Springtime Insurance review on Bainbridge Island

Spring appears to have finally arrived! If you are like myself, during the Bainbridge Island wintertime, we leave the house in the dark and return home in the dark. The color of the house, lawn, flowers and trees is lost in the winter darkness. Now that spring is here, rub your eyes, open them wide and assess the spring cleaning at hand! Yard wise: prepare the sprinklers, make sure drains are clear and get ready to plant that garden! If you upgrade sprinkler systems, build new decks, or add a pool or hottub...be sure to let us know! These items are covered via your homeowners insurance, as long as they are added as other structures. House wise: Check the paint, clean the gutters, assess the moss levels on roof ( notice I said levels...not if you have moss or not...lol) Be sure to check those smoke detectors and CO2 detectors. Your homeowners insurer appreciates it ! Lastly, DO NOT forget to insure those summer toys: Boats, Jetskis, Rowing Skulls, ATV, Motorcycles ( road and dirt), and if you have a golf cart, be sure to let us know...a golf cart is one item that can have liability via your homeowners insurance. If you are unsure about your insurance coverage, want to add, remove or have a simple question...call us anytime!!! 206 842 7410

“Objective” Evidence of Disability

Frequently disability insurance companies and benefit plans will deny a claim for benefits on the ground that the claimant hasn’t provided “objective evidence” of disability. “Objective evidence” typically means medical testing of some kind, such as x-rays, MRIs, or electrocardiograms. On the other hand, “subjective evidence” typically refers to your perception of your condition, such as reports of pain or fatigue.

On the surface, this may make sense. After all, it is the claimant’s burden to prove that he or she is entitled to the disability benefit. Shouldn’t claimants have to provide some kind of objective evidence that they are disabled? If not, wouldn’t insurance companies just have to “take everyone’s word for it” and pay every claim, regardless of its merit?

Certainly, claimants should have to provide sufficient evidence of their disability. If your disability is due to a broken arm, it makes sense that an insurer would want to see an x-ray of your arm.

However, most insurance policies and benefit plans don’t require that claimants provide “objective evidence.” And there are many seriously disabling diseases that cannot be diagnosed or assessed solely through objective testing. For example, fibromyalgia and chronic fatigue syndrome are very real diseases for which there are no definitive tests. Instead, these diseases are determined through clinical symptoms, interpreted by the claimant’s physician. Similarly, back pain and cognitive problems are often difficult to measure objectively.

If you have a disabling disease like fibromyalgia or chronic fatigue syndrome, or another condition in which your disabling symptoms are not susceptible to “objective testing,” you must be careful when applying for disability benefits. Try to document your symptoms as much as possible. Report all your symptoms to your physician, and provide him or her with diaries if necessary.

If there is any objective testing that might assist in your diagnosis or treatment, such as fatigue testing or a neuropsychological examination, you and your physician may want to consider doing that. It won’t guarantee that your claim will be approved, but it may help you avoid one of the most common insurer traps. If you are having difficulty with your insurer, contact us on 888-569-6013 for a free consultation.

Spring Legislative Session Update

It’s the midpoint of Illinois Governor Rauner’s first legislative session, and the Shriver Center is hard at work in Springfield. Shriver Center advocates are pursuing legislation that will advance the interests of low- and middle-income Illinoisans. Amidst budget cuts to key programs, our advocates work to maintain and expand access to these programs, preserve and defend housing and employment opportunities, and forestall measures that would inhibit progress the state has made.

Below is an update on some of the legislative initiatives the Shriver Center is pursuing. Please join us in supporting the passage of these bills.

Community Justice

Lifetime bar bill. HB 494 removes lifetime bars to employment in schools for individuals with old drug, prostitution, and public indecency convictions so schools have the freedom to hire applicants with old convictions if the school deems it appropriate. The bill passed out of the Elementary & Secondary Education: School Curriculum and Policies Committee with an amendment that includes special provisions for certain narcotics offenses. It is now on the House floor waiting for a vote.

