Mining for Gold Guardianship & Decedent s Estates

Transcription

1 Mining for Gold Guardianship & Decedent s Estates Zivic Solutions, Ltd. (800) 400-HELP Zivic Solutions, Ltd.

2 Introduction and Overview Jerrold S. Zivic, President Definition of Social Security Disability You must be so severely impaired either from a physical or mental problem that you are unable to perform any type of work for a period expected to last one year or more. The (SSA) has two disability programs paying benefits to eligible individuals, SSDI (Title II) and SSI (Title XVI). The does not pay benefits to individuals with partial or short-term disabilities.

3 Types of Benefits Social Security Disability Insurance (SSDI) You must have a minimum number of credits of Social Security coverage to be insured. These credits are earned by working and paying FICA into the system. The benefit amount varies with individuals. Social Security Income (SSI) Benefits for individuals 65 and over with limited income and resources or those who are blind or disabled. Disabled and blind children can receive SSI benefits. If an individual receives SSI, they may also be able to obtain other benefits, such as Medicaid and food stamps. The basic benefit amount is the same throughout the Country.

4 The Future According to Social Security, Disability Benefits paid to disabled workers or their dependents make up 18% of the total Social Security Benefits paid out annually. With these current numbers, that means almost 3 in 10 of today s 20 year olds may become disabled before retirement age. 30% 25% 20% 15% 10% 5% 0% Social Security Benefits Present Projected

5 Social Security Disability Facts Waiting Period: SSA does not pay benefits for the first five months from the onset date. Benefits may not occur indefinitely, but will continue as long as the Claimant s medical condition has not improved and the Claimant is unable to work. The Claimant s benefits may be subject to review to ensure that the recipient is still eligible for benefits.

6 Additional Disability Facts Disability benefits are not payable if your disability is based solely on drug or alcohol addiction. If a disabled individual dies before filing a claim, you can file a claim for up to three (3) months after the worker s death. A spouse and minor children also receive a benefit if a worker is found disabled.

7 Approval Rates and Data State of Illinois Data (as of December, 2009) Initial Approval Rate: 45.7% Number of Beneficiaries in Illinois: 308,983 Percentage of total US beneficiaries in the State of Illinois: 3.5% Total monthly benefits paid to beneficiaries in the State of Illinois: $318,550 Percentage of the State s population receiving benefits: 3.6%

8 Date Last Insured (DLI) You must prove that the Claimant became disabled prior to their DLI to be eligible for SSDI benefits.

9 Onset Date This is the date Social Security determines the Claimant became disabled.

10 Possible Cases You may find that you already have clients in your office who are eligible for Social Security Disability In a Guardianship proceeding, your client may be disabled for ten (10) or more years and still be eligible for benefits, including Medicare.

11 Rules of Professional Conduct ILCS S Ct Rules of Professional Conduct, RPC Rule 1.1 A lawyer shall provide competent representation to a client. Competent representation requires the legal knowledge, skill, thoroughness and preparation reasonably necessary for the representation. In re Matter of Connor, 525 N.E. 2d 214, 121 Ill.Dec. 408 (1988) states, in part: Assets of ward s estate would not have been liquidated to pay ward s nursing home arrearage but for guardian s failure to seek public aid for ward in diligent and orderly manner; therefore, guardian had to reimburse ward s estate for maximum amount of assets ward could have had and still been eligible for public aid at time of first application had guardian sought public aid in diligent and orderly manner.

12 Advantages of Filing a Claim It does not cost anything to file a claim Filing a claim can be a proactive move on behalf of your client Filing a claim can also be a defensive maneuver in the case that there is ever a complaint as to why a claim was not filed

13 Applying for Benefits Matthew Edwards, Senior Attorney If you have a client who has been declared Incapacitated, it is imperative that you apply for benefits immediately. If you have a client who is experiencing mental or physical disabilities which would preclude them from working, it is not necessary to wait until they are declared Incapacitated to file for SS benefits. Delays in filing for benefits may impact monetary and Medicare benefits.

14 Filing an Initial Claim Filing for Social Security Disability Benefits Initial Claim is filed at the District Office Processing of the Initial Claim is handled by the State DDS Office Make certain that you obtain proof of filing, whether the claim is filed by mail, fax or electronically Beware of Federal rules regarding the filing of initial claims online Do not be surprised if the initial claim is denied

15 Filing for Reconsideration Reconsideration appeals are filed with the District Office or online at: ( Remember, when filing online, a Social Security form letter, receipt of filing and new medical releases must also be faxed to the District Office. Appeals must be filed within sixty (60) days from the date of denial of the initial claim Again, make certain to obtain proof of filing Remember that, as with the Initial Filing, there is still a high likelihood of the claim being denied

16 Filing a Request for Hearing A Request for Hearing is the next step in the Appeal Process; at this point, you are requesting that your client s claim be brought in front of an ALJ for a decision Obtaining a hearing date from the local ODAR office can take up to 300 days, perhaps even longer Make certain that you obtain proof of filing, whether the claim is filed by mail, fax or electronically

17 Video Hearings Video hearings are held at the national Hearing Center. We suggest that you avoid a video hearing at all costs.

