Work Incentives Working Group

State Public Benefits Manual

Returning to Work:
Questions and Answers for People Recieving SSI and/or SSDI

 

State Public Benefits Manual

CHAPTER NINE
OTHER BENEFITS AND/OR PROTECTIONS

A. UNEMPLOYMENT INSURANCE BENEFITS

If 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 employee’s 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:

  • be unemployed at the time of application and
  • have been paid more than $1600 during their "base period" (prior 4 quarters) and
  • had at least $440 in wages during a quarter outside of the quarter in which their earnings were the highest and
  • be able, available, and actively looking for work.

Even if an applicant meets the above criteria, they may be disqualified from receiving benefits if:

  • they quit work without good cause; good cause to quit includes for health reasons, acceptance of another job, sexual harassment, or unsuitable work or
  • they were discharged from their job for misconduct.

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 person’s 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.

B. BANKRUPTCY

Filing of a bankruptcy will:

  • discharge most debts;
  • stop garnishments and harassment by collection agencies;
  • stop foreclosures and repossessions;
  • allow a debtor to keep exempt property; and
  • may stop utility shutoffs, or restore service after paying a reasonable deposit.

PROTECTIONS

After 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.

FILING FOR BANKRUPTCY

The 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.

CHAPTER 7 BANKRUPTCY

Summary. 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.

Debts. 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:

  1. up to $7,500 of equity in a home, including a mobile home, cooperative or condominium;
  2. up to $1,200 of equity in one motor vehicle;
  3. necessary clothing;
  4. up to $2,000 of personal property of any kind;
  5. tools of the trade;
  6. pension benefits and qualified retirement accounts.

CHAPTER 13 BANKRUPTCY

Summary. 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.

Chapter 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.

WHO IS A "VETERAN"?

Any 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

Generally, 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.
However, in general, the compensation program does not authorize payments for disabilities that are caused by a veteran's "willful misconduct" (e.g., substance addictions, venereal diseases).

VETERANS IMPROVED PENSIONS

Veterans Improved Pensions are awarded only to disabled veterans who:

  1. are permanently and totally disabled or unemployable; and
  2. served for 90 days with at least one of those days occurring during a "war-time period"; and
  3. are living on limited income and net worth.

The 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 veteran’s family, and the severity of the veteran’s disability. The current maximum pension benefit for an individual veteran is $14,999 per year.

Pensions 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 benefits.

The 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.

The DVA evaluates disability according to a Ratings Schedule for pension purposes considering adverse vocational factors, employability, age, and any evidence of willful misconduct.

PROCEDURE

To 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.

SURVIVORS BENEFITS

Widow/widowers may be eligible for survivor’s 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.

VETERANS MEDICAL CARE

Veterans 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 home care.

RESOURCES

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.


D. WORKERS' COMPENSATION/OCCUPATIONAL DISEASES

I. Introduction
Workers’ compensation is a system of benefits provided by law to most workers who have job-related injuries or diseases. These benefits are paid regardless of fault and are paid by the employers. The amount of benefits paid are limited by law. In Illinois, the workers’ compensation laws are contained in the Illinois Workers' Compensation Act (820 ILCS 305/1 through 305/30) and Workers' Occupational Diseases Act (820 ILCS 310/1 through 310/27). Most employers (some are excluded by statute) are required to provide the mandatory benefits by purchasing insurance or by receiving authorization to self-insure their obligations.
The Illinois Industrial Commission is responsible for administering the law, providing information and assistance to employees and employers, and resolving any disputes regarding employees’ entitlement to benefits and the amount of those benefits. The Industrial Commission does not pay benfits–that is the responsibility of the employers. The Industrial Commission has additional information on workers’ compensation on its website (www.state.il.us/agency/iic).

II. Injuries Covered By Workers’ Compensation
In most instances, workers’ compensation benefits are paid for accidental injuries that are caused, in whole or in part, by the employee’s work. An injury or disease for which workers’ compensation is available may result from a single accident, from exposure to a toxic substance, or from the cumulative effect of repetitive trauma or stress and in some instances, emotional stress may also be considered. Claims for emotional stress are generally limited to those resulting from physical trauma or by a sudden, severe emotional shock producing immediate, substantial psychological injury.

Employers 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.

To 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.

The 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.

The 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.

Employees 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.

III. Exclusive Remedy
When an employee sustains an injury arising out of and in the course of the employment, the sole remedy against the employer is, in most cases, under the Workers' Compensation Act. The employee does not have the right to file a personal injury lawsuit against the employer, except in very limited circumstances.

If 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.

When 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.