Admonishment bill. HB 2569 updates the admonishment instructions given to defendants so that defendants are properly educated on the consequences of pleading guilty to a crime. Specifically, the bill requires that defendants be informed that a conviction will impact their ability to retain or obtain housing in the public or private market; acquire loans for educational or other purposes; enroll in certain degree programs; retain or obtain employment; retain or obtain an occupational or driver's license; possess a firearm; and retain or obtain custody of a child. The bill passed out of the House unanimously and is now in the Senate awaiting committee assignment with Senator Terry Link as Chief Sponsor. 

Sealing of convictions. HB 3149 allows people who earn a vocational certification, GED, high school diploma, or some other degree to petition to have their eligible convictions sealed prior to the statutorily required four-year waiting period. The bill passed unanimously out of the Judiciary-Criminal Committee and passed out of the House with an overwhelming majority. The bill does have strong bipartisan support, and advocates are optimistic about its passage.

Health care background check. HB 3212 removes lifetime bars in the health care sector by amending the Health Care Workers Background Check Act. It replaces language prohibiting a health care employer from hiring, employing, or retaining any individual in a position with duties involving direct care for clients if the individual is convicted of committing specified offenses with language providing these employers with more discretion in hiring. The bill failed to be voted on by the Health Care Licenses Committee prior to the March deadline, and it has now been re-referred to the Rules Committee. 

Fair Sentencing Act. HB 3322 allows people to petition the courts to be resentenced if the penalty for the offense they were convicted of is modified by the Illinois General Assembly in some way so that their sentence will be consistent with what is current law. The bill passed out of the Judiciary-Criminal Committee with a close vote of 9 for and 6 against. It is now on the House floor awaiting a vote from the full chamber. 

Certificate of Good Conduct. HB 3475 expands eligibility for Certificates of Good Conduct to include people who have committed non-sex-related forcible felonies. This allows people who have made grave mistakes to have at least one avenue beyond clemency to demonstrate they have turned their lives around so they can better care for themselves and their children. The bill passed unanimously out of the Judiciary-Criminal Committee and passed out of the House with an overwhelming majority.

Sealing Criminal Records. HB 4021 shortens the waiting period to petition for sealing so people who have gone three years without committing a crime after completing their sentences have a chance to petition for sealing. The bill passed unanimously out of the Judiciary-Criminal Committee and is now on the House floor awaiting a vote from the full chamber.

Budget and Tax Justice

Ensuring adequate revenue to meet needs. The Shriver Center is a leader of the Responsible Budget Coalition (RBC), a large and diverse coalition of about 200 organizations working to secure adequate revenue to support state priorities and make smart investments. The RBC has established a profile as a leading opponent of Governor Rauner’s proposed cuts to vital services and has been working closely with Senate and House staff on hearings into the budget. The Shriver Center’s Budget and Tax Justice Unit continues to work through the 2015 session to ensure that critical programs that serve low-income people throughout the state are sustained.

Economic Justice

Defending critical public benefits. The Shriver Center, working with other advocates, successfully defeated all of the legislative proposals this session that would have decreased access to critical public benefits and/or stigmatized or dehumanized their recipients. These included bills that would have (1) mandated that all applicants for and recipients of public benefits pass a drug test, (2) required a photograph on the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps) EBT card recipients use to redeem their benefits, and (3) limited SNAP recipients’ food choices. 

Making working families with high living expenses eligible for SNAP benefits. SB 1847 expands eligibility for SNAP benefits to 40,000 working families in Illinois. These families would receive an average of $125 per month in SNAP benefits. SNAP benefits are 100% federally funded, and this expansion would bring $60 million into the state. SB 1847 has cleared the Senate Human Services Committee and will be taken up by the full Senate in the next two weeks.

