The Social Security Administration (SSA) implements two separate programs that provide cash benefits to disabled individuals. The primary focus of this blog is on Disability Benefits (aka “Disability Insurance,” “DI,” “RSDI,” and “Title II benefits”). The other type of benefit is called Supplemental Security Income, “SSI” or “Title XVI benefits.”
Both programs use the same definition of disability and identical rules and regulations to determine disability. (See 5 Step Disability Evaluation Process) SSI benefits are less money per month and, most importantly, means tested. Thus a claimant must meet certain income and resource qualifications tobe eligible for these benefits — besidesproving disability. Disability benefits, on the other hand, have no means testing. Your current income or resourceshave no bearing on your eligibility. In addition to the absence of means testing, disability benefits are more desirable as they are typically more money per month and include health insurance coverage through Medicare.
Disability benefits, however, are only paid to those who become disabled while they are “insured.” The social security disability system is designed to function like insurance. To be covered, premiums must be paid. For social security disability, the premiums are the social security taxes taken out of your paycheck while working. To be insured under the disability benefits program, the disabled individual must have worked 20 of the last 40 quarters (i.e., payed premiums for 20 of the last 40 quarters). For those who worked consistently (without gaps) this means that they must prove disability within 5 years from when they stopped working.
In every claim for social security disability benefits, SSA calculates the “date last insured” or DLI. This is the last date that the claimant met the insured status based upon their quarters of work. The claimant must prove disability before that date.
Application Date versus Onset Date
Please note that there is no requirement that the application for benefits be filed before the DLI. The application can be filed well after the DLI. However, the claimant will need to prove that the disability began before the DLI. In the application, the claimant is asked for the date when they became unable to work. This is called the “onset date.” So long as the onset date is before the DLI, the claimant is insured and thus eligible for disability benefits.
Applications filed well after the DLI are notoriously difficult to win, however, as the evidence to support the disability is often hard to find. Medical providers routinely destroy older records. Doctors who treated the claimant before the DLI have retired or died. Finally, current medical providers may not be able (or willing) to provide evidence to support an onset date at some point in the past before they began treating the claimant.
By David Galinis