Illinois Assistive Technology Program Funding Manual

You will need to know your rights to fully participate in the decision making and funding process. Consider asking these questions:

What eligibility criteria exist for this program?
Are reevaluations, training, follow-up and repair included in funding considerations?
If I get an assessment, will you consider appropriate assistive technology?
Who makes the decision to fund or purchase an assistive device? Are those funds limited?
Are funding policies available in writing?
What legislation governs this program?
Is there an appeal process? If so what is it?

No matter what funding source you're approaching, it's crucial to show and verify that your request is appropriate and necessary. How?

Get an evaluation

Many funding sources require validated proof that you need the equipment or services. A certified professional -- doctor or therapist or treatment center -- can supply the proof. They can also help you decide what device(s) and services are right for you. The Illinois Assistive Technology Program has two papers that may be helpful: "The Right Stuff . . . How to Choose Appropriate Assistive Technology" and; "The Pros from Dover . . . Using Experts to Justify an Assistive Technology Need."

Document, Document, Document

Keep all logs and documents about your search for financial help. . . that includes all applications, medical reports, therapists' reports, diagnostic evaluations, school evaluations, etc. Never send anyone the original document unless the funder absolutely requires it. Instead make copies. Keep your papers on-hand as you move through the system. It will save you an unimaginable amount of time and effort

In addition to the "paper trail," keep track of all the telephone calls. Log the date and whom you spoke to about your request. This too will come in handy when going after your initial request or appeal.

A doctor's prescription and a letter describing your need, will go a long way in making your case. Other helpful information includes:

an outline of your functional skills;
how they will improve using assistive technology;
an explanation of the device that meets your needs;
an explanation of the device, its features and cost; and
a photograph or catalog picture.
Keep a file of all information related to the device.

Appeal

If a funding source denies your request... appeal it. Don't think it's the end of the line. It's said that no is often a gatekeeping function, to see if you'll go away. Appeals are quite common and nearly every funding source has an appeal process. Assistive technology appeals are often successful.

Appeals demand precise written proof to support your claims. Keep copies of all letters and telephone notes related to your case. First find out why they denied your request . . . lack of funds or information? If it is the latter, find out what they want, and submit it quickly. Handinet, a source for disability information has a paper by Lewis Golinker, A Baker's Dozen Excuses for Denying Funding and responses to those excuses.

Working with State Agencies

If a state or federal agency declares you ineligible. . . appeal. All government agencies have an appeals procedure. Mid-level managers and other "higher ups" will review your request. Every set of eyes looking at your request increases your chances for a positive response. Prepare yourself to work with state agencies by asking:

Will this device give me the tools to enter employment, receive vocational training, live more independently, or otherwise improve my independence and integration in society? You already did this in your initial request, now look for ways to strengthen it.

Do agency guidelines specifically exclude the device? Have they ever purchased a like device in a similar case? Of so, they set a precedent, and eventually will have to honor your request.

Do you meet the agency's financial requirements and other criteria? If you do not, an appeal won't help. However, if you have information that would prove your eligibility, your chances dramatically improve.

Don't forget to contact your Illinois state Senators and State Legislators or federal legislators about your issues with a state agency. They will check into your situation and try to find some resolution. You are part of their constituency; they want you to be happy. At the very least, you may get another hearing with the agency. Contact your county clerk's office for names and addresses of your state and federal office holders.

Workers' Compensation Claims

If a work-related accident or illness caused your disability, look for funding through your employer's workers' compensation insurance carriers. Workers' Compensation is a mandatory program that covers employees medical and disability expenses that occur from a job related illness or injury.

Don’t be too hasty to settle the claim. If the injury caused a permanent disability, workers’ compensation carriers generally want to settle the claim as soon as possible. Take the time necessary to understand how having the disability will affect your life and find out what kind of assistive devices you will need and for how long. Let the insurance company know that you will not settle the claim or sign any waivers or release forms until there is ample medical evidence that the disability is permanent and unchanging. If there is an attorney involved, make sure s/he understands why you may need certain assistive devices and services necessary to support them. Take time to learn how workers' compensation benefits are structured.

