Articles on Medical Diseases and Conditions

Tag: Finances

  • Finances: Managing finances

    Power of Attorney

    You may, at some point, feel the need for someone to take over your financial arrangements. If so, you will almost certainly need good legal advice, perhaps at first from Citizens Advice if you have not already got a good solicitor. Because this situations tends to happen when you get older, and some good documentation is available from Age Concern, especially their Factsheet Number 22: Legal Arrangements for Managing Financial Affairs. There are two versions, one for England and Wales and the other for Scotland. Age Concern offices will have these available.
    There are a range of options that a relative (or friend) might consider, from very limited permissions to deal with specific issues, to more all embracing powers, including what is called an Enduring Power of Attorney, which enables someone to act virtually in all respects on your behalf in financial matters. A special form is necessary for a Power of Attorney, which gives someone the right to act for you; you will need to sign it, as will your relative and a witness – usually not a family member, but someone who is independent. If, after signing, you become incapable of understanding the situation, then your relative will need to apply to the Court of Protection (part of the Supreme Court) for the Power of Attorney to be recognized, so that he or she can continue to act without your formal consent. If you cannot understand the situation and a Power of Attorney has not been obtained, your relative will have to apply to the Court of Protection (in England) requesting it to act as the
    ‘Receiver’ of your affairs.
    The complex procedures are designed to ensure that a decision to take over someone else’s financial affairs is not taken lightly. It does mean that it is far easier, and less costly, to try and deal with this problem at an early stage, when it can be done with the understanding and agreement of all parties.
    By the way, it is also important to make your Will, if you have not already done so; it becomes a complex area of law when a person has failed to make a Will, and subsequently interpretations have to be made of their wishes or intentions.

    Financially planning for a child when you have Multiple Sclerosis

    If you have not yet written a Will, you ought to do so. Consider the nature of your estate (including your house if you own one), and how best to ensure that the part of it you wish to use for your child is available, with the least taxation as is legally possible on your death. Even if you have made a Will, you may need to ensure that the process of passing on resources is as tax efficient as possible. You will almost certainly need to seek legal and financial advice. If you do not already have a solicitor, get advice first at Citizens Advice in your area.
    Another issue is whether it is sensible to transfer some of your assets at an earlier stage than your death to your child. This may have some long-term tax advantages. On the other hand it may reduce the eligibility of your child for certain state benefits both currently and in the future.
    Also, another thing to consider is whether your child is likely to be able to manage his or her own finances if you die, and you might need some arrangement whereby someone can manage the financial affairs – in the child’s interests, of course. There are a number of formal ways in which this can be organized – through the setting up of a Trust with your child as a beneficiary, for example. These considerations are invariably complex and need a detailed knowledge of the relevant legal situation; you need sound judgement about the long-term as well as the short-term financial consequences of the chosen course of action. It would be unwise to make major decisions on these issues without impartial advice.

  • Finances: Healthcare finance

    Prescriptions

    Unfortunately you are not entitled to free prescriptions just because you have Multiple Sclerosis – it is not yet included as one of the relatively few diseases or conditions for which free prescriptions are available. However, prescriptions are free if you are aged under 16 or in full-time education and aged under 19; if you are aged over 60; or if you are either pregnant, or have had a baby within the last 12 months. In these cases you need only to sign the appropriate section of the prescription form. Prescriptions are also free when you are receiving many forms of state benefit and this may also apply to your partner or dependent children.
    If you or your partner are on state benefits (specifically Income Support, Jobseeker’s Allowance, Family Credit, or Disability Working Allowance), you can also claim free prescriptions. Some prescriptions are also free for people receiving hospital care or diagnosed with very specific medical conditions not including MS itself, but including some of its possible complications such as genitourinary infections. There are also a number of other specific circumstances in which free prescriptions may be available, and these need to be checked out with your local Social Security Office.
    In some of these circumstances you will require a completed HC1, HC2 or HC3 form and certificate number. You can obtain the form from a Social Security office, NHS hospital, dentist or doctor.
    Even if you are not entitled to free prescriptions, you can save money if you need more than five items in 4 months or more than 14 items in
    12 months by using a pre-payment certificate. You will need to get an application form FP95 from a Post Office or pharmacy.

    Eye and dental care costs

    In addition to free prescriptions, most of the categories of entitlement listed above also entitle you to NHS (not private) dental care, eye tests and glasses or contact lenses. Necessary costs of travel to hospital for NHS treatment include the cost of travel for a partner or helper if you are unable to travel alone.
    Given the high costs of prescription, eye care and dental treatment, it is well worth exercising your claim to whatever qualifying benefits you are entitled, in order then to have these free treatments, even if you feel the qualifying benefit itself is of relatively little value to you.

