State Public Benefits Manual
A. UNEMPLOYMENT INSURANCE BENEFITS
a person has recently stopped working, they may be eligible for unemployment
insurance benefits for up to 26 weeks. An eligible employee may also be
able to receive additional benefits for their dependents. The amount of
weekly unemployment insurance benefits are determined based upon the employees
wages during the year preceding their separation from work. An applicant
must apply at the state Department of Employment Security.
To qualify for benefits, an applicant must:
Even if an applicant meets the above criteria, they may be disqualified from receiving benefits if:
An employer may object to an employee receiving unemployment benefits if the employer contends that the employee left work without good cause or was discharged for misconduct. An employee may appeal a decision to deny them unemployment insurance and is entitled to a hearing on the appeal. The receipt of unemployment insurance may affect a persons eligibility for other government benefits such as TANF, Medicaid, SSI, and food stamps. In addition, if a person is concurrently applying for unemployment insurance and disability benefits, there may be a conflict between asserting that they are able and available for work and, at the same time, unable to engage in substantial gainful employment.
Filing of a bankruptcy will:
a bankruptcy is filed, all collection activity by creditors or collection
agencies must stop. Foreclosures and repossessions may not proceed unless
the Bankruptcy Court gives its permission. It is also illegal for an employer
to terminate an employee for filing bankruptcy. After a bankruptcy is
filed, a utility must restore service if the debtor provides assurance
of future payment by paying a deposit. The Social Security Administration
will normally not pursue overpayments under $3,000 through a bankruptcy
claim unless the debtor has committed fraud. The filing of a bankruptcy
by the parent of an overpaid child SSI recipient does not discharge the
overpayment debt or stop collection efforts unless the child is specifically
named in the bankruptcy.
debtor files papers listing all debts and all property. The debtor also
files a budget listing their income and assets. After the papers are filed
with the Bankruptcy Court, the debtor must go to a meeting of creditors
in which the creditors may object to the bankruptcy plan. After the meeting
of creditors, the bankruptcy trustee (a subsidiary of the court) will
approve or disapprove of the plan and submit the plan and their recommendation
to the court.
In this type of bankruptcy, the debtor receives a "discharge"
of all their debts, except for certain types of debts. A "discharge"
is a court order that the debtor no longer has to pay the debt.
Most debts are dischargeable. Debts that are not dischargeable in a Chapter
7 include child support, alimony, most taxes, criminal fines or restitution
orders, debts due to fraud, drunk driving, or willful and malicious injury
to another, debts arising out of a property settlement in a divorce, and
student loans unless paying back the student loan would be an undue hardship.
Property. The debtor can keep exempt property as long as it is not subject to a lien (a mortgage or security interest). Liens on property generally survive a Chapter 7 bankruptcy. The major types of exempt property are:
The debtor proposes a plan to repay creditors. The court reviews the Chapter
13 plan and will approve it if the plan can work and meets the requirements
of the bankruptcy laws. Payments are made to the Chapter 13 trustee, who
pays the creditors according to the plan. The debtor can keep some property
that would be lost in a Chapter 7.
13 requirements. The debtor must pay their creditors in full if possible.
If that is not possible, the debtor must pay all of their disposable income
(after necessary living expenses) for 3-5 years. Once the plan is completed,
the debtor will get a discharge of remaining debts.
Advantages over Chapter 7. In addition to the benefits of a Chapter 7, the debtor can keep property that is secured by a lien by paying for it through the Chapter 13 plan. This can save a home from foreclosure, or stop repossession of a car. Chapter 13 can also stop evictions, if filed before a lease termination expires and if the debtor can pay the back rent owed through the Chapter 13 plan. All debts except alimony, child support, criminal fines and restitution, drunk driving judgments, taxes and long term debts, such as mortgages, can be discharged in a Chapter 13. Student loans are not discharged unless denying a discharge would cause an undue hardship to the debtor.
