Using a Special Needs Trust to Ensure Your Settlement Does Not Affect Public Benefits

Using a Special Needs Trust to Ensure Your Settlement Does Not Affect Public Benefits

In Wisconsin, Medicaid (sometimes also called Medical Assistance) covers 1 in 9 adults and 1 in 3 children; in fact, 16% of the Wisconsin population gets its health care coverage through Medicaid.  Unlike the similar sounding Medicare, Medicaid is a means tested, needs-based health care coverage program, which means there are various income and asset limits that determine a person’s, or his/her family’s, eligibility.

By virtue of being a means tested program, Medicaid eligibility can be affected by receipt of funds, such as a personal injury settlement, if proper steps are not taken.  For example, to qualify for Medicaid, a single person can have no more than $2,000 in total countable assets.  If that Medicaid recipient receives a personal injury settlement of $25,000, he or she is going to be above the asset limit and at risk to lose Medicaid coverage.  Considering the exorbitant cost of medical procedures and medications, the loss of Medicaid coverage, or any needs-based benefits, can be devastating.

No injury victim should face the choice of being fully and fairly compensated for his or her injuries versus keeping his or her health care coverage.  Such a harsh outcome can be avoided by transferring the settlement funds to a properly drafted “special needs trust.”  Under normal rules, if a Medicaid recipient gives away or transfers assets to someone else, or to a trust, this results in disqualification from Medicaid (a penalty period).  A special needs trust is a type of trust that is specifically allowed under the Medicaid rules as an exception to the asset transfer rule.  A Medicaid recipient can transfer assets to a special needs trust without disqualification, and the recipient will no longer be over the asset limit.  Although the injury victim no longer has access to the funds, the trustee of the special needs trust can make distributions for his or her benefit, and there will be no loss of public benefits.

For example, our hypothetical accident victim, Courtney, receives a $25,000 settlement but is on Medicaid and Social Security Income (SSI), which are public benefits with asset limits.  Courtney wants to save this money for a car (a non-countable asset) or other items but is not sure what she would like to purchase.  If she is going to stay on public benefits, she only has ten days to report that she has received the money, and then will receive a notice that her benefits will be terminated.  Instead, Courtney’s attorney creates a special needs trust for Courtney, naming her mother as the trustee.  Courtney transfers the $25,000 to the trust without any disqualification for public benefits.  Later, Courtney decides she wants to buy a car with the settlement proceeds.  The car is bought and paid for by the special needs trust; the funds to buy the car come directly from the special needs trust, not Courtney.  Courtney gets her car and continues to receive Medicaid and SSI.

It is important to remember that Medicaid and SSI are just a couple examples of means tested/needs-based public benefits that could be affected by receipt of personal injury settlement funds.  This all serves to highlight the risk of going it alone following an accident or injury, as well as the need to hire a skilled attorney.  To be sure, when the insurance adjuster is pressuring you to settle your claim, the insurance company is not going to care whether the settlement will cause you to lose your public benefits.

 

Children Moving Out?  Make Sure They are Still Insured

Children Moving Out? Make Sure They are Still Insured

Often families with teenage drivers living at home do not have those teenage drivers listed as named insureds on the auto insurance policy.  Frequently, Mom and Dad are the named insureds on the insurance policy and all the vehicles are listed, and the teenagers qualify for coverage by virtue of being related to Mom and Dad and living in their home.  This type of familial relationship coverage for the teenage drivers usually has a special term of art in the insurance policy, such as “resident relative,” “member of same household” or “resident of your household.”

While each insurance company defines their terms differently, generally speaking, this type of familial coverage means that drivers who are living with their parents qualify for insurance coverage even though they are not the “named insureds” on the auto insurance policy.  This type of coverage is usually defined as a person related by blood (or adoption) to the named insured and living with the named insured; some insurers may limit this category to minor children only, but others may include adult children as well.

The reason this topic is being raised, is that sole reliance on resident relative coverage can create potential problems when that child moves away from home (goes to college or armed forces) or splits time between two homes (divorced parents).  Hopefully, a hypothetical will illustrate.

Billy is a hypothetical 18-year-old high school senior living with Mom and Dad.  The family has a hypothetical auto insurance policy that lists Mom and Dad as the named insureds and covers both of the family vehicles.  While Billy is not a named insured on the policy, by virtue of being related by blood to Mom and Dad and living in the same household with them, he qualifies as a resident relative insured, even as an 18-year-old.