Health Care Justice

Medicaid cuts. Shriver Center advocates along with allies across the state are working to stop the massive cuts to health care Illinois Governor Rauner proposed in his fiscal year 2016 budget (starting July 1, 2015). The governor wants to cut $1.5 billion from the Medicaid budget by eliminating care for whole classes of people, eliminating services such as adult dental, limiting access to therapies, and reducing payment rates to providers. His proposals ignore key facts about the Medicaid program; Illinois providers are among the lowest paid in the nation, and the Medicaid program's costs per beneficiary are also among the lowest in the nation. Moreover, these proposals, if enacted, would unravel progress in improving quality, outcomes, and costs made in the last several years. Shriver Center advocates work at General Assembly Appropriations hearings and through the media to inform the public about the painful impact of the proposed cuts on vulnerable people and the likelihood that, in the long run, these cuts will result in sicker people who need more expensive care.    

The Shriver Center is working with allies for the passage of
SB 1729 and HB 2731, identical bills requiring the state Medicaid agency to make available Medicaid enrollment and renewal data and data related to the quality in Medicaid managed care plans.

The Shriver Center is also working for passage of HR 253, a resolution stating that General Assembly members do not support changes to the Medicaid program that leave people without access to medically necessary care or erroneously result in eligible people being terminated from or denied Medicaid coverage.

Housing Justice

Protecting survivors of domestic violence. SB 1547, sponsored by Senator Toi Hutchinson, protects survivors of violence and persons with disabilities who need police assistance. Its passage will ensure that no more survivors of domestic violence or people with disabilities are harmed through the enforcement of flawed local ordinances. It passed unanimously out of the Senate Judiciary Committee in March and now has bipartisan support—over 20 co-sponsors in the Senate, and over 80 supporting organizations throughout the state. Because SB 1547 will require a two-thirds vote out of the Senate, it has a more difficult journey than most bills. For that reason, the ongoing efforts of both advocates and community members are critical in the coming weeks to ensure that this bill continues to move through the General Assembly and ultimately becomes law in Illinois. 

Women's Law and Policy

Granting employment protections to domestic workers. Domestic workers play a critical role in the Illinois economy, working to ensure the health and prosperity of Illinois families and freeing others to participate in the workforce. Despite this, domestic workers have historically been excluded from state law protections extended to other industries. The Shriver Center’s Women’s Law and Policy Project (WLPP), as part of the Domestic Workers’ Coalition, is advocating for the Domestic Workers’ Bill of Rights. This legislation grants domestic workers employment protections, such as the right to the state’s minimum wage, the right to be free from sexual harassment, and the right to one day of rest in a workweek. The bill’s sponsors are Representative Elizabeth Hernandez and Senator Ira Silverstein. Please note that the current bill number is likely to change in the next few weeks. 

Increasing the state’s minimum wage. The current minimum wage in Illinois is $8.25 an hour—about $17,000 a year. Inaction at the federal and state level has allowed the minimum wage to erode over time. Had the minimum wage kept pace with inflation, it would be $10.90 today. This year, the WLPP and its allies continue to advocate for a raise in the state’s minimum wage, phased in to $11 an hour. Currently, there are bills in both the Senate and the House, but the current bill numbers are likely to change in the next few weeks.

Paid sick days for all workers. Forty-three percent of private sector workers in Illinois (over 2.5 million) have no right to a single paid sick day. Workers can be fired for missing work if they are sick or caring for their sick child or elderly parent. The WLPP is working with the Illinois Earned Sick Time Coalition to pass legislation that gives all workers in Illinois access to paid sick days. The legislation introduced in the Illinois General Assembly allows employees to earn up to seven paid sick days (or 56 hours) per year. Senator Toi Hutchinson is the Senate sponsor, and Representative Christian Mitchell is the House sponsor. Please note that the bill numbers are likely to change in the next few weeks. 

Rachel Hanley contributed significantly to this blog post. 

 

 

Make Your Long Term Care Insurance Work For You

As one of the few firms in California who handle long term care disputes, Kantor & Kantor frequently sees long term care claims which were denied on the basis that the facility or caregiver were not “eligible” under the Policy. One of the reasons for frequent denials is that the long term care policies sold in the 1990’s were written before the popularity of "assisted living facilities." As a result, policyholders try to use their policies to cover the cost of room of board in an assisted living facility, when the policy may only provide benefits for a stay in a “licensed” nursing home.

