Draft letter for OPM WRT DW competence

Crushed

I had to draft a letter for DW's physician to explain her condition to OPM and in support of me being her representative payee.   You might find it useful (they do not recognize POA)
Since we have different last names I call her Dr World Famous 
 

Dr. World Famous is the last stages of Alzheimer's disease Major or Mild Neurocognitive Disorder Due to Alzheimer's Disease DSM-5 331.0 (G30. 9)
I am her treating physician.
This condition does not improve and ends in death. She has been treated by our Kaiser team for it for over 10 years. . Since 2017 she has been in  a secure memory facility (address)   She does not leave the facility due to her condition. I have signed 'do not transport' orders for her due to her advanced conditions
Dr Famous  has no significant cognitive functioning whatever. She requires 24 hour care and can do no ADLs She can not assist in her care .
Her husband Prof. Crushed has been extremely active in her care. When she broke her arm He held her while the surgeon did a painful closed reduction of the fracture.
I currently see her , when necessary via a telemedicine interface
She is not competent in any way due to the Alzheimer's disease and has been for at least a year with no prospect of improvement 

Boston Beauty Wolfe tones (song by Liam Reilly)

And nights when I'm alone my love, you come into my mind
And visions flash upon that Emerald Isle
Well, I watch the moon there up above then I'll leave this earth behind
And I'll call to you as I go sailing by

Goodbye my Boston beauty, farewell my Boston rose
I'll wait for you, I'll think of you, no threat to you I'll pose
Goodbye my Boston beauty, farewell my Boston rose
I wish that you were here but I know that's the way life goes
I wish that you were here so farewell my Boston rose

https://www.youtube.com/watch?v=3aKvxVYFC3I

  

JJ401

Crushed, thank you for this. I’ve bookmarked it in my may need for DH someday folder. While details would need to be changed for DH, having a template for me to use to draft something for the doctor would be very useful. Very few doctor offices are skilled at writing the letters that are needed. They will redo them if you are rejected, but it’s so much easier if it is accomplished the first time. Thanks.

extex

If you know her OPM retiree account number and password I would just go to OPM On Line Services and have her retirement benefit amount transferred into whichever bank account you want.   If she has TSP, do the same there. Im sure you are already the beneficiary of her life insurance. Your DPOA would give you authority to do this as I’m sure you know.

OPM Retirement Services Online.

• Get your monthly annuity payment statement
• Get your annual summary of payment
• Verify life insurance enrollment (FEGLI)
• Get your 1099-R tax form
• Change your federal and state income tax withholdings
• View or print your retirement card
• Check your interim retirement pay status
• Start or change direct deposit
• Start or change a checking or savings account allotment
• Start or change allotment to an organization
• Request a copy of your annuity booklet
• Update your profile and contact information
• Change your mailing address

Crushed

 

  If the annuitant cannot handle the benefits, we require that the payments be made to a court-appointed fiduciary or to a person

 

 OPM will not make payment based on a power of attorney or the existence of a joint account with the annuitant at a financial institution. If you are responsible for the care or custody of a person who is either mentally or physically unable to handle his or her own money, you should contact OPM as soon as possible.

 

 https://www.opm.gov/retirement-services/my-annuity-and-benefits/representative-payees/

 

 I'm a lawyer   I sued OPM (and won) to get her full retirement benefit. 

 Anything I do will ring bells.  

No I don't play games with the government (everything else you describe DW took care of in 2016) 

 

  

extex

Ok. I was only trying to help you avoid a lot of red tape.  I assume she has already been receiving benefit payments since  the time she qualified for retirement.  

I reviewed the OPM form RI 20-7, application for Representative Payee and didn’t see anything about a physicians certification letter being required.

Crushed

LINE 15   If not adjudged incompetent "you must attach medical documentation showing incompetence as described on the enclosed RI33"

  

Tfreedz

Crushed, forgive me I am confused and rather new to this. Was your wife not receiving her full retirement benefits before the diagnosis?

My mother retired 14yrs ago from the post office. She receives a pention and has a thrift savings account that I just found. She has always been very private about all finances, now she has no clue what, where or how much money she receives. Fortunately when she was diagnosed 5 months ago I got DPOA and have been piecing together her finances. I was extremely hopeful for the federal LTC insurance but she never enrolled and they state that now that she has an official diagnosis it is too late.