  • Finances: Insurance

    Telling your insurance company

    In the case of health insurance, life assurance or endowment policies associated with a mortgage, you must tell the company that you have MS. Such information may also be required for car insurance purposes in order to ensure that any future claim you make will not be denied, on the grounds that you had not told the company about MS. As you will probably be aware, insurance application forms generally have a ‘catch- all’ request that you provide ‘any information that you feel may be relevant’, or a similar wording. What this means is that, if you have failed to provide information that the insurance company – not just yourself – feels is relevant to a claim that you may make at a later date, then the claim could be invalidated and it will not be met. In this case the burden is on you, as the insured or the applicant, to disclose information relevant to any future claim, and ensure that the full facts are given when the insurance is first taken out.
    For existing policies, you are obliged to give all details of any changes in your circumstances, whenever your insurance is renewed. However, so long as the changes in circumstances (e.g. a diagnosis of MS) occurred after you took out the policy, there should – in principle – be no substantial change in the terms of your insurance, although the company may make enquiries as to whether in fact you did know about the Multiple Sclerosis when taking out that insurance.
    Almost all health insurance policies carry exclusions for ‘pre-existing conditions’ which is taken to mean any condition of which there was significant evidence before insurance commenced. In the case of a condition such as MS, this would include any tests or examinations that you have had for MS, including all those that you underwent before diagnosis. It is wise to be as accurate and as detailed as possible to give as few grounds as you can for exclusion at a later date. It is worth noting that few insurance companies will refuse to insure you, although most will charge higher premiums when there is a reasonable cause to expect a higher risk of claims.
    Do be careful to read the terms of any attractive policy that guarantees acceptance and has fixed premiums. The maximum payout and range of exclusions may seriously limit the value of the cover, and a
    ‘no questions asked, no medicals’ policy can still exclude claims where the insured failed to provide information when the cover was taken out.

    New policies and renewals

    Although insurance companies can, and sometimes do refuse to insure people with conditions like MS, their usual response is to load the premiums according to the risks they estimate of you making a claim. Although these risks are calculated (or should be) on the basis of what are called ‘actuarial tables’, which provide information on how long people of certain ages, genders, or with certain conditions live, or are likely at any rate not to make a claim, sometimes insurance companies may load premiums even further if they do not want a particular kind of business. You may find quite big differences between insurance companies in the way they respond to information about MS. More recently there has developed what might be described as a ‘niche’ insurance market which is beginning to specialize in people with disabilities and certain kinds of medical condition; you might find this more supportive. There are also now life policies, particularly for older people over 50, that guarantee acceptance, and pay out fixed sums after
    2 years without a medical examination or other questions needed. These may seem like a good idea, and indeed, they can provide additional money for your family if you die. However, generally, the benefits are fixed amounts of money so that, if you do live a long time, you find yourself paying more in premiums than would be returned in benefits if you die.
    On health – as opposed to life – insurance you may find some difficulty getting a new policy, or it may contain key exclusions, related to some of the more common medical complications of MS. A company may also be concerned about another issue, which is whether you will be able to continue to pay the premiums, if they are substantial, and they feel that there is a risk that you may not be able to continue in employment. This seems to be very unfair, but insurance companies are essentially commercial concerns, and thus their bottom line is the balance between premium income and future claims.
    The moral is that in all cases you need to seek impartial advice, to shop around, and to consider very carefully any conditions or exclusions to policies – in short you must read the small print!

    Mortgages

    Mortgage lenders take many factors into account, including your savings, your income and the security of your employment, and of course how much you may wish to borrow. However, the key factor will be the company’s estimation of how likely you will be able to continue paying for your mortgage until its term is complete. In this respect, different companies may take a different view of the future, partly depending on whether they feel you will be able to keep in employment for the term of the mortgage. Some may take a more pessimistic view than others of the progress and effects of your MS, so it is important that you shop around, as with other major financial transactions.

  • Finances: Benefits

    Sources of help

    The most obvious written source is the Disability Rights Handbook. This is updated every April and published by the Disability Alliance (see Appendix 2). This guide is very readable but, unless you are familiar with interpreting legislation, you should still seek advice from other sources.

    • The Benefits Agency handles social security payments for the
    Department of Social Security.
    • Your local Citizens Advice is the best source of detailed and impartial information available; there are bureaux across the United Kingdom – the telephone directory will list the address and phone number of your local office, or you can contact the national bureau listed in Appendix 1. They will try to answer questions on almost any issues of concern to you, but will direct you to more appropriate sources of help and advice if you need any.
    • Your local authority’s welfare rights advisor.
    • Welfare advisors at your local branch of the MS Society.
    • The Post Office, particularly larger branches and regional offices, stock a wide range of government forms and leaflets, which are normally prominently displayed. These include leaflets detailing entitlements to health care under the National Health Service, family benefit and disability allowances. Contact addresses and telephone numbers are given for further information in each of these leaflets.
    • Your local Employment Service Office (Job Centre) will also stock a range of helpful information, including a pack of employment- related publications that cover most issues related to employment and benefit entitlements. Staff will usually be able to answer specific questions that you have, although you may have to book an appointment in advance.

