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About Brain Injury

Adults & Brain Injury: Financial Issues

Individuals who have sustained a brain injury often have cognitive, emotional, and behavioral difficulties that impair their ability to manage their personal finances. The assistance that is required depends on the unique needs of the individual and can range from merely providing help to pay bills to complete management of the person’s financial affairs. It is important to utilize the least restrictive solution to protect a person with a brain injury from their inability to manage finances and to allow the person as much freedom and personal control as possible. In other words, a remedy needs to be found that is tailored to the individual, lawful, and limited to only those activities for which the individual needs assistance.

Tips for Managing Money After Brain Injury

  • Take a close look at monthly expenses and figure out what can be cut and what must be spent to maintain a reasonable standard of living. If possible, refrain from waiting on a cut to be necessary and, instead, make decisions quickly. These may be things like downgrading cable, selling an extra car, or eliminating your home phone in lieu of your mobile.
  • Therapies for brain injury can be costly. If finances are tight, take the opportunity to speak with the clinicians on your treatment team about various options. It may be that you can assume some therapy at home, on your own or with the help of a loved one - that allows you to go to a clinic less frequently.
  • Prepare and follow a reasonable budget.
  • Utilize available social services. The Brain Injury Association of America, and its network of state affiliates, can give you more information on available sources for help near you.
  • If recommended, apply for Social Security Disability as soon as possible.
  • Be open and honest with yourself, your friends, and your family. Tell all your family and friends that times are tight, so for special occasions and holidays, you’d like gift cards.

Social Security Disability Insurance (SSDI)

Social Security pays benefits to people who cannot work because they have a medical condition that is expected to last at least one year or result in death. Federal law requires this very strict definition of disability. While some programs give money to people with partial disability or short-term disability, Social Security does not. Certain family members of disabled workers also can receive money from Social Security.

In general, to get disability benefits, you must meet two different earnings tests:

  1. A “recent work” test based on your age at the time you became disabled; and
  2. A “duration of work” test to show that you worked long enough under Social Security.
If you recently became disabled... Then, you generally need:
...in or before the quarter you turn age 24 1.5 years of work during the three-year period ending with the quarter your disability began.
...in the quarter after you turn age 24 but before the quarter you turn age 31 Work during half the time for the period beginning with the quarter after you turned 21 and ending with the quarter you became disabled. Example: If you become disabled in the quarter you turned age 27, then you would need three years of work out of the six-year period ending with the quarter you became disabled.
...in the quarter you turn age 31 or later Work during five years out of the 10- year period ending with the quarter your disability began.

The calendar quarters are:
First Quarter: January 1 through March 31
Second Quarter: April 1 through June 30
Third Quarter: July 1 through September 30
Fourth Quarter: October 1 through December 31 

If you become disabled... Then, you generally need:
Before age 28 1.5 years of work
Age 30 2 years of work
Age 34 3 years of work
Age 38 4 years of work
Age 42 5 years of work
Age 44 5.5 years of work
Age 46 6 years of work
Age 48 6.5 years of work
Age 50 7 years of work
Age 52 7.5 years of work
Age 54 8 years of work
Age 56 8.5 years of work
Age 58 9 years of work
Age 60 9.5 years of work

You should apply for social security disability benefits as soon as possible, because it can take longer than six months to be approved. For more information on applying for SSDI benefits, contact the National Brain Injury Information Center at 1-800-444-6443 or visit socialsecurity.gov.

Supplemental Security Income (SSI)

The Supplemental Security Income (SSI) program makes payments to people with low income who are age 65 or older, are blind, or have a disability. The Social Security Administration manages the SSI program. The basic SSI amount is the same nationwide. However, many states add money to the basic benefit.