An article in Money Magazine suggested that long term insurance is a valuable investment. It cites lower statistics for those who may need care in the future: 44% of men and 58% of women may ultimately need long term care of more than 3 months. Other statistics have suggested that up to 70% of the population may require long term care in their lives. Regardless, the article suggests that the insurance may be a worthwhile investment since it is meant to protect against catastrophic events.

If you have long term care insurance, you can take steps to make sure that it works for you. Many insurers who issued policies in the 1990’s no longer underwrite long term care insurance policies. However, if you have a policy which was issued by an insurer who is currently in business, such as Genworth or Bankers, you should contact your agent to ensure that your policy is up to date. Specifically inquire whether your policy will provide coverage for a stay in an assisted living facility. If you are assured that there is such coverage, ask for confirmation in writing.

If you are under the age of 80 and healthy, you might also consider replacing your old policy with a newer product. Again, if your insurer is currently in the business of issuing long term care policies, it may offer you a financial incentive to stay with the Company, by offering you expanded coverage.

The most important thing you can do is to check your policy, or that owned by your parents, before you make any decisions regarding long term care. Generally, long term care insurers will not guarantee that a facility is eligible before a claim is made. Therefore you have little guidance, other than the policy language itself, as to whether a facility meets the criteria under the Policy. You can ascertain whether the Policy requires that a facility have a particular license, number of beds or a certain level of nursing care by the policy language. When you are investigating facilities, you should ask for documentation that the facility has the necessary license to qualify under the Policy.

The same is true with respect to home care. Often, long term care policies will require that care be provided by a “licensed” home health care agency. We have seen instances where our clients have inquired whether an agency is “licensed.” The agency will advise the client that it is “licensed,” but it only has a business license and is not licensed as a home health care agency by the proper state authority. This may lead to a claim denial.

The facility or the caregiver should be fully investigated before crucial decisions are made to move a loved one. Transitioning to a new home or entrusting one’s care to a caregiver is often a disturbing event; especially for those who are cognitively impaired. Ensuring that the insurance will pay for what it was intended before these decisions are made will help smooth the transition.

Thanks to the Senate for Renewing Children’s Health Coverage

We applaud the U.S. Senate for passing a bill last night, 92-8, that extends funding for the Children’s Health Insurance Program (CHIP). The vote follows passage of identical legislation in the House and demonstrates that members of Congress overwhelmingly support the CHIP program and understand it is vital to keeping kids across the country healthy. The legislation also allocates $7.2 billion in additional funding for community health centers.

When children’s health was on the line, the U.S. Senate stepped up for millions of kids. Last night’s vote demonstrates the overwhelming popularity of CHIP and support for getting kids the health care coverage they need to succeed.

CHIP has a long history of bipartisan support, providing coverage for children in families that earn too much to qualify for Medicaid but don’t have access to affordable health care. As a result of CHIP’s implementation, coverage rates for kids across the country are at a historic high of close to 93 percent. 

CHIP funding makes it possible for Illinois to offer children of families up to 300 percent of the Federal Poverty Level (FPL) access to affordable and comprehensive All Kids coverage. Both Illinois Senators Durbin and Kirk voted in support of this legislation. CHIP is life changer for 174,000 Illinois children. This vote demonstrates that Congress understand the impact this critical program has on millions of families and we will look to lawmakers to continue to demonstrate their support in 2017 when the program is up for renewal.

 

Eagle Harbor Insurance – independent broker

A few simple reminders on why you should always use an independent insurance broker for your personal and business insurance needs: 1. At Eagle Harbor Insurance work for YOU , not the insurance carrier 2. We offer numerous carrier options and have the ability to shop your insurance portfolio annually for the best rates and coverage 3. At claim time, we represent You , not the insurance carrier 4.Portfolio Service : one stop, one location shopping, for all of your insurance needs: Home, Auto, Umbrella, Health , Life, Business and Travel Insurance 5. We are local and know the entire Kitsap County area and the risks involved It is worth your time to develop a relationship with a local broker, hopefully you will chose Eagle Harbor Insurance on Bainbridge Island!