    Stopping work

    Benefits available will depend very much on your personal circum- stances, the extent of your disability from MS, the nature of your occupation and any health insurance and/or early retirement pensions provision, amongst other factors. This is why you need careful and detailed impartial advice from someone who is able to go through all the aspects of your situation, and point out both the short- and long-term financial consequences of any decision you make.
    The first important consideration is whether you are likely to consider a different type of work to that you have been doing, either now or in the future. If you are younger, a considerable way from normal retirement age, this is a crucial issue. Of course the work might be part-time rather than full-time, or involve being self-employed rather than employed. Although MS, as we have said, is very unpredictable, it may be worth discussing your medical outlook with your doctor, particularly regarding your skills and abilities related to the symptoms and any disabilities that you may have now. As a medical assessment of your situation is likely to prove crucial to some of the financial and other benefits you could receive, the role of your doctor – GP or specialist – will be important.
    Second, if you have decided that you would like to retire, probably on the grounds of ill-health or disability, then you need to work out how best this can be undertaken. It would be sensible to seek the advice of your Trade Union, if you belong to one, or your professional body, and/or to seek advice from Citizens Advice, before taking any action. How you leave your work – taking early retirement on grounds of ill-health, resigning or being dismissed – also affects the financial benefits for which you may be eligible. Some of these depend on what pension arrangements you might have. You should find out all this from your employer’s personnel department or the relevant pensions company. Your employer should help you to retire at the most opportune time for you to gain financially
    If you find yourself being peremptorily or unfairly dismissed, you need to seek further advice immediately from your Trade Union, professional body or Citizens Advice. In these circumstances, if you have been employed by your employer for longer than 2 years, you can pursue your case through an industrial tribunal – but again seek advice.
    Third, you need to think through carefully the financial consequences of your retirement in the light of your eligibility for a range of benefits. This will depend on many factors. You will need to be realistic about your current and future financial commitments. You may also have to consider your family, as to whether other members of your household are or can be earning, even if you cannot. Even if you have taken early retirement, and thus possibly have an occupational pension, you may still qualify for various means-tested benefits. These may depend not only on your current income, but on your National Insurance Contribution record and your degree of disability. You may be eligible for some or all of these benefits:

    • Incapacity Benefit
    • Severe Disablement Allowance
    • Disability Living Allowance (see Multiple Sclerosis – the ‘at your fingertips’ guide in Appendix 2).

    If you do not have an occupational pension you may be eligible for other means-tested benefits, such as:

    • Income Support
    • Housing Benefit
    • Council Tax Benefit.

    If you are eligible for Income Support, then you also become eligible for a wide range of other benefits, such as:

    • free prescriptions
    • free dental treatment
    • free school meals for your school-age children.

    Help for services and equipment

    If you need a particular piece of equipment, a particular service or a holiday, there are funds held by trade unions, professional organizations or charitable bodies for such purposes. Often there is a question of eligibility, but of a different kind than that for the Benefits Agency. You may have to be a current or former member of the organization concerned, or have some other characteristic that gives you entitlement
    – such as living in a particular area.
    The problem is often finding out which organizations you can apply to, for many local charities are small and are not widely advertised. However, there is a Charities Digest (your local library should have a copy) which lists many, although not all, sources of funds. Your local library, or Citizens Advice, may be able to give you some sources as well. There is also another directory called A Guide to Grants for Individuals in Need which contains a relatively comprehensive list of charities who provide support for individuals with certain eligibility criteria (see Appendix 1). The MS Society can help here too.

    Children as carers

    There are a number of allowances that may be available, again depending on your eligibility, when you require the support of others for your care. Some benefits are payable to you, and others to those looking after you. There are, as usual, quite complicated eligibility rules about which you will almost certainly need to seek detailed advice. For example, if one of your children is looking after you on virtually a full-time basis (35 hours a week or more), and you have Disability Living Allowance at the middle or higher rate, or Attendance Allowance, then he or she may be eligible for Invalid Care Allowance. You yourself may be able to obtain Attendance Allowance, or the care component of Disability Living Allowance. The criteria for these allowances are very specific, and trying to help your children out might be difficult, without quite a lot of investigation and advice about your and their eligibility from either Citizens Advice or another impartial source of advice about disability.