IV. Reporting An Injury or Exposure
A. Notice

Under the Workers' Compensation Act, an injured employee must give notice to the employer of an accidental injury arising from the employment as soon as practicable, but not later than 45 days after the accident. While the employee has up to 45 days to give notice, any delays in prompt reporting can seriously prejudice an employee's claim. The notice may be written or oral and must give the exact or approximate date and place of the accident.

In cases of radiological exposure, notice is to be given within 90 days of the time the employee knows of or suspects an excessive dose.

The giving of notice is jurisdictional, and a failure to give notice will bar a claim. The Industrial Commission has ruled, however, that knowledge of the employer from almost any source will constitute sufficient notice.

Under the Occupational Diseases Act, notice of the disablement is to be given as soon as practicable.

B. What Must The Employer Do After Receiving Notice

Once notified of an injury, an employer should promptly take the following steps:

  1. Inform the insurance carrier or administrator responsible for the workers’ compensation program.
  2. Provide all necessary first aid and medical services, and pay temporary total disability benefits when due.
  3. If the employee cannot work for more then three days because of the injury, the employer must do one of the following:
  • begin payments of temporary total disability; or
  • provide the employee with a written explanation of what additional information the employer needs before payments can begin; or
  • provide the employee with a written explanation of why benefits are being denied.

C. Statute of Limitations
In addition to giving notice, the injured employee must file an Application for Adjustment of Claim at the Industrial Commission within two years from the last payment of compensation or three years from the date of injury, whichever comes later.

In 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.

V. What Interim Benefits Are Available
A. Medical Treatment

The employer must provide all necessary first aid, medical and surgical services that are reasonably required to cure or relieve the effects of the accidental injury or occupational disease.

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.

B. Temporary Total Disability (TTD)
If the injury or disease results in the total inability to work for at least three working days, the employee becomes entitled to benefits beginning with the fourth day for the duration of the period of temporary total disability. If the disability persists for 14 days or more, the first three days are not excluded from coverage.

Temporary total disability benefits are paid at the rate of two-thirds of the average weekly wage, excluding overtime and bonus, during the 52 weeks immediately preceding the injury. Overtime is included in cases arising under the Illinois Occupational Diseases Act and is included in benefits under the Workers' Compensation Act at the straight pay rate provided the employee regularly worked overtime. The maximum benefit is equal to 133 1/3% of the statewide average weekly wage; currently (through January 14, 2022) the maximum TTD rate is $927.06. The minimum benefit is set by statute; for a single employee with no children, it is $100.90. The benefit cannot exceed the average weekly wage of the injured employee.

C. Vocational Rehabilitation
When the injured worker cannot return to his/her former job or to approximately the same economic position he/she was in prior to the accident, the employer may be required to provide vocational rehabilitation in the form of retraining or other assistance. The Act is vague in terms of the nature and scope of the rehabilitation entitlement, and, as a result, the parameters of the rehabilitation program have been set by the courts.

VI. What Benefits Are Available for Permanent Injury
If, after the healing process is completed, the employee is left with permanent consequences of the injury, permanent disability will be paid pursuant to rather complicated alternative sections of the Act. Most permanent partial disability benefits are paid at a rate of 60 percent of the employee's average weekly wage, subject to a maximum which is periodically adjusted. The current maximum rate through June 30, 2022 is $485.65. The maximum rate applicable to a particular accident depends on the prevailing maximum on the date of the accident, not at the time benefits are awarded. The minimum rate for a single employee with no children is $80.90, but, again, it may not exceed the weekly wage.

A. Disfigurement
Disfigurement is not a true functional disability, but a cosmetic result of injury or "impairment". To be compensable, it must be serious and permanent and involve the head, face, neck, arm, leg below the knee, or chest above the axillary line. Generally, an employee cannot receive both compensation for disfigurement and also for specific loss of the same body part or for permanent total disability. The maximum compensation for disfigurement is 150 weeks of benefits.

B. Specific Loss
The Act sets forth a schedule which describes benefit amounts for total loss of specific parts of the body. For example, a 100 percent loss of a hand amounts to 190 weeks. Benefits for partial loss or partial loss of use of a specific body part listed in the schedule are paid on the basis of the percentage loss of use multiplied by the maximum number of weeks payable for the part of the body involved. As an illustration, if the Industrial Commission determines that the employee has sustained a 50 percent loss of use of the hand, 95 weeks (50 % x 190) of permanent partial disability benefits would be payable. Disability benefits would be payable at the rate of 60% of the employee's average weekly wage.