Whether you can get SSI depends on your income and resources (the things you own). Income is money you receive such as wages, Social Security benefits, and pensions. Income also includes such things as food and shelter. When determining your total income, Social Security does not count all of your income. Specifically, you are exempt from:

  • The first $20 a month of most income you receive;
  • The first $65 a month you earn from working and half the amount over $65;
  • Supplemental Nutrition Assistance Program (SNAP) benefits, formerly known as food stamps;
  • Shelter you get from private nonprofit organizations; and
  • Most home energy assistance.

If you are married, social security will also include part of your spouse’s income and resources when deciding whether you qualify for SSI. If you are younger than 18, social security will include part of your parents’ income and resources. If you are a student, some of the wages or scholarships you receive may not count. If you are disabled but work, Social Security does not count wages you use to pay for items or services that help you to work. For example, if you need a wheelchair, the wages you use to pay for the wheelchair do not count as income.

Resources that social security will count in deciding whether you qualify for SSI include real estate, bank accounts, cash, stocks and bonds. You may be able to get SSI if your resources are worth no more than $2,000. A couple may be able to get SSI if they have resources worth no more than $3,000. If you own property that you are trying to sell, you may be able to get SSI while trying to sell it. Social Security does not count everything you own in deciding whether you have too many resources to qualify for SSI, specifically:

  • The home you live in and the land it is on;
  • Life insurance policies with a face value of $1,500 or less;
  • Your car (usually);
  • Burial plots for you and members of your immediate family; and
  • Up to $1,500 in burial funds for you and up to $1,500 in burial funds for your spouse.

If you are eligible for Social Security or other benefits, you should apply for them immediately. For more information, contact the National Brain Injury Information Center or visit socialsecurity.gov.

Guardianship

When faced with a diagnosis of brain injury, family members often find it very difficult to consider the issues of guardianship. A guardianship is a legal relationship between the guardian (typically court appointed) and an incapacitated individual. The guardianship gives the guardian the legal duty and right to act on behalf of an incapacitated person and make decisions that affect the person’s money and life. It is vital to have open, honest discussion between family members, doctors, and attorneys to ensure the individual's interests are protected and determine if a guardianship is in order.

Guardianship should be considered in situations where an individual with brain injury is impaired to the extent that he or she is partially or totally unable to manage finances or take care of their physical health and safety. Guardianship laws differ from state to state, and there is no federal law regarding guardianship. Hospital case workers, doctors, and lawyers are reliable sources for information on guardianship in your community.

Financial Planning

Brain injury can cause a strain on finances and, therefore, it is important to be as organized and informed as possible. While specifying preferences for decisions ahead of time can relieve the burden of decision-making, many must make these decisions after the brain injury. While each state has its own unique requirements, there are many standard legal documents that are commonly associated with a catastrophic injury. These can include:

Advance Directive: An advance directive contains directions or written instructions that state a person's wishes about his or her future medical care and end-of-life measures and is used when a person cannot think clearly or tell people what health care they want. The most common types of advance directives are living wills, power of attorney, and “Do Not Resuscitate” orders.

Living Will: A living will is a statement, made in advance, of an individual's end-of-life medical instructions in the event of incapacity or terminal illness. Instructions in a living will guide doctors and significant others about an individual's preference for life-prolonging procedures, such as allowing the use of tubes for nutrition and hydration or administering pain medicine.

Power of Attorney (POA): A power of attorney is a legal document that authorizes one person or agent to manage all parts of another person's personal or financial affairs. The designated person's authority is limited to the scope of the document and does not include the ability to make medical decisions.

Power of Attorney for Health Care (POA): A power of attorney for health care specifies a certain person to direct an individual’s health care wishes according to instructions that were made in advance, and can apply to specific instructions or limitations as well as to life-sustaining treatments.

Durable Power of Attorney for Health Care (DPOA): A durable power of attorney for health care is used when the POA indicates an agency or person to make health care decisions for an individual when he or she is unable to do so. A DPOA is "durable," meaning that it remains in effect even after a person experiences disability. A DPOA remains effective beyond the disability and will also become effective upon subsequent disability or incapacity.

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