How long does a claim take?

Because we submit ready-to-rate applications with no missing information, your claim goes right to processing.  It typically takes about 6 weeks for the claim to be entered into the VA's system.  We have seen some claims approved in about 2 to 3 months, with the maximum being about 6 months.  The good news is that the VA will pay retroactive back to the first date of the following month the VA application was submitted. 

 

Does the money go directly to assisted living?

No.  The payment is direct deposited directly into the bank account listed on the application.

 

What happens if there is benefit left over each month?

Say your income is $1,200 a month and your cost of care is $2,000 a month.  If you were a single veteran, you would still most likely receive the $1,758 a month pension, leaving you with $958 left over each month.  The VA allows you to keep this money to pay for what is necessary for the care of the veteran.

 

How do I pay for utilities or other non-medical expenses?

When evaluating your claim, the VA will not consider other non-medical expenses such as groceries, utilities, car payments, and things of like nature.  Either these expenses will have to paid from another source, or it will be compensated with any left over benefit (see above question).

 

What is a retroactive benefit?

The VA will reimburse the claimant for any benefits due from the first of the month following the date the VA receives your application.  The retroactive benefit includes the length of time it take to process your claim until approved.  The monthly benefit and retroactive benefit will be paid within 15-30 days from the date of the VA approval notification letter.  There is one exception - retroactive benefits are withheld for claims in the fiduciary process until after an appointment has taken place with a VA Field Examiner, the claimant, and appointed family member as fiduciary.  Monthly benefits will continue to be paid throughout the fiduciary process.  Note the VA pays one month behind (payment for the month of May would be paid on or around June 1st).

 

What is the fiduciary process?

The VA determines a claimant may not be eligible to handle their VA benefit based upon medical evidence submitted with his/her VA application (Doctor’s statement and/or letter from doctor). The VA will propose to rate incompetent patients with cognitive disorders, dementia, Alzheimer’s, or memory loss. The VA allows a 60 day due process period to dispute the incompetency proposal. If you agree with their proposal, the VA will appoint a family member or power of attorney as fiduciary (legal custodian) to assist claimant with his/her VA benefits. If you disagree with their proposal to rate incompetent, you must provide a letter from patient’s doctor stating claimant is able to handle his/her own financial affairs. Retroactive benefits are released 15 – 30 days after the appointment with a Field Examiner.

 

What are accrued benefits?

The VA will not consider payment of any accrued benefits when claimant passes away before claim has been rated eligible for benefits by the Rating Board. 

Married Veteran - Veteran passes away while claim is in process The VA will allow payment of accrued benefits (due to deceased veteran) for the spouse when veteran’s claim has been rated eligible for benefits by the Rating Board, approved and payment is pending, or when the VA has been withholding retroactive benefits due to the fiduciary process. The surviving spouse must apply for accrued benefits by submitting an application for Accrued Benefits Due a Deceased Beneficiary (21-601) to the VA. If the surviving spouse is interested in applying for the VA benefits, she must apply in her own right; and be in need of aid and attendance based upon medical evidence, receiving a minimum of two (2) activities of daily living (ADL) and meet financial eligibility prior to submission of an application. 

Single Veteran or Surviving Spouse passes away while claim is in process If the claimant has been rated eligible for benefits by the Rating Board, approved and payment is pending, or retroactive benefits are being withheld due to the fiduciary process and a single veteran or surviving spouse passes away, the VA will only allow reimbursement to an adult child/children (from accrued benefits) for last physician and hospital expenses, funeral and burial expenses. The family member may apply for accrued benefits by submitting an Application for Accrued Benefits Due a Deceased Beneficiary (21-601) with proof of expenses (copies of invoices or statements) that clearly show expenses were paid out-of-pocket by family member. The VA will not reimburse funeral and burial expenses that have been prepaid by a funeral and burial policy or reimbursed by a life insurance policy.