Social Security Disability Eligibility

When is a person covered for Social Security disability claims?

By: Pitt Dickey – Attorney

This column examines how the Social Security Administration determines the time period during which a person is eligible for Disability Insurance Benefits.

Previous columns covered the medical criteria the Social Security Administration (SSA) uses to determine disability from illness and injury. But medical eligibility is only part of the equation. The SSA also has strict rules about when you are "covered" by disability insurance—meaning the SSA will actually pay benefits if you become disabled.

To qualify for disability insurance benefits, you need two things: a health condition expected to last at least a year or result in death, and an inability to work at any substantial job. You also must have paid into the Social Security system for at least ten years—specifically, 40 quarters of credits through FICA taxes. There is an exception for very young workers who become disabled before reaching age 22.

You can earn up to four credits per year. Think of disability coverage like car insurance: you pay premiums (FICA taxes), and if something happens while you're covered, the insurance company pays. The difference is that Social Security gives you a five-year grace period after you stop working. As long as you file within that window, you're still covered.

The SSA calls this cutoff your "Last Date Insured." Let's say Ron Raley worked full time from age 22 and quit in December 1995 to write a book. His Last Date Insured would be December 2000 (five years later). If Ron gets injured on November 30, 2000, he's covered. If he's injured on February 1, 2001, he's not—even if the injuries are severe.

The Last Date Insured matters in most claims. But many cases are messier than Ron's example. Consider Linda Jones, who worked the required ten years, then quit in 1992 to have and raise her first child. She developed diabetes during pregnancy and never returned to work. Her Last Date Insured is 1997 (five years after she stopped working).

By 1993, Linda became insulin dependent with difficult-to-control blood sugar. She developed diabetic retinopathy and painful nerve damage in her legs and feet. But she didn't file for disability until November 1999, when her doctor suggested it. At that point, she had to pick an "onset date"—when her illness became too severe to work. She chose August 1993.

Linda's claim was denied initially and on reconsideration. At her hearing before an Administrative Law Judge, she had to prove she was disabled in 1993 to get benefits from that date. If she couldn't meet the medical criteria for 1993, she could still qualify if she could show she was disabled before her Last Date Insured in 1997.

Even though her diabetes was clearly disabling by 1999, the judge wouldn't award benefits unless medical evidence from 1997 or earlier—plus her testimony about her condition then—proved she was disabled before 1997.

The judge focused on Linda's medical condition before 1997 and gave little weight to how sick she was after that date. In disability claims, proving you met the medical criteria before your Last Date Insured is the key to winning benefits.

Note: Social Security Disability is a federal program, so these rules apply throughout the United States. However, individual district offices and appeals judges may interpret them differently. This column focuses on how Social Security offices and appeals judges evaluate disability claims.
– Pitt Dickey

Pitt Dickey has practiced law in Fayetteville since 1978 and has handled Social Security disability claims for over twenty years. He practices with Smith, Dickey, Smith, Hasty & Dempster, P.A. at 555 Executive Place. He can be reached at 910-485-8020, at the firm website www.smithdickey.com, or by email.

Copyright © 2002 Pitt Dickey – Used with permission