS
  2. File an IRS Identity Theft Affidavit if you are a victim or suspect you are a victim (http://www.irs.gov/pub/irs-access/f14039_accessible.pdf) 
  3. Contact the Taxpayer Advocate Service (http://www.irs.gov/uac/Taxpayer-Advocate-Service-6)
  4. Block elective on-line access to your social security records (http://ssa.gov/myaccount/)
  5. Contact the credit bureaus to report identity theft
  6. Request a credit freeze from the credit bureaus
  7. Request a copy of your credit report on an annual basis
  8. Request a copy of your IRS tax transcripts
  9. Report identity theft to the appropriate government agency, including the FTC and the Internet Crime Complaint Center (https://www.ic3.gov/default.aspx)
  10. File a police report

Indiana POST

As of July 1, 2013, Indiana law allows Physician Orders for Scope of Treatment, or what are commonly referred to as POST forms. A POST form is a new standardized form which contains a physician’s orders for cardiopulmonary resuscitation, medical interventions, medications, and artificially administered nutrition. For example, a POST form allows the physician

  • to specify whether the patient is a “code” or “no code
  • to set the lever of medical intervention (comfort measures only, limited intervention, or full intervention)
  • to order antibiotics for comfort only or for full treatment
  • to provide full artificial nutrition, artificial nutrition for a set period of time, or no artificial nutrition

A POST form is intended for patients who are seriously ill and whose death is anticipated within the reasonably near future. It differs from a living will in that it is an actual order signed by the physician which is meant to accompany the patient throughout the course of the patient’s treatment.

For a copy of the Indiana POST form, go to http://www.in.gov/isdh/25880.htm

No More Taxes

Well at least there are no more inheritance taxes for individuals who die as residents of Indiana. For Indiana residents who die in 2013 or later, there is no longer any need to file an Indiana Inheritance Tax Return (Form IH-6). Additionally, Consents to Transfer (Form IH-14) and Notices of Intended Transfer of Checking Account (Form IH-19) are no longer required. The is no longer any inheritance tax to be paid. For more information go to: www.in.gov/dor/3807.htm

Resources to Choose Nursing Home

RESOURCES TO HELP CHOOSE A NURSING HOME

Last week I discussed some points to consider when choosing a nursing home. Today I will share some online resources that can be helpful when making a decision on an appropriate nursing home.

First, review the Nursing Home Report Cards that are prepared by the Indiana State Board of Health, Long Term Care Division. http://www.in.gov/isdh/reports/QAMIS/rptcrd/search.htm

Second, check out the Nursing Home Compare page on the Medicare website. http://www.medicare.gov/nursinghomecompare/search.aspx

Choosing A Nursing Home

I am often asked about what nursing home is best. When I am asked that question I respond that everyone is different and everyone’s needs are different. So what may be a good placement for one person may be a bad placement for another. That being said there are certain things to consider when choosing a nursing home.

First, remember the number one rule of real estate: Location, location, location. This is true in choosing a nursing home. A convenient location will promote contact with family and friends for the nursing home resident which is an important part of every resident’s care plan.

Next, inspect each facility. Do not rely on second hand information. Everyone’s experience is different. Just because one person may like a particular nursing home does not mean that it is right for you or your loved one. The only way to get a true picture of a facility is to visit it in person, and it is important to visit each facility that you are considering at least three times.

First, go in during business hours, and tour the facility. Meet with the Administrator, Director of Nursing, and social worker, and ask questions. Discuss finances, and find out if the facility accepts Medicaid.

Second, go in during the evening meal. Observe interactions between the staff and residents. Pay particular attention to residents who need encouragement with meals.

Third, go in on the weekend. Talk to family members visiting other residents about their experiences with the facility. Look to see if there are activities on weekends.

Next, find out whether or not your physician sees patients at the facility. Many doctors do not see patients in nursing homes. If your doctor does not see patients at the facility, you will need to find another that does.

With this information you should be able to make an informed and reasoned decision.

What to do when someone dies

The death of a loved one is difficult to deal with at any time. The family is stressed and generally has lots of questions about what to do. So I thought it might be helpful to review some of the things that need to be done shortly after a loved one dies.

First, determine if the deceased had a written funeral planning declaration.

Second, find documents such as:

  • Will
  • Trusts
  • Life insurance policies
  • Real estate deeds and mortgages
  • Vehicle titles
  • Bank statements
  • Investment records
  • Pension and retirement account records
  • Tax returns

Third, order several copies of the death certificate.

Fourth, contact the following:

  • Attorney
  • Investment broker
  • Bank
  • Credit card companies to cancel credit cards
  • Social Security office if on Social Security
  • Veterans Administration if receiving VA benefits

Of course this is just a brief list. There are other things that need to be done. But I hope that it might provide some guidance at that difficult. Of course for assistance with probate and estate administration, please contact our office.