Billy graduates from high school and goes off to college in another city; he is no longer living with Mom and Dad, nor is he listed as a named insured under any other auto insurance policy.  While at college, Billy gets injured in a terrible auto wreck while riding in a friend’s car.  Unfortunately, the at‑fault driver does not have sufficient insurance (or worse, no insurance at all) to cover Billy’s extensive injuries and damages.  However, Billy and his parents think that Billy should have underinsured motorist coverage available to him under Mom and Dad’s auto policy.

The problem is, Billy may no longer qualify as an insured under Mom and Dad’s auto policy.  Billy was never a named insured, the crash did not involve Mom and Dad’s cars, and Billy may no longer qualify as a resident relative.  Because Billy was not living with Mom and Dad at the time of the car crash, he may not qualify as a resident relative anymore.  Whether Billy qualifies for coverage under Mom and Dad’s policy will depend on the policy’s definition of resident relative and Billy’s precise living situation at the time of the wreck.  Had Billy completely moved out or did he leave his furniture and personal belongings at home?  Where was he getting his mail, or what was his voting address?  Regardless of the facts, by virtue of no longer living under the same roof with Mom and Dad at the time of the wreck, the insurance company will likely argue that Billy does not qualify as an insured.

You and your family, can avoid being left in this limbo by making sure your children who are leaving and not getting their own auto insurance are specifically listed as named insureds on your auto policies.  That way, if they are injured in a car wreck, they can have the benefits and protection of the uninsured and underinsured (if underinsured was purchased, and it should be purchased) coverage.

 

Protect Your Rights After a Hit-and-Run

Protect Your Rights After a Hit-and-Run

When people envision an auto wreck, their minds usually go to an image of two crashed vehicles on the side of the road, and the police are present talking to the parties and witnesses to document what occurred. As a result, an accident victim can readily identify the at-fault party and insurance company to pursue compensation for his or her injuries and losses. However, in a hit-and-run, if the other driver is never identified, the accident victim obviously cannot identify a driver or insurance company to pursue. Therefore, in order to obtain compensation for injuries sustained in a hit-and-run, the accident victim must use his or her Uninsured Motorist coverage. This can make recovering compensation more complicated, as there are procedural pitfalls awaiting an accident victim.

While using Uninsured Motorist coverage (also referred to as “UM”) may seem counterintuitive, under Wisconsin law, one of the definitions of an “uninsured motor vehicle” is “an unidentified motor vehicle involved in a hit-and-run accident with another person.” Since Wisconsin law requires every automobile insurance policy sold in the state to contain UM coverage, every Wisconsin automobile insurance policy has protection for a hit-and-run (the amount of protection depends on the limits of UM purchased).

The “more complicated” part referenced above comes from policy language that imposes additional duties on the accident victim in order to utilize the UM coverage for a hit-and-run. While every insurance company and policy is different (and they are always changing), many policies require the person making a claim for a hit-and-run to notify the police and the insurance company in a timely matter. Some insurers only require the person “promptly notify,” while others have even more stringent requirements of 30 days or even 72 hours. As always, you want to read and follow your policy’s duties and deadlines to avoid the argument that you breached the policy and are not entitled to UM coverage. Therefore, in addition to the ever-present three-year statute of limitations that the claim must be brought within, the policy imposes its own obligations.

As if not already complicated enough, if you are injured in an accident in which the unidentified vehicle did not physically make contact with your vehicle (a/k/a “phantom motor vehicle”), a set of even more stringent requirements await you. For example: a driver comes over the centerline forcing you to swerve, your vehicle overturns and you are injured. In this type of scenario, Wisconsin law requires that: (1) the facts be corroborated by “competent evidence” provided by someone other than the insured or the person making the claim; (2) within 72 hours of the accident, a report of the accident is made to the police, peace or judicial officer, or the DOT (or equivalent in another state); and (3) within 30 days after the accident, a statement under oath is filed with the insurer setting forth the claim and facts in support of the statement.

Depending on your viewpoint, these obligations permit the insurance company the opportunity to investigate difficult claims timely, serve as a way for insurance companies to deny meritorious claims, or a little bit of both. Regardless, they are but one example of why it is so important to seek representation immediately after an accident. Even without these potential procedural pitfalls, an accident victim is likely to face a fight with the insurance company over liability for the accident and what compensation is owed. You do not want to be barred from even making a claim because of failure to comply with any policy and statutory requirements.

 

Injured at Work? Remember to Choose Your Own Doctor!

Injured at Work? Remember to Choose Your Own Doctor!