    Mobility

    As part of the Disability Living Allowance, it may be possible to claim for the higher or lower rate mobility components to help with additional expenses incurred with your decreased mobility. If you are able to obtain the higher rate component in particular, then it opens the door for a range of other benefits. Both the components are open to people below the age of 65 (or 66 if the disability began at the age of 65). The tests for eligibility for this mobility component are increasingly stringent, and it is not possible to go into them in great detail here; you should seek advice about the criteria and their application to you from the MS Society. As someone with MS, to obtain the higher rate allowance, you will need to demonstrate, in the formal words of the regulations that your ‘physical condition as a whole’ is such that you are ‘unable to walk’, or are ‘virtually unable to walk’, or that ‘the exertion required to walk would constitute a danger to [your] life or be likely to lead to a serious deterioration in [your] health’.
    There are other criteria under which the higher rate can be claimed but they are unlikely to apply to people with MS. As you can see, the crucial issues in adjudicating any claim for people with MS, apart from when you literally cannot put one step in front of another, are likely to be the meaning of being ‘virtually unable to walk’, or the relationship of exertion in walking to a possible deterioration in health. In these cases, the assessment process and medical judgements are both critical – the variability of MS does not help. For the lower rate of mobility allowance, the major criterion is not so much whether you are physically able to walk, but whether you require someone most of the time to guide or supervise you, to enable you to walk outdoors.
    The Disability Rights Handbook published by the Disability Alliance Educational and Research Association has a comprehensive section describing in detail the requirements and procedures for claiming these benefits. You could also telephone or write to the Benefits Agency – which handles such claims for the Department of Social Security – for information on mobility allowances (see Appendix 1). Further help can be obtained through the MS Society’s Helpline (the Benefits Advisor) or your local DIAL (Disability Information and Advice Service). If their number is not available in your local telephone book, the Social Services Department of your local council should be able to provide it for you. There are appeal procedures if your claim is turned down. In any case it is very important that you monitor your situation so that, if your mobility decreases through the MS, or indeed through another cause, you claim for the appropriate allowance. Many relevant and useful local addresses can be found in your area telephone book, or the Yellow Pages or Thomson guides.

    Wheelchairs

    Under the NHS, both hand- and electric-powered wheelchairs are supplied and maintained free of charge for people who are disabled and whose need for a wheelchair is permanent. Although, in principle, any wheelchair can be supplied by the NHS, in practice the decision is made locally, where the circumstances of the individual and local resources will be taken into account. Since April 1996, powered wheelchairs can be provided by the NHS, if you need a wheelchair, cannot walk and cannot propel a wheelchair yourself. Again local decisions are made about provision of such wheelchairs, although it is anticipated that local decisions will fit with the broader national criteria. These include being able to handle the wheelchair safely, and being able to benefit from an improved quality of life in a wheelchair. If you already have a wheelchair, move to new area and do not meet the local criteria in that area, you can still keep your wheelchair – unless there are clinical reasons for withdrawing it. Attendant-controlled powered wheelchairs can also be issued where it is difficult for the person to be pushed outdoors – if the area is very hilly, if the person is heavy, or the attendant is elderly and unable to push a wheelchair manually.
    There are voucher schemes operated by NHS Trusts whereby people can contribute towards the costs of a more expensive wheelchair than a Trust would provide. Schemes either give responsibility to the Trust for repair and maintenance of the wheelchair, or allow you to take responsibility yourself. You may not be able to use this scheme to obtain a powered wheelchair, but it may be possible to use the Motability Scheme to obtain such a wheelchair. Wheelchairs, pavement vehicles (usually electrically operated wheelchairs or scooters), crutches and walking frames are exempt from VAT.
    The MS Society branches and HQ can offer advice on financial help for wheelchairs or even provide one in some cases.

    Driving

    There are a number of benefits for which you may be eligible as a driver. If you receive the higher rate mobility allowance you will be allowed to claim exemption from vehicle excise duty (road tax) on one vehicle. This exemption is given on condition that the vehicle is used ‘solely for the purposes of the disabled person’, so care must be taken as to the use of the vehicle. Nevertheless, it is likely that some commonsense latitude will be given.
    If you have the higher rate mobility allowance, you will be automatically eligible for the Blue Badge, which gives parking privileges, and also for access to the Motability Scheme (see below). You will also get VAT exemption on adaptations to make your car suitable for driving by you, as well as exemption on the repair, maintenance or replacement of these adaptations.
    Note that the mobility allowance does not count as income for these purposes. Furthermore arrears will not count as capital for means-tested benefits for up to 1 year after they are paid.

  • Finances

    This chapter deals with some very complicated issues. This is not only because people’s own circumstances are all different, but because the rules and regulations governing eligibility to benefits, pensions and so on are themselves complex and can change frequently. It is very important that, in addition to taking note of the points we make below, you consult other sources of information. Choices that you may make about continuing or leaving work, or about benefits or pensions, may have long-lasting consequences, so it is important to think them through carefully, after seeking impartial advice.