D. VETERANS BENEFITS
The Department of Veterans Affairs ("DVA") administers two programs that provide substantial cash benefits to eligible veterans and their families. Additionally, the DVA operates free medical facilities for veterans and administers other programs that provide job counseling, job placement, educational benefits, clothing allowances, adaptive housing, and programs for homeless veterans.
IS A "VETERAN"?
individual who served in the armed forces and received an honorable discharge
or a general discharge under honorable conditions is a "veteran"
and is potentially eligible for benefits. Former service members who received
discharges "under other than honorable conditions" are ineligible
for veterans benefits if that characterization of service was because
of an "offense involving moral turpitude."
Veterans Compensation is awarded for service-connected disabilities. Disabilities
are rated on a percentage scale and the veteran's monthly award is set
accordingly. Payments range from $98 - $2,036 per month depending upon
the severity of the disability. Additional compensation payments are made
if the eligible veteran has dependents or a disabled spouse. Veterans
compensation is not "need-based". These benefits are paid despite
other household income and resources.
Veterans Improved Pensions are awarded only to disabled veterans who:
veteran's disability does not have to be service-connected. The amount
of the pension is based upon the countable family income of the veteran,
the number of dependents in the veterans family, and the severity
of the veterans disability. The current maximum pension benefit
for an individual veteran is $14,999 per year.
are need-based and are reduced if the veteran has other countable income.
In determining countable income, all veteran and spousal income is counted.
In general, earned income and Social Security Disability payments are
counted. However, some of the veteran's educational and unreimbursed medical
expenses may be excluded. Income such as welfare benefits and Supplemental
Security Income is not counted. A veteran who is "housebound"
or needs "aid and attendance" can also receive increased pension
pension program has no strict asset limit. Rather, a pension will be denied
if the net worth of the veteran and spouse are such that, considering
all the circumstances, it is reasonable that some part of the estate be
used for the veteran's maintenance.
DVA evaluates disability according to a Ratings Schedule for pension purposes
considering adverse vocational factors, employability, age, and any evidence
of willful misconduct.
file a claim, the veteran generally must file a written application on
the prescribed DVA form. The DVA's Regional Offices ("RO") make
Initial Decisions on all claims. When the initial decision is a denial,
the veteran can ask the RO for reconsideration or s/he can file a Notice
of Disagreement ("NOD") within one year of the date of mailing
of the decision. There is a right to an administrative appeal and a hearing.
In addition, administrative decisions are appealable to the Court of Appeals
for the Federal Circuit.
may be eligible for survivors benefits, including health care insurance,
under the Civilian Health and Medical Program of the Dept. of Veterans
Affairs ("CHAMPVA"). The surviving spouse is eligible only if
s/he was living with the veteran at the time of his/her death. However,
if the veteran caused the separation, and there is no fault by the spouse,
the spouse is eligible for benefits.
are eligible for free care at a DVA hospital. Priority is given to veterans
seeking treatment of service-connected injuries. Non-priority veterans
may have to make a co-payment for outpatient care, inpatient care or nursing
Department of Veterans Affairs has a toll-free numbers for the convenience of veterans and dependents: VA Benefits, 1-800-827-1000. Information can also be found on the VA World Wide Web Home Page Server at http://www.va.gov including fact sheets, current benefits amounts, and applications.
Injuries Covered By Workers Compensation
take their employees as they find them. If a pre-existing condition is
aggravated, exacerbated or accelerated by the work effort, the employee
is entitled to benefits.
be compensable, an injury must arise out of the employment. If the risk
of improvement is no greater than for the general public, the injury does
not arise out of the employment. For example, if an employee's back goes
out while bending to tie his or her shoes at work, this would not be compensable.
The employment need not be the sole causative factor or even the principal
causative factor; it simply must be a factor.
injury must also occur in the course of the employment. In other words,
the time, place and circumstances of an accident must indicate that the
employee was doing the employer's work at the time rather than attending
to some personal matter of his own.
course of employment is not necessarily considered broken merely by certain
acts relating to the personal comfort of the employee, such as lunch on
the company premises or changing clothes in the company locker room.
having fixed hours and fixed places of work are generally not considered
to be in the course of their employment while going to or coming from
work. Exceptions exist, as, for example, where the employee makes a special
detour to perform a work-related task or where the employer arranges transportation.
