The Top Five Reasons VA Pension Applications are Denied

By September 1, 2009Uncategorized

Senior News
September 2009, Volume 12, Number 3

The Top Five Reasons VA Pension Applications are Denied
By Ron Buchanan, Veterans Pensions Benefits Consultant
rbuchanan@jacksonwhitelaw.com

The VA’s own website (www.va.gov) confirms that 75% of all VA pension applications are denied the first time.  Is this a conspiracy by the VA?  Does the VA have a “quota” for approvals?  Are they trying to save federal money?  Do they know the proper regulations? In my 34 years with the VA, I even heard that “pension applications are only approved the last 10 days of the month”.  NONE OF THESE ARE TRUE!
The fact of the matter is, VA applications for pension are disapproved because they are not complete and well-documented.  I hope the following 5 reasons for denial will help you understand the VA process.

# 5: Missing or Incomplete Information. The VA pension applications are multiple-paged and have hundreds of questions.  Address and answer every single one of them.  If the question is non-applicable, answer “N/A”; if income is zero, answer with a “0”. NEVER, EVER leave a space blank.

# 4: Failure to Respond to Clarifications.  Always answer VA letters or phone calls as soon as possible.  If you need more time, send a letter saying “I’m working on it”.  You have at least 60 days to respond and can supply the information within one year and still have a valid claim.

# 3: Documenting Dependents.  According to the VA, a “dependent” is younger than 18, where the veteran is the father, or the veteran is married to the mother (step-children are fine).  Grandparents must have court-issued adoption decrees.  If dependents are under 23- years- old, they must be in school full-time.  Spouses are dependents, but their income also counts, as well as their Unreimbursed Medical Expenses.

# 2: Documenting Shortfalls.  If your Unreimbursed Medical Expenses, especially your Room & Board (R&B), exceed your income, the VA will ALWAYS delay your claim to clarify this.  So, anticipate this question!  If you are using savings or assets to meet this shortfall every month, explain this as an attachment to your application.  If your assets are depleted, and a friend, sibling or family member is supplementing your R&B, explain this.  To be sure the VA understands what is happening, write a simple loan agreement and submit it with your application.  This will prove that you are borrowing this shortfall every month.

And Finally, # 1: Failure to Document Income and Unreimbursed Medical Expenses.  On the application, the VA can ONLY confirm the amount of your Social Security benefits independently.  Everything else should be documented with a written explanation, this year’s award letter or an annuity agreement.  When in doubt, document it.  Unreimbursed Medical Expenses should be documented on the VA form 21-8416.  If you have any other recurring, ongoing or continuous Unreimbursed Medical Expenses (including R&B), document them!

With the VA, you can never provide too much information.  If they have to write you for clarification, your claim will be delayed or denied.  Always include your phone numbers, an email address and a next-of-kin’s contact information with every application.

If you have any questions regarding VA pension, please contact JacksonWhite at 1-800-243-1160 or pose a question to our blog at www.arizonaseniorlaw.com/blog.

Facilities Can Seek Representative Payee Status to Obtain Share of Cost Payments
ALTCS members living in residential health care facilities such as group homes and skilled nursing facilities are most often required to pay a share of cost (also known as room and board).  This means they are responsible to pay a portion of their income directly to the facility.  The amount of the share of cost varies depending on the ALTCS member’s specific situation.  It is the facilities’ responsibility to collect the member’s share of cost from the members.  Many times, health care facilities have no problem collecting the share of cost from their patients. Other times, it is harder. It may be that the member has reached a stage where paying the facility has become difficult; or it may just be that the member’s family simply has trouble remembering to pay the share of cost.  Whatever the reason, facilities need to find a means of collecting payment from their patients.

One solution available to health care facilities is using representative payee status.  When Social Security receives notice that one of its recipients is not managing Social Security income appropriately, they can elect to designate a representative payee.  Once designated, the representative payee receives the monthly Social Security checks on behalf of the recipient and uses funds for the recipient’s needs and expenses.

Social Security selects representative payees who know the ALTCS member well and have their best interest in mind.  Oftentimes the member’s family member or friend serves as a representative payee, but it is also not uncommon for health care professionals to act as the designated representative payee.  The main requirements are that a representative payee sees the ALTCS member often and understands his or her needs.  A health care professional working at a residential facility where the recipient resides clearly satisfies these requirements.

Health care professionals can request to be designated as a representative payee by executing and submitting Form SSA-11-BK.  Upon designating the health care professional as representative payee, Social Security notifies the ALTCS member.  Members then have 60 days to appeal the decision or request that an alternative representative be designated.  If no appeal is made, Social Security sends the member’s monthly checks directly to the representative payee for disbursement.  Even if the ALTCS member requests that an alternative representative be appointed, the new representative is obligated to make timely share of cost payments.

A health care professional acting as a representative payee should take the share of cost from the Social Security check and then deposit the remainder into a patient trust account. If the remaining amount is more or less than $101.10, call the ALTCS office to have the member’s share of cost adjusted.

When faced with the alternative of not receiving payment in full for services provided, facilities should seriously consider requesting to be selected as representative payee.  Some facilities, however, would rather not act in this capacity.  There are agencies which will act as a representative payee for a fee.  Health care facilities which choose not to pursue acting as a representative payee can consider utilizing one of these agencies.  Another option is to request that a family member or friend be appointed as representative payee.  Social Security will take any request under consideration so long as the person being recommended is amenable to being designated.

Facilities should take caution not to seek representative payee status for individuals who have a Miller Trust.  Miller Trusts are used by ALTCS members whose income exceeds the monthly income allowance.  By assigning their income to a Miller Trust, individuals with excess income can meet ALTCS eligibility requirements.  Here’s the problem – once a social security representative payee is approved, the member’s income goes directly to the payee and not the Miller Trust account. This may cause the ALTCS member to become ineligible to receive future benefits.

For more questions regarding the ALTCS benefit, please contact JacksonWhite at 1-800-243-1160.

Join us for an ALTCS 101!
Learn about the ALTCS program, eligibility requirements, and the medical PAS.

Central Phoenix
Thursday, September 3
Foundation for Senior Living, Caregiver House
1:30 – 3:30 p.m.

West Valley
Tuesday, October 13th
Immanuel Campus of Care
9 – 11 a.m.

East Valley
Friday, October 30th
JacksonWhite Mesa Office
9:30 – 11:30 a.m.

Upcoming ALTCS 102 Training Dates
Already attended an ALTCS 101 but feel like there is still more to learn about ALTCS? ALTCS 102 picks up where the 101 training left off. If you’re an ALTCS 101 alumnus, register today!

East Valley
Thursday, September 10th
JacksonWhite Mesa Office
1 – 2:30 p.m.

West Valley
Wednesday, September 16th
JacksonWhite Peoria Office
2 – 3:30 p.m.

Central Phoenix
Tuesday, October 6th
Foundation for Senior Living, Caregiver House
2 – 3:30 p.m.

Seats for all ALTCS 101 and ALTCS 102 trainings are limited. Please RSVP to Julie Boyster at (480) 464-1111 or by email at jboyster@jacksonwhitelaw.com.