C. Man As a Whole
If the employee sustains injuries not compensated under the disfigurement or specific loss provisions, benefits may be paid for non-specific injury to the whole person. One-hundred percent of the whole person amounts to 500 weeks. Benefits for partial loss of the whole person are paid for the percentage loss of use multiplied by the maximum number of weeks (500 weeks) for the whole person. For example, if as the result of a compensable injury to the lower back, the employee is found to be 20 percent disabled, 100 weeks of permanent partial disability benefits would be due. If the injury involves certain specified parts of the body, the statute provides that a minimum number of weeks of compensation must be paid. In the case of a fractured vertebra, for example, the minimum is six weeks. For fractures of various facial bones, the minimum is two weeks.

D. Wage Impairment
For an employee who becomes partially incapacitated from pursuing his/her usual and customary line of work, instead of receiving compensation for a percentage loss of use, an employee may elect to receive compensation based on a percentage (66 2/3%) of the difference between the average amount he/she would be able to earn in the full performance of the duties of the occupation in which he/she was engaged at the time of the accident, and the average amount which he/she is earning or is able to earn in some suitable employment or business after the accident. Compensation for the diminution in earning capacity continues as long as the disability lasts. This benefit is subject to the same maximum benefit described above for permanent injury.

VII. Benefits for Permanent Total Disability
If the employee's injury is so severe that he/she cannot perform any services except those for which no reasonably stable market exists, he/she is totally disabled and entitled to benefits at the same rate and subject to the same maximum and minimum as the temporary total disability benefits previously described (i.e. 66 2/3 of average weekly wage). The minimum benefit for permanent total disability is 50% of the State's average weekly wage; currently (through January 14, 2022) it is $347.65. Benefits continue only as long as the disability lasts. If the employee is able to return to work, the award ceases. If the employee is able to earn something, but not as much as before the accident, the award is to be modified.
Another type of permanent total disability award is possible in the case of the permanent complete loss of use of both hands, arms, feet, legs, eyes or any two of them as the result of a single accident. Such loss is, per se, a permanent total disability even if the employee returns to the previous employment.

VIII. Death Benefits
Death benefits at the same rate and subject to the same maximum and minimum as the permanent total disability benefits previously discussed are provided to widows, widowers and children. If the employee leaves no surviving spouse or children, benefits may be paid to dependent parents, grandparents, grandchildren, or collateral heirs, based on their percentage of dependency upon the dead employee. Total compensation in death cases cannot exceed the greater of $250,000 or 20 years of benefits. Funeral expenses in the amount of $4200 are also payable in cases where death occurred on or after 1, 1992.
IX. Procedures

A compensation case is usually commenced by filing an Application for Adjustment of Claim. No filing fee is charged, and the form is available at the Illinois Industrial Commission, 100 West Randolph Street, Suite 8-200, Chicago, Illinois 60601. The document calls for basic information about the employee and the employer, the date of accident, the geographical location of the accident, the part of the body injured, and the manner in which notice was given to the employer, as well as a brief description of how the accident occurred.
Although there is no requirement that an applicant be represented by counsel, most cases benefit significantly from legal representation. In many areas, the statute is vague and imprecise. It is, therefore, often impossible for a lay person or even an attorney not well-versed in this area of law to fully appreciate all of the issues presented by a particular fact pattern and/or the ramifications of a given development.

Legal fees paid by injured workers in workers' compensation cases are strictly regulated and limited by statute and are only recoverable from compensation actually paid to the employee or dependents.

E. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

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.

Under 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.

If 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.

However: 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.

If 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.

Every 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.

Example 1:
A person is covered under Medicaid for two years and, during that time, they are diagnosed and treated for diabetes. The client then becomes employed at an employer that offers group health insurance. The health plan may not impose any exclusion of coverage for diabetes because the insured was previously covered for at least 12 months under Medicaid prior to getting the job.

Example 2:
A person is covered by a group insurance plan at a job for six months during which she is diagnosed with multiple sclerosis. The client then switches to a new job which offers group insurance. The new health plan may choose to exclude her from coverage for treatment for multiple sclerosis for 6 months only.

 

BACK TO TOP

CHAPTER ONE
SOCIAL SECURITY DISABILITY PROGRAMS

CHAPTER TWO
HOW TO WORK AND MAINTAIN SOME SSDI OR SSI BENEFITS

CHAPTER THREE
STATE ADMINISTERED BENEFITS

CHAPTER FOUR
HOW THE MEDICAL ASSISTANCE PROGRAMS WORK

CHAPTER FIVE
MEDICARE

CHAPTER SIX
OTHER STATE AND LOCAL PROGRAMS THAT PROVIDE CASH OR MEDICAL ASSISTANCE

CHAPTER SEVEN
FOOD STAMPS

CHAPTER EIGHT
OFFICE OF REHABILITATIVE SERVICES (ORS)

CHAPTER NINE

OTHER BENEFITS AND/OR PROTECTIONS