Eagle Harbor Insurance – independent broker

A few simple reminders on why you should always use an independent insurance broker for your personal and business insurance needs: 1. At Eagle Harbor Insurance work for YOU , not the insurance carrier 2. We offer numerous carrier options and have the ability to shop your insurance portfolio annually for the best rates and coverage 3. At claim time, we represent You , not the insurance carrier 4.Portfolio Service : one stop, one location shopping, for all of your insurance needs: Home, Auto, Umbrella, Health , Life, Business and Travel Insurance 5. We are local and know the entire Kitsap County area and the risks involved It is worth your time to develop a relationship with a local broker, hopefully you will chose Eagle Harbor Insurance on Bainbridge Island!

Join the Clearinghouse Community

Practical tips on how to collect wage judgments won for low-wage clients.

The guilty pleasure of a young leader in the antipoverty movement.

A model of using the Violence Against Women Act Amendments to protect tenants in developments financed by the Low-Income Housing Tax Credit Program.

A live conversation about the 2014 Poverty Scorecard.

An examination of racial justice and the antipoverty movement.

What do all these things have in common? They are all examples of what is available on the Shriver Center’s new Clearinghouse Community site.

Launched at the end of March, the Clearinghouse Community gives antipoverty and equal justice advocates a steady stream of useful and interesting content about poverty law topics and the people who work on them. For decades advocates have relied on the Clearinghouse Review journal for high-quality articles about poverty law. The Clearinghouse Community has evolved from that history; it will host the same high-quality content, only now that content will be delivered faster and more frequently.

And best of all, readers no longer need a subscription to access this content—including the archive of Clearinghouse Review articles dating back to 1967. Readers simply need to register on the site at the link found in the top right corner of the screen.

The Clearinghouse Community will link readers to articlesadvocacy storiesfeatured collections of articles with editorial podcasts, and interviews. And it will offer opportunities to interact with and learn from your fellow community members through Google+ Hangouts on Airwebinars, and training programs. We plan to incorporate more interactivity into the site as we continue to develop it. For a fuller description of how the Clearinghouse Community came to be, take a look at the welcome message from Shriver Center President John Bouman.

Much of the initial content on the site has ties to another community—the venerable Community Legal Services (CLS) of Philadelphia. The first-ever Clearinghouse Article, Finishing What You Started: Collecting on Judgments for Low-Wage Workers, was written by Michael Hollander, a staff attorney at CLS. He also joined us for a live Google+ Hangout on Air to talk about his article and work. The first person profiled in 2015 in a short written interview was Rebecca Vallas, who began her legal career at CLS. And one of the authors of the site’s newest advocacy story, Domestic Violence and Good-Cause Evictions in Pennsylvania After the 2013 Violence Against Women Act Amendments, is Rachel Garland, a staff attorney in CLS’s housing unit.

We appreciate CLS’s strong work and its willingness to share that work with the national community of antipoverty and equal justice advocates. We look forward to highlighting more good work on the Clearinghouse Community site, beginning with April’s focus on criminal records and reentry.

We encourage you to join the Clearinghouse Community now. And be sure to sign up for our monthly email that will link you to all of that month’s new content. Welcome to the community!

Domestic Partner files Complaint after Cigna Fails to Recognize Domestic Partnership

When purchasing life insurance, the policyholder usually nominates a beneficiary, as the person who will receive the money should something happen to the policyholder. Usually, if a beneficiary is not nominated, the spouse or closest heir will automatically be the beneficiary.

A life insurance claim denied by Cigna has ignited a debate in Pennsylvania over whether domestic partners should be viewed as spouses under insurance policies.