Any injured employee is entitled to all necessary medical care. Where necessary, the employee is also entitled to receive appropriate physical, mental or vocational rehabilitation (including assistive technology) and even permanent disability benefits.

For more information about compensation benefits, claims, settlements and the hearing process contact the Illinois Industrial Commission

Illinois Industrial Commission
100 W. Randolph, Suite 8-200
Chicago, IL 60601
312-814-6611

Illinois Industrial Commission
701 South Second Street
Springfield, IL 62704
217-785-7084 866-352-3033

For workers' compensation involving an employee of the federal government contact:

US Department of Labor
Office of Worker's Compensation
Chicago Division Chicago,
Illinois 60606
312-353-5656

Private Disability Insurance

Disability insurance protects someone unable to work due to injury or illness. Some employers provide disability insurance through group insurance plans. A person can also purchase an individual plan.

Disability policies vary widely. The typical policy provides a percentage of the pre-disability income for a specified period of time under specific circumstances outlined in the policy.

The insurer's goal is to return the policy holder back to work as quickly as possible. This creates a built-in incentive to consider assistive technology. You'll need to prove why it is cost effective. Insurance companies often have rehabilitation counselors working with you, your employers and physicians. They can arrange for specialized equipment and coordinate vocational rehabilitation services, all in an effort to return you to the ranks of the employed as quickly as possible.

Short-term disability insurance pays a percentage of your salary if you become temporarily disabled, meaning that you are unable to work for a short period of time due to sickness or injury or pregnancy. A typical Short-term disability policy provides you with a weekly portion of your salary, usually 50, 60, or 66 2/3 percent for 13 to 26 weeks.

If you have long-term disability coverage, you can continue to receive benefits after your short-term disability benefits expire if your disability continues. Policies vary on the length of coverage, but usually long-term disability provides benefits until age 65 for physical disabilities (or as long as the disability continues), but only for two years for mental disabilities.

What should I do if my disability insurance company denies my insurance claim?

If your claim is denied, some polices require that you pursue administrative appeals (grievances) within certain deadlines. If your appeals are denied, you may file a private lawsuit. In the case of employer-sponsored disability insurance plans, those claims might be governed by a federal statute (the Employee Retirement Income Security Act). Otherwise, the claims would be based on state law for breach of contract or bad faith insurance denial. To find an attorney experienced in this area of law, you may contact the Illinois Bar Association, Lawyer Finder

How does private disability insurance differ from SSDI and workers’ compensation?

Employees who develop a disability that prevents them from working may be eligible for Social Security Disability Insurance (SSDI), the amount of which is based on the amount of Social Security taxes you have paid. Private disability insurance does not bar you from collecting or reduce the amount of your SSDI benefits, but some private disability insurance policies require that you apply for SSDI benefits and, if you receive them, your disability insurance benefits will be offset by the amount of your SSDI. Workers’ comp is available when you are injured on the job. Some private disability insurance policies will deny or reduce benefits if workers’ comp is available.

Group Insurance Policies

Private insurance is an industry regulated by both the state and federal governments. In Illinois, the Department of Insurance regulates and oversees all private insurance companies with the exception of companies/organization that are "self insured".

Organizations that are self insured set aside the money they would have spent on insurance to cover their employees themselves.

Private insurance is designed to assist covered individuals in paying for their medical care, which may include assistive technology devices and services. Illinois does not mandate assistive technology coverage.

The language in your policy defines the scope of services you can claim. Historically, insurance is set up to meet the insured's acute care needs. For that reason they are usually willing to fund durable medical equipment, (wheelchairs) rather than augmentative communication devices or other rehabilitative or restorative devices.

If you submit a claim for assistive technology and your insurance company denies the claim... appeal. Each time you appeal, you increase the chances for success.