Recent trends have seen some employers hire on-site healthcare providers, oftentimes a nurse or a physical therapist. Depending on your viewpoint and utilization, these healthcare providers can be seen as a convenient benefit to employees, a way to contain healthcare costs, or a way to minimize workplace injuries. While an employer may encourage an injured worker to see the on-site nurse, therapist, or physician, it is important that workers know that Wisconsin’s Worker’s Compensation law allows them to choose their own doctor.

Injured workers in Wisconsin have an almost unrestricted right to choose their treating healthcare provider. Wisconsin statute allows the injured worker his or her choice of any physician, chiropractor, psychologist, dentist, podiatrist, physician assistant, or nurse practitioner, so long as they are licensed to practice in Wisconsin. If the worker wants to obtain treatment out of state, then the worker must obtain a referral from a Wisconsin practitioner or obtain the employer’s consent.

An employee is limited to two choices of a treating provider. If the employee is unhappy with the first treating provider, he or she has the right to choose a second treating provider. However, treatment by providers who practice together as partners or as a clinic only counts as one choice. Further, a referral from one healthcare provider to another healthcare provider also counts as one choice.

Part of the convenience of on-site healthcare for work injuries is offset by the worker’s compensation policy that allows employees to claim reimbursement for mileage related to medical treatment. This policy applies to medical appointments, physical therapy, and pharmacy visits.

More importantly, the choice of a healthcare provider has ramifications well beyond the type and scope of medical treatment that the injured worker receives; the healthcare provider’s opinions about an injured employee’s work injury plays a huge role in determining the amount of compensation the injured worker receives. The healthcare provider determines very important medical-legal issues, such as (1) whether the injury is indeed work-related; (2) whether the injury is permanent; (3) what is the amount of permanency; and (4) what are the work restrictions. The healthcare provider’s answers to these questions can determine the amount of compensation for a work injury.

Because so much of the worker’s compensation system depends on a healthcare provider’s opinions, it is crucial that an injured worker does not feel restricted to their employer’s suggestion. Remember, you have a right to choose your own doctor.

 

Life Events Require a Fresh Look at Insurance Coverages

Life Events Require a Fresh Look at Insurance Coverages

I recently had the incredibly good fortune of getting married to my wonderful wife, Kat.  In addition to the name, address, and health insurance changes that came with this life event, I volunteered to get our auto and homeowners insurance policies and coverages melded and up to date.  Since I focus my practice on representing injury victims, as we were updating our policies, I kept an eye out for a number of insurance policy issues that I recently came across in my practice.

Arbitration for Underinsured (UIM) and Uninsured (UM) Motorist Coverage

One of the greatest, if not the greatest, protection that an injury victim has is his or her Seventh Amendment right to a jury trial.  If the negligent party’s insurer is unwilling to provide fair and reasonable compensation for the injuries and damage sustained, you can seek recourse from a jury of your peers.  This is also true if the negligent driver does not have sufficient, or any, insurance and you need to make an underinsured or uninsured motorist claim with your own insurance company.

However, the Seventh Amendment protection is disappearing in some automobile insurance policies that include provisions that require arbitration for uninsured and underinsured motorist claims.  As a result, if the injured person and his or her insurance company cannot agree as to whether UIM/UM coverage applies or the amount of damages, rather than a jury of your peers deciding the issues, a group of arbitrators (usually three) decides the issues.

It is easy to pass this issue off as an “only lawyers read the insurance policy” type of issue.  However, depending on the issues and type of injuries, having your claim limited to a three-person arbitration body with limited discovery, limited evidence and limited appellate review could have a huge influence on your injury claim.  Unfortunately, by the time a lawyer reads your insurance policy, it is often after the injuries have occurred, and it is too late for the injured party to make an informed choice.

Breed Restrictions and Limits for Dog Bites

In Wisconsin, there is statutory liability for an owner, harborer and keeper of a dog when a dog bite occurs.  Normally, insurance coverage for this type of incident falls under a homeowner’s or renter’s insurance policy.  Just as all UIM/UM policy provisions are not written the same, not all policy provisions involving dog bite liability are the same.  There are a number of insurance policies in Wisconsin that limit, or completely exclude, coverage for certain dog breeds.

Some insurance policies exclude coverage for bodily injury or property damage caused by what the policy defines as prohibited or excluded breeds of dogs, including mixed breeds.  If not excluded, some policies limit the amount of insurance to an amount that is much lower (e.g. $25,000 or $10,000) than the policy’s normal liability limit.  As such, if you or your family owns a dog, make sure to check your policy for any dog breed restrictions or limitations of coverage.  Fortunately, my new married life includes only a teacup Chihuahua, which I have yet to see listed as an excluded breed.

 

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