Also, if the employment requires travel, as in the case of a travelling
salesman, the employee may be deemed in the course of the employment from
the time he/she leaves home until the time he/she returns home.
the injury was caused by the acts of a third party (neither the employee
nor the employer), the worker can sue the third party. Such actions may
be based on negligence, intentional torts or strict liability such as
with a defective product. For example, if a punch press operator suffers
an amputation due to the improper design of the press, the employee may
file a workers' compensation claim against the employer and sue the machine
manufacturer in common law.
the injured employee recovers against a third party, the employer is entitled
to reimbursement for amounts paid under the Workers' Compensation Act.
The Act gives the employer a lien against any third party recovery equal
to the Workers' Compensation benefits paid. However, in the event the
employee retains an attorney to recover against the third party, the lien
is reduced to 75%. Additionally, the employer must pay a pro-rata share
of the costs incurred in making the third party recovery. As a result,
it may not always be in the injured employee's best interests economically
to proceed with a third party case.
Reporting An Injury or Exposure
B. What Must The Employer Do After Receiving Notice
Once notified of an injury, an employer should promptly take the following steps:
Statute of Limitations
Occupational Diseases cases, the application must be filed within three
years of the date of disablement or within two years after the last payment
of compensation. Disablement must occur within two years of the last exposure
in most cases, and within three years in silicosis, berylliosis and asbestosis
cases. Special rules apply to certain diseases. For example, in coal miners'
pneumonoconiosis cases, claims must be filed within five years of the
last exposure or payment of compensation. Claims resulting from exposure
to radiation or asbestos must be filed within 25 years of the last exposure.
What Interim Benefits Are Available
The employer's liability to pay for medical services from providers selected by the employee is limited to all first aid emergency treatment, plus two health care providers and anyone in the chain of referral from the first two providers. In other words, the employee may choose his/her treating physician and may change the treating physician once without the employer's acquiescence. The change-of-treatment limitation does not apply to referrals from the treating physician.
No limitations exist on the amount or duration of treatment, other than it be reasonable and necessary. Issues often arise, however, because different doctors vary in their diagnoses and opinion on reasonableness and necessity of treatment.
Temporary Total Disability (TTD)
What Benefits Are Available for Permanent Injury
Benefits for Permanent Total Disability
E. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)
is a federal law that applies to all persons insured under group health
insurance plans. HIPAA limits the use of pre-existing condition exclusions
by group health insurance plans. This means that persons who are insured
by a group plan (usually health insurance plans furnished through an employer,
union, or school) are protected from pre-existing condition exclusions.
HIPAA, group health insurance plans may not impose a pre-existing condition
exclusion for any person previously covered under a group insurance plan,
Medicaid, or Medicare for at least 12 months.
a person has been receiving insurance, Medicaid, or Medicare for at least
12 months before changing to a new group health insurance plan, the new
plan cannot impose an exclusion. This means that if a person has or had
a prior diagnosed or treated condition, such as asthma, cancer, etc.,
the group health insurance plan cannot state that it will not cover the
person for that pre-existing condition.
In order to receive full protection, a person may not have more than
a 63 day break in coverage. This means that they cannot have been uninsured
for more than 63 days before applying for the new insurance.
a person is previously covered under group insurance, Medicaid, or Medicare
but for less than 12 months, the new insurance plan must give the person
credit for every month that they were covered under an old plan. This
means that if a person was only on Medicaid for 6 months prior to getting
a new job and had a pre-existing condition, the new insurance plan could
still impose an exclusion (not cover the person for the pre-exiting condition)
but only for 6 months.
employer, health insurance company, the Illinois Department of Human Services
for the Medicaid program, and the Social Security Administration for the
Medicare program must issue certificates of creditable coverage to persons
previously insured. This means that a person is entitled to receive a
certificate stating exact dates of coverage to prove to the next employer
or insurer that they were covered.