Albert Celec and Dr. Philip Ginnetti lived together as domestic partners beginning in 1994. In 1999, they entered into a shared living arrangement. In 2010, Dr. Ginnetti signed on as accepted a job in Ohio as Edinboro University's provost and vice president. A big point of attraction for Dr. Ginnetti was the school's non-discrimination policy toward employee benefits.

Dr. Ginnetti subsequently applied for and received recognition of Mr. Celec as a qualified domestic partner for health care and other benefits. Dr. Ginnetti received $50,000 coverage of life insurance from Prudential under the management benefits program and a right to purchase supplemental coverage.

The complaint states that during the application for an additional $100,000 in coverage from Cigna, a human resources staff member from the University allegedly neglected to list Mr. Celec in the paperwork as the beneficiary.

In June 2012, Dr. Ginnetti died. Prudential paid the $50,000 portion of the claim however Cigna refused to provide the remaining $100,000 on the basis that Mr. Celec was not the deceased's spouse under Delaware law, where the insurance company is headquartered. This, despite the fact that Dr. Ginnetti was a resident of Ohio at the time of his death.

The Vice-President of human resources at Edinboro, and Dr. Ginnetti's mother (who received the policy payment as next of kin), both wrote letters confirming Mr. Celec was Dr. Ginnetti's spouse, Nonetheless, Cigna continued to deny Mr. Celec the proceeds.

The complaint argues that Dr. Ginnetti and Mr. Celec met the standards for the definition of spouse in a civil action. It also argues that Edinboro should be held responsible because the school "violated the equal protection clause by offering a life insurance policy that did not equally cover same sex relationships and heterosexual marriages."

The complaint further contends that Cigna regularly provides insurance payouts to heterosexual spouses regardless of whether or not the spouse had been named as a beneficiary.

In 2005, the California Insurance Equality Act (AB 2208) was enacted. This is a state law that requires California insurance providers and managed care plans (HMOs) to provide coverage for registered domestic partners that is equal to spousal coverage. The law complements California’s Domestic Partnership Rights and Responsibilities Act of 2003 (AB 205), which grants registered domestic partners most of the same rights and responsibilities under California law as belong to married couples.

Interestingly, in 2012, California Governor Jerry Brown signed into law a provision that, if successfully implemented, will close a loophole in the California Insurance Equity Act which exempts out of state employers from having to offer domestic partner health insurance coverage to employees residing in this state.

However, in Pennsylvania, the law is unclear on this matter. We will be watching this case very closely to see how the court rules.


The Importance of Neuropyschological Testing in Disability Claims Including Cognitive Impairment

If you suffer from certain medical conditions, including Multiple Sclerosis, Complex Seizure Disorder, Dementia to name just a few, you likely also suffer from cognitive impairment which can affect your ability to perform the duties of your job. If your illness, or the cognitive decline associated with that illness, makes it impossible for you to perform in your job, you might be able to access the benefits of a Long Term Disability Policy. Such policies are often provided to employees through their employer benefits plans, or might be acquired individually. If you become disabled and make a claim for disability benefits based on cognitive issues, it is extremely important to document the cognitive impairment you suffer. Neuropsychological testing is one excellent way to document that cognitive impairment.

Your neurologist may order this testing as a routine part of your care. If that has happened, you should consider using the test results as part of the evidence you provide to your disability insurer. If that has not already happened, we strongly recommend you get this testing done to support your claim. Note that if your neurologist orders the testing as part of your treatment and care, your medical insurance may cover the cost, which is high. If, however, you have the testing done on your own or through your attorney, insurance most likely will not cover the cost as it is forensic testing – testing to provide evidence.

Not all neuropsychologists understand the intricacies of documenting cognitive impairment to support a disability claim. Make certain that the neuropsychologist you see has a good reputation and plenty of experience performing the testing and preparing comprehensive written reports.

If you have been diagnosed with a medical condition that causes you to experience cognitive impairment, and have questions about long term disability, contact Kantor & Kantor for a no-cost consultation.

We understand and we can help.
www.kantorlaw.net (800) 446-7529