18 Evaluating Your Client If the Claimant suffers from a mental impairment, it may be important to discuss the possibility of them not having to be in attendance at the hearing as they may be harmful to themselves or others If the Claimant suffers from a highly contagious disease, it is important to discuss with the ALJ, prior to the hearing, whether or not they wish the Claimant to be present in Court

19 Hearing Day Who is in attendance Expected time frame for the hearing Medical Expert Vocational Expert Rules of Evidence Who asks what questions of the Claimant

20 Staffing & File Development Deborah Boggs, Case Technician Supervisor There are four very distinct aspects to the Claim Process. While staff certainly can and should be cross trained in all areas of the Claim process, it is often best to have a key member of the staff responsible for certain areas: Intake File Development Filing Process/Scheduling Hearing Preparation

21 File Development File development should begin as soon as possible. Do not delay the filing of an initial claim while waiting for information as any claim can be supplemented throughout the process Gathering as much information about treatment (hospitals, clinics, doctors and other providers) should be done as soon as possible Importance of Claimant completing Info Sheet Throughout the process, it is important to gather updated information on treatment as often as possible

22 Responsibilities of the Guardian The Guardian of the Estate is responsible for helping to provide information regarding file development (i.e., past work history, medical providers). This information is critical to the development of the file! Client preparation meeting and speaking with the Claimant and their Guardians or caretakers

23 Useful Evidence Other sources of information helpful to a Disability Claim could be: Employment records from former employers Letters from family members, friends or former co-workers of the Claimant explaining why, in their opinion, the Claimant is unable to work Impairment Questionnaires completed by any treating sources (see examples of these forms on our website at

24 Computerization Social Security has recently begun to force our hand to file all Appeals online, suggesting that if Appeals are not filed using the internet, our fees would be withheld at the conclusion of a case. Social Security prefers that we electronically submit correspondence, requests of the Court, medical evidence of record This online program gives us almost immediate access to status of a claim, new evidence and any decisions

25 Questions and Answers

26 Local Social Security Offices 1233 W. Adams Chicago, IL Fax S. Ashland Ave. Chicago, IL Fax S. Cottage Grove Chicago, IL Fax W. Fullerton Ave. Chicago, IL Fax W. Lawrence Ave. Chicago, IL Fax N. Milwaukee Ave, #600 Chicago, IL Fax (773) W. North Avenue Chicago, IL Fax S. Pulaski Chicago, IL Fax S. Sacramento Ave. Chicago, IL Fax S. Cottage Grove Chicago, IL Fax N. Lake Street Aurora, IL Fax W. Lake Street Bloomingdale, IL Fax S. Halsted Street Chicago Heights, IL Fax Fletcher Drive Elgin, IL Fax Green Bay Road Evanston, IL Fax North Mannheim Road Hillside, IL Fax

27 Local Social Security Offices 522 Houbolt Road Joliet, IL Fax N. Wheeling Road Mount Prospect, IL Fax W. Cermak Road, #600 North Riverside, IL Fax S. Roberts Road Palos Hills, IL Fax N. Lewis Ave. Waukegan, IL Fax Providence Drive Woodridge, IL Fax E. 85th Ave. Merrillville, IN Fax E. Douglas Street Hammond, IN Fax

28 Copying Costs in Illinois Illinois The cost for copying medical records for Social Security claims in 2012 is a $25.55 handling charge plus 96 per page for pages 1-25, 64 per page for pages and 32 per page for any pages after that, plus actual shipping costs. The cost for copying microfiche is $1.60 per page. The cost for copying medical records for Social Security claims in 2011 was a $24.81 handling charge plus 93 per page for pages 1-25, 62 per page for pages and 31 per page for any pages after that, plus actual shipping costs. The cost for copying microfiche was $1.55 per page. The cost for copying medical records for Social Security claims in 2010 was a $24.44 handling charge plus 92 per page for pages 1-25, 61 per page for any pages after that, plus actual shipping costs. The cost for copying microfiche is $1.53 per page. 735 ILCS 5/Art. VIII, Part 20, effective August 2001, with the annual adjustment of copying fees as required under 735 ILCS 5/ When available and requested by the patient, records produced in an electronic format must be provided at 50% of the paper copy rate. Public Act , effective August 27, HIPAA preempts the Illinois rule by prohibiting the provider, and the provider s copy service, from charging a handling fee to patients or their personal representatives. The prohibition on handling charges does not apply to requests made by the patient s attorney.