The Law Office of William C. Wombacher
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August 2010 Archives

What you didn't know about the social security disability process

Very few people realize that most of the decision makers in the Social Security disability process are not federal employees. The processing and decision making at the initial application stage and the reconsideration stage are actually state employees under contract to SSA.  These are disability determination services (DDS) and each state has one.  DDS is where employees called disability examiners or adjudicators gather medical records and evaluate such records in conjunction with a claimant's vocational factors (age, education, work history and job skills) to arrive at a decision.Though it seems they do not truly consider the vocational factors in making their decisions.
There are also medical consultants that are under contract to DDS.  A medical consultant is a doctor who works for DDS.  Often they are retired doctors who receives a flat fee for each file they review. Their medical estimations of claimants physical abilities they have never seen before are actually completed by the disability examiners and then they review and sign off on them. They many times review files of claimants who have conditions outside their practice areas. In Illinois, we have a retired pediatrician who has not been in private practice for more than 10 years who reviews adult disability claims. About the only thing you can say about them is they have a license to practice medicine. These are not the doctors that SSA may send you for an exam. The exam is known as a consultative exam (CE). Those doctors are private physicians who perform exams on a contract basis. Medical consultants actually work in the same processing units as disability examiners and their job, officially, is to provide consultation to examiners who are deciding claims. It is DDS that is the most dysfunctional part of the system. Need help with your disability claim in central Illinois, contact my office.William Wombacher

Death and Dying

The Huffington Post had an excellent article on end of life issues. Judith Johnson provides some interesting facts .
(1) Eighty percent of Americans do not put their personal affairs in order before they die.
(2) In 2009, Medicare paid 55 billion just for doctor and hospital bills for the last two months of patients' lives. That's more than the budget for the Department of Homeland Security or the Department of Education. And, it's been estimated that 20-30 percent of these medical expenses may have had no meaningful impact. Most of the bills are paid for by the Federal Government with few or no questions asked. ("The Cost of Dying," 60 Minutes, 8/8/10
(3) A vast majority of Americans say they want to die at home, but 75 percent die in a hospital or nursing home...18-20 percent of Americans spend their last days in an ICU. (4) Most hospital patients, relying on doctors to advise them of their healthcare options, fail to take into consideration the vested interests of the doctors and hospitals. As a result, many terminal patients are given false hope by a frenzy of tests and procedures that do little more than protect the doctors and hospitals against potential lawsuits and provide financial benefit to the doctors, hospitals, insurance and drug companies while denying the patient the opportunity to transition into his or her process of dying.Read Wombacher

Disabled waiting for Medicare

Most people don't know that just because Social Security determines that you are disabled that you do not immediately qualify for Medicare medical benefits. SSI does qualify you for Medicaid medical coverage but not SSDI.  Nearly 2 million disabled Americans who fall into this no man's land with the first monthly Social Security disability payment (SSDI), for they then must wait two years to become eligible for Medicare. Remember there is a five month waiting period before you receive the first check and so the waiting period is actually 29 months from the date on which Social Security finds you disabled.  The waiting period went into effect in 1972 to keep costs down, avoid overlaps with private insurance and to preserve Medicare for those with severe, long-lasting disabilities. In 2010, nearly 8 million Americans are receiving Social Security disability income (SSDI). About a quarter, 1.8 million, are in the 24-month waiting period. About 12 percent of Social Security disability recipients will not survive the two years to receive Medicare medical coverage. The only thing for the uninsured persons waiting may be COBRA from prior employment or state CHIPS programs if they can afford the premium. Help from O'Bama care won't arrive to 2014 when they may be purchase insurance through medical exchanges. 

William Wombacher

Illinois Nursing Home Law Changes

On July 29th the Governor of Illinois signed into law Senate Bill 326, which resulted from strong collaboration between state agencies, members of the Illinois General Assembly, advocates, home and community based service providers, residents and the nursing home profession, led by Governor Quinn’s Nursing Home Safety Task Force.The new law remakes the system of admission to nursing homes, ensuring that only those in need of 24-hour skilled care are admitted. The law also strengthens the screening process to prevent residents with violent criminal histories from being placed with vulnerable, older adults.The law sets higher nursing home quality and staffing requirements, raises penalties for violations, and increases inspections and monitoring. The new law also requires nursing homes to help all residents achieve their highest level of functioning and prepare to transition to more independent, community-based living.The Governor also signed Senate Bill 2863, which is designed to reduce fraud and abuse in nursing homes. An initiative of the Office of the Attorney General, the law requires prompt reporting of fraud, abuse and neglect in nursing homes, broadens the definition of criminal neglect, and requires greater disclosure by nursing home owners. Both laws went to into effect immediately.For a link to SB 326-- see Public Act 96-1372 a link to SB 2863-- see Public Act 96-1373 Wombacher

Difference between SSI and Social Security Disabilty (SSDI)

The Social Security Administration has two programs to help disabled people. The first program is Supplemental Security Income (SSI). This many times is just known as SSI. People who receive SSI are persons who have not worked enough to earn the necessary credits to receive Social Security Disability (SSDI) benefits. To receive SSI you must also show that you and your spouse have very limited income and very limited resources. If you are a child (under 18) the Social Security Administration (SSA) will also look at your parents income and resources. If you qualify for SSI, you will be eligible immediately for medicaid medical coverage.Social Security Disability (SSDI) is a  program to  help people who are disabled and have worked enough to have earned enough credits to receive this benefit and it sometimes provides benefits to their spouses and children. This can also provide benefits to widows and widowers. The amount of your benefits is based on your earnings.Proving disability under the SSI program is the same as it is for Social Security disability.

SSA Disability-Why You Need An Attorney

The Office of Inspector General (OIG) just released a report involving the SSA disability process (SSDI & SSI) which recognizes the value of having an attorney.  At page 6 it recognizes that at the hearing level having an attorney is important. Attorneys assist claimants in developing medical evidence; pre-screen applicants to identify cases likely to receive allowance decisions; are skilled at noticing additional impairments, especially mental impairments, that may not have been alleged at the DDS level; and ensure claimants stay focused at hearings. Many claimants find it necessary to secure representation at the hearing level to continue through SSA’s complicated disability process. In fact, a recent Allsup survey found that 78 percent of claimants experienced barriers to handling the disability process on their own. Those barriers included reading, understanding, and completing forms. Read all about it. Wombacher

Why do Estate Planning?

     Ever wonder why Estate planning is important? Below is link to a New York Times article that explores the issue.  I know that wills, powers of attorney, trusts including special needs trusts are not the most exciting topics but without them your life or death aftermath could get real exciting, expensive and complicated. These are not do it yourself projects unless you want to leave a mess behind. I'll help you! Wombacher

Council of Advanced Practitioners- National Academy of Elder Law Attorneys

      I just returned from the the meeting of Council of Advanced Practitioners of the National Academy Of Elder Law Attorneys (NAELA) in Chicago. I met with 50 of the top Elder Law attorneys in the country to discuss what we are doing to help to our clients.  I got lots of tips and ideas to help my clients. This is going to be especially important as Illinois moves to change it rules related to nursing home assistance more than 4 years after the federal law changed.  It is going to be more important than ever to get the best advice. On Friday, August 13,2010, the Illinois Department of Healthcare and Family Services issued it's proposed rules related to the implementation of the federal Deficit Reduction Act (DRA) of 2005, which was signed into law on February 6, 2006 by President Bush.  We are just a little slow in Illinois. This will make significant changes in how the Medicaid program in Illinois will work for those applying for nursing home assistance. Watch for more stories about these changes. Visit my website to learn more about what I do.Bill Wombacher