Are there other benefits she is not receiving that I should know about? If not I’m not sure why I would become a payee when I already have access to her accounts to pay her bills. You sound more more knowledgeable than I in this area, any advice would be great.

Crushed

My wife retired on disability after  the diagnosis of Alzheimer's  and before age 62

Her pension was thus affected by Redetermination   

 § 844.305 Redetermination of disability annuity at age 62.

Effective on and after the annuitant's 62nd birthday, the rate of annuity payable to a disability annuitant will be the amount of an annuity computed with respect to the annuitant under 5 U.S.C. 8415 (including subsection (g) of that section), including credit for all periods before the annuitant's 62nd birthday during which he or she was entitled to an annuity under this part. The average pay used in computing the annuity under 5 U.S.C. 8415 is adjusted by all cost-of-living increases effective under 5 U.S.C. 8462(b) during the period the annuitant

  was receiving the disability annuity under this part

Normally, for most federal retirees redetermination is a downward adjustment of the pension

However in DWs case it was an upward adjustment  due to her length of service and age. So they refused, making the clam the redetermination was always downward.  So I sued them before the merit system protection board and the day before the case went  public they settled  for our demands.  It was worth about $8000 a year .  Best lawyering I ever did . 

Tfreedz

Thank you for the clarification and great job advocating for your DW!!

extex

Tfreedz,

Check with OPM on a possible life  insurance policy.  If she had government life insurance while she was working she had the option of taking the insurance into retirement with her.  If you have her retirement account number and password you can check her pay statement at OPM services on line. Servivesonline.OPM.gov

Tfreedz

Thanks extex, I did find her original retirement paperwork. Very disappointed to see she checked no for life insurance! I really can’t believe she didn’t think it was necessary because she was caring for my brother with Downs. Now that has fallen into my lap along with planning her LTC. I wish she would have been more willing to speak openly about finances with me years ago. My husband and I are very open with our adult children with our finances and future wishes. I begged my mom 20 years ago (I’m 46 now) to consider my brother for a group home and to include me in her future planning. Unfortunately, she never believed I would need to become involved in either of their lives like I am now.

 I do see she has GEHA along with Medicare so I am a bit surprised she is still getting medical bills from the hospital and dentist. I thought GEHA would cover anything Medicare doesn’t. I’m very behind on all the info since she is not able to help me answer any questions, had no organization of financial paperwork and I’ve been her and my brother’s full time caregiver for the last 5 months so not able to leisurely search her home for paperwork.

extex

GEHA is just one of the many companies who provide health insurance under the umbrella Federal Employees Health  Benefit (FEHB).  Your mom could have  carried FEHB, including GEHA, into retirement to be used as a Medicare pickup insurance, she would, however, have had to continue paying the GEHA  premium.  Again, you may be able to find information  about her retirement pay, including deductions for health insurance at OPM Online Servives.

extex

Tfreezd, 

You can also get help at any OPM Civilian  Personnel Office.  Most Military bases have  a CPO if you have one nearby.

Caring4two

Tfreedz wrote:

 I do see she has GEHA along with Medicare so I am a bit surprised she is still getting medical bills from the hospital and dentist. I thought GEHA would cover anything Medicare doesn’t. 

Nope, a few thoughts: 

The hospital or dentist may not be on GEHA’s “preferred provider” list therefore a percentage of the bill will still be owed by the patient (copay). Not knowing what “type” of GEHA policy she has I’m just throwing things out here. I’m assuming it’s a medical policy? Does she also have GEHA’s dental supplement policy? 

Does she have regular Medicare or an advantage plan? Makes a difference.

Also, check with the hospital or dentist to make sure they are billing Medicare as “PRIMARY” and GEHA as secondary. Many times GEHA will not pay until Medicare has been billed first and refuses to pay the claim THEN the claim gets sent to GEHA. Without that Medicare “refusal” it never gets sent to GEHA.  

Also, most medical plans, including regular Medicare, do not cover routine dental. (Only if caused by a an accident or something). Advantage plans may, have to check the particulars of the policy. Many have restrictions on what doctor or dentist you can use. It’s all